Timothy Porter

The applicant sought accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline (MIG).

She also claimed entitlement to a non-earner benefit and a physiotherapy treatment plan.

The Tribunal found that the applicant's injuries were predominantly minor sprains and strains, and she failed to prove that pre-existing conditions precluded her recovery within the MIG.

Furthermore, the applicant did not demonstrate a complete inability to carry on a normal life, as required for the non-earner benefit.

All claims were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant argued he suffered from chronic pain and a psychological injury warranting removal from the MIG.

The Tribunal found the applicant failed to establish functionally disabling pain, noting his active lifestyle and lack of objective medical evidence.

The Tribunal also afforded diminished weight to the applicant's psychological assessment due to its heavy reliance on self-reporting and inconsistency with objective scores.

The application was dismissed, and the applicant was found not entitled to the disputed treatment plans, an award, or interest.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

The insurer denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant suffered a psychological impairment, removing him from the MIG.

The Tribunal approved treatment plans for psychological and psychiatric assessments, as well as a physiotherapy plan, but denied two chiropractic plans.

The applicant was awarded interest on overdue payments, but the claim for a special award under s. 10 of Regulation 664 was dismissed as the insurer's reliance on its medical assessors did not constitute unreasonable behaviour.

The minor applicant was involved in a motor vehicle accident and sought statutory accident benefits for chiropractic treatment.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit was largely exhausted.

The Tribunal found that the applicant failed to meet her burden of proving her injuries, including alleged chronic back pain, fell outside the MIG.

As the applicant remained within the MIG and the limits were exhausted, the disputed treatment plans were deemed not reasonable and necessary.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent insurer initially confined the applicant to the Minor Injury Guideline (MIG) and denied various treatment plans and income replacement benefits (IRB).

The Tribunal found the applicant's injuries were non-minor, removing her from the MIG.

The Tribunal awarded IRB for a specific period due to the insurer's non-compliance with s. 36(4) response timelines, but denied post-104 IRB.

The Tribunal approved treatment plans for physiotherapy, a psychological assessment, and a chronic pain assessment, finding them reasonable and necessary.

Notably, the Tribunal ordered a 35% special award against the insurer under s. 10 of Reg. 664, finding its conduct in adjusting the claim—including ignoring clear evidence of psychological injury and delaying IRB responses for over a year—to be imprudent, inflexible, and unyielding.

Costs were not ordered.

The applicant sought payment for a neurological assessment following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant had already been assessed by multiple neurologists and a neurosurgeon through OHIP, and that the proposed assessment plan lacked sufficient information to demonstrate its reasonableness or necessity.

The application for the assessment, along with claims for interest and an award, was dismissed.

The applicant sought a post-104-week income replacement benefit (IRB) following a motor vehicle accident, which the respondent insurer denied.

The Tribunal found that the applicant suffers a complete inability to engage in any employment for which she is reasonably suited by education, training, or experience, primarily due to chronic pain syndrome and psychological impairments.

The Tribunal preferred the evidence of the applicant's expert assessors over the respondent's assessors, noting that the alternate employment roles proposed by the respondent were not comparable in status or wages.

The applicant was awarded the IRB and interest on overdue payments, but her claim for a special award under section 10 of Regulation 664 was dismissed as the insurer's conduct was not found to be unreasonable or vexatious.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including a determination of catastrophic impairment under criterion 8 (mental and behavioural impairments).

The Licence Appeal Tribunal found that the applicant suffered a marked impairment in three spheres of functioning (Activities of Daily Living, Social Functioning, and Adaptation) and was therefore catastrophically impaired.

The Tribunal awarded attendant care benefits of $3,233.31 per month but dismissed the applicant's claims for various treatment plans, assessments, and a special award, finding insufficient evidence to support those claims.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing that her pre-existing condition, chronic pain, and psychological injuries warranted removal from the MIG.

The Tribunal found that the applicant failed to provide compelling evidence that her pre-existing condition precluded recovery within the MIG, did not meet the AMA criteria for chronic pain, and failed to establish a psychological injury caused by the accident.

As the applicant remained within the MIG and the remaining funds were insufficient, the claims for psychological assessments and physiotherapy were dismissed.

The claim for an award for unreasonable delay was also dismissed.

The applicant sought accident benefits following a motor vehicle accident, claiming a psychological condition warranted removal from the Minor Injury Guideline (MIG).

The Tribunal found the applicant's evidence, including clinical notes and a social worker's assessment, insufficient to establish a psychological condition caused by the accident, noting the symptoms were more likely related to an unrelated chronic health condition.

As the applicant remained within the MIG and the limits were exhausted, the claim for a psychological assessment was denied, along with claims for interest and a special award.

The applicant was involved in a motor vehicle accident and sought a determination of catastrophic impairment and entitlement to various statutory accident benefits.

The Licence Appeal Tribunal found that the applicant sustained a catastrophic impairment under both Criterion 6 (64% whole person impairment) and Criterion 2 (severe and permanent alteration of lower extremities with a SCIM score of 4).

The Tribunal awarded incurred attendant care benefits from October 2021 to March 2022 but denied ongoing attendant care benefits as the applicant failed to provide an updated Form 1 reflecting her current needs.

Claims for four specific treatment plans were dismissed as the applicant provided no evidence to support them.

Interest was awarded on all overdue payments.

The applicant sought statutory accident benefits following a motor vehicle accident.

The applicant failed to attend the scheduled videoconference hearing despite receiving proper notice.

The Tribunal proceeded in the applicant's absence pursuant to section 7(3) of the Statutory Powers Procedure Act.

As the applicant tendered no evidence or submissions, she failed to meet her onus to prove entitlement to the claimed benefits.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and a treatment plan for physiotherapy.

The insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to prove her pre-existing conditions precluded recovery within the MIG, noting a lack of compelling medical evidence.

The Tribunal also dismissed the claim for a non-earner benefit, finding the medical records did not demonstrate a complete inability to carry on a normal life.

As the applicant remained within the MIG and the limit was exhausted, the treatment plan and claim for interest were also dismissed.

The applicant, who was 6 years old at the time of the motor vehicle accident, sought a determination of catastrophic impairment under Criterion 8 of the Statutory Accident Benefits Schedule due to mental and behavioural disorders.

The Tribunal found that the applicant sustained a Class 4 marked impairment in the domain of social functioning, relying on the applicant's psychiatric expert who linked the psychological diagnoses to the applicant's avoidance of interpersonal relationships and severe social withdrawal.

The Tribunal dismissed the claims for an assessment plan and an OCF-6 invoice as the applicant provided no evidence or submissions to support them.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries fell outside the Minor Injury Guideline (MIG) due to pre-existing conditions (spinal fusion, Brown-Sequard Syndrome), chronic pain, and psychological impairments.

The Tribunal found the applicant failed to prove his pre-existing conditions precluded maximal medical recovery within the MIG.

Claims of chronic pain and psychological injury were unsupported by persuasive medical evidence, with the Tribunal noting inconsistencies in the applicant's reported vehicular phobia.

The Tribunal also dismissed the claim for a non-earner benefit, finding the applicant did not suffer a complete inability to carry on a normal life.

All disputed treatment plans, interest, and an award under s. 10 of Regulation 664 were denied.

The applicant sought statutory accident benefits following a 2020 motor vehicle accident, including income replacement benefits (IRBs), various treatment plans, and an award for unreasonable delay.

The respondent denied the benefits, arguing the applicant's impairments were due to pre-existing degenerative disc disease and a prior 2016 accident.

The Tribunal found the applicant failed to prove her impairments were caused by the subject accident, relying on the respondent's s. 44 assessors who concluded her physical and psychological complaints were not accident-related.

All claims for IRBs, treatment plans, assessments, interest, and an award were dismissed.

The respondent's request for costs was also dismissed.

The applicant sought statutory accident benefits following a 2012 motor vehicle accident, claiming she sustained a catastrophic impairment and was entitled to non-earner benefits.

The Tribunal found the applicant did not meet the 55% whole person impairment threshold under Criterion 7, nor did she demonstrate the required marked impairments under Criterion 8.

The Tribunal preferred the evidence of the respondent's assessors, noting the applicant successfully attends university full-time and maintains part-time employment.

The claims for catastrophic impairment and non-earner benefits were dismissed.

The applicant sought payment for the outstanding balances of seven partially approved treatment plans, specifically the 'PR' charges for document support activity.

The respondent had reduced these charges to a one-hour 'HR' rate without providing medical or other reasons, citing only section 25 of the Schedule.

The Tribunal found the respondent failed to comply with the notice requirements under section 38(8) of the Schedule and ordered payment of the outstanding balances with interest.

The applicant's request for a section 10 award was dismissed, as the respondent's conduct did not rise to the level of being excessive or imprudent.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found he was subject to the Minor Injury Guideline and not entitled to income replacement benefits due to non-compliance with section 33 of the Statutory Accident Benefits Schedule.

The applicant argued that he was muted during the virtual hearing, that the adjudicator improperly preferred the respondent's evidence, and that new medical reports should be considered.

The Tribunal dismