Thérèse Reilly

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident, claiming she suffered a substantial inability to perform her pre-accident employment duties as a lab technician assistant.

The respondent insurer terminated the IRB based on insurer examinations concluding the applicant sustained only minor strain injuries and did not suffer a substantial inability to work.

The tribunal dismissed the application, finding the applicant failed to present expert medical evidence or other proof demonstrating a substantial inability to perform her essential work tasks, while the medical evidence suggested she should remain active and attempt to return to work.

The applicant sought statutory accident benefits, including a determination of catastrophic impairment and medical benefits for psychological and physiotherapy treatment, following a 2014 motor vehicle accident.

The respondent denied the claims, arguing the applicant's psychological issues were pre-existing and unrelated to the accident.

The Tribunal found that the applicant failed to meet his burden of proof, as he presented no medical evidence to support his claims, while the respondent's expert evidence established that his psychiatric condition predated the accident.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits, physiotherapy, a service dog, assistive devices, and an attendant care assessment.

The respondent denied the benefits based on its independent medical examinations.

The Tribunal found that the applicant failed to meet her burden of proof to establish entitlement to the attendant care benefits, as she did not prove the expenses were incurred and the respondent's occupational therapy assessment was preferred.

The Tribunal also found that the disputed treatment plans were not reasonable and necessary.

The claims for an award for unreasonably withheld payments and interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming physical and psychological injuries that warranted removal from the Minor Injury Guideline (MIG).

The respondent denied the treatment plans on the basis that the injuries were minor and the $3,500 MIG limit had been exhausted.

The Tribunal found insufficient evidence of chronic pain causing functional impairment or a psychological impairment to remove the applicant from the MIG.

As the MIG limits were exhausted, the disputed treatment plans and the claim for interest were dismissed.

The applicant sought to rescind a settlement agreement entered into with the respondent insurer regarding statutory accident benefits following a 2007 motor vehicle accident.

The applicant argued the settlement was not full and final and did not comply with Regulation 664.

The Tribunal found the settlement was valid and governed by Regulation 664.

The Tribunal dismissed the application, holding that the applicant was not entitled to rescind the settlement because he failed to provide written notice of rescission and did not repay the settlement funds as required by section 9.1(7) of Regulation 664.

The applicants sought statutory accident benefits following a motor vehicle accident, claiming entitlement to non-earner benefits, housekeeping and home maintenance benefits, and various treatment plans.

The Licence Appeal Tribunal dismissed the claims, finding that the applicants failed to establish a complete inability to carry on a normal life to qualify for non-earner benefits and failed to prove they had purchased optional coverage for housekeeping benefits.

The Tribunal also noted the applicants failed to attend multiple examinations under oath without valid reasons.

The disputed treatment plans had already been approved by the respondent.

The Tribunal awarded $500 in costs to the respondent because the applicants misstated their whereabouts to obtain an adjournment of the hearing.

The applicant sought a special award under section 10 of Regulation 664, alleging the respondent unreasonably withheld or delayed payment of income replacement benefits and a medical benefit for psychological treatment.

The adjudicator found that the applicant was responsible for delays by failing to provide medical documents in a timely manner and refusing to attend a functional abilities evaluation.

The respondent acted reasonably in scheduling independent examinations to assess the new medical information provided.

The claims for a special award and interest were dismissed.

The applicant sought income replacement benefits (IRB), attendant care benefits (ACB), and approval for numerous treatment plans following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal found the applicant failed to prove a substantial inability to perform her pre-accident employment as a cashier or a complete inability to work post-104 weeks, relying on video surveillance showing no physical distress and independent medical examinations.

The ACB claim was dismissed because the care was provided by family members who did not suffer an economic loss, and the benefit was not deemed incurred as it was not unreasonably withheld.

The disputed treatment plans were found not reasonable and necessary, as the medical evidence did not support the claimed injuries, including a concussion, and the applicant had reached maximum medical improvement.

The applicant sought statutory accident benefits, including a non-earner benefit and various medical benefits, following a motor vehicle accident.

The respondent denied the claims, arguing the accident was minor and the applicant's ongoing complaints were related to pre-existing conditions.

The Tribunal found that the applicant failed to prove she suffered a complete inability to carry on a normal life, noting that video surveillance and medical assessments contradicted her claims of severe impairment.

The Tribunal also dismissed the claims for medical benefits, finding the proposed treatment plans were not reasonable and necessary.

The application was dismissed in its entirety.

The applicant sought attendant care benefits following a motor vehicle accident.

The respondent paid a portion of the claimed expenses but denied the remainder, arguing they were not incurred.

The Tribunal preferred the respondent's occupational therapy assessments, finding the applicant's condition had improved and she did not require the level of care claimed, particularly for night-time emergencies.

The Tribunal concluded the applicant was not entitled to any attendant care benefits beyond what the respondent had already paid, as the additional expenses did not meet the definition of an 'incurred expense' under section 3(7)(e) of the Schedule and could not be deemed incurred.

The applicant sought a determination that he sustained a catastrophic impairment as a result of a motorcycle accident, along with entitlement to income replacement benefits, medical benefits, an award, and interest.

The Licence Appeal Tribunal found that the applicant did not meet the 55% whole person impairment threshold under either Criterion 6 or 7 of the Statutory Accident Benefits Schedule, preferring the respondent's medical experts and video surveillance evidence over the applicant's experts.

The Tribunal also dismissed the claim for post-104 week income replacement benefits, finding the applicant did not suffer a complete inability to engage in employment, as he had returned to modified work and performed some DJ work.

The claims for unpaid assessments, assistive devices, an award, and interest were also dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs) and various medical and rehabilitation benefits.

The respondent insurer denied the benefits based on insurer examinations.

The adjudicator found that the applicant failed to prove she suffered a substantial inability to perform the essential tasks of her pre-accident employment for the pre-104 week IRB, and failed to prove a complete inability to engage in suitable employment for the post-104 week IRB, noting she had returned to part-time work.

The adjudicator also found that the disputed treatment plans for physiotherapy, physiatry, chronic pain, ENT, neurological, psychological, and dental assessments were not reasonable and necessary, relying on the respondent's medical evidence which found no ongoing accident-related impairments.

The application was dismissed.

The applicant was injured in a motor vehicle accident in 2016, sustaining a severe right elbow fracture.

He received income replacement benefits (IRBs) for the first 104 weeks, after which the respondent denied further IRBs.

The applicant applied to the Licence Appeal Tribunal, claiming a complete inability to engage in any suitable employment due to physical pain, fear of reinjury, and psychological impairments including depression and anxiety.

The adjudicator dismissed the application, finding that the applicant's physical injuries had healed and his psychological issues were primarily related to boredom and lack of motivation rather than a complete inability to work.

The adjudicator preferred the respondent's expert evidence, which demonstrated the applicant retained the functional capacity and vocational aptitude for alternative employment.

The applicant insurer sought repayment of $14,983.43 in statutory accident benefits paid to the respondent, alleging wilful misrepresentation regarding a motor vehicle collision.

The insurer's accident reconstruction expert testified that event data recorder information and physical evidence showed the respondent was not a passenger in the vehicle and that the collision was intentionally caused.

The adjudicator accepted the expert's uncontradicted evidence, found the respondent's testimony not credible, and ordered repayment of the benefits with interest.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to medical benefits and examination costs for psychological, neurological, and chronic pain assessments.

The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and raised causation issues, attributing her symptoms to a pre-existing multiple sclerosis (MS) condition.

The Tribunal found that the applicant's physical and psychological complaints were largely attributable to her pre-existing MS, which was not aggravated by the accident.

The Tribunal concluded that the applicant failed to establish a psychological impairment, concussion, or chronic pain that would warrant removal from the MIG.

Consequently, the disputed treatment plans were deemed not reasonable and necessary, and the application was dismissed.

The applicant sought a non-earner benefit and medical benefits for physiotherapy and assistive devices following a motor vehicle accident.

The respondent insurer denied the claims based on insurer examinations and video surveillance.

The Tribunal found that the applicant had resumed many of her pre-accident activities, including child care, driving, and exercising, and therefore did not suffer a complete inability to carry on a normal life.

The Tribunal also found that the proposed treatment plans were not reasonable and necessary, as the applicant had reached maximum medical improvement and had regained independence without the need for the requested assistive devices.

The application was dismissed in its entirety.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits from the respondent insurer.

The insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued she should be removed from the MIG due to pre-existing injuries and psychological impairments.

The Tribunal found insufficient evidence of pre-existing conditions preventing recovery or clinically significant psychological impairments, preferring the respondent's psychological assessment over the applicant's.

The Tribunal concluded the applicant's injuries were predominantly minor, and since the MIG limits were exhausted, the claims for treatment plans and interest were dismissed.

The applicant, a Chinese citizen visiting Ontario, was struck by an unidentified vehicle as a pedestrian and sought statutory accident benefits from the Motor Vehicle Accident Claims Fund (MVACF).

The respondent denied the claim on the basis that the applicant was not ordinarily resident in Ontario at the time of the accident, as required by section 25 of the Motor Vehicle Accident Claims Act.

The Tribunal applied the Thomson residency test and found that the applicant's stay in Ontario was not of a sufficiently permanent nature to establish ordinary residence.

The applicant was in Ontario on a visitor visa, had no Canadian income or bank account, and returned to China shortly after completing an English language course.

The application for benefits was dismissed.

The applicant sought statutory accident benefits following an alleged motor vehicle collision.

The respondent insurer denied the claim, arguing the accident was staged and did not meet the definition of an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

Relying on expert accident reconstruction evidence which concluded the vehicles' damage and resting positions defied the laws of physics for the reported collision, the adjudicator found the applicant failed to prove the accident occurred as claimed.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) for both the pre-104 week and post-104 week periods.

The respondent insurer denied the benefits based on multidisciplinary assessments concluding the applicant suffered minor injuries and could return to work.

The Tribunal found that the applicant was entitled to IRBs for a limited period from November 1, 2017, to December 31, 2017, as her injuries temporarily prevented her from working.

However, the Tribunal dismissed the claim for ongoing IRBs, noting that the applicant had retrained as a personal support worker, completed practicums, and travelled internationally, demonstrating she no longer suffered a substantial or complete inability to work.

The claim for a special award was dismissed, but interest was awarded on the overdue benefits for the limited period.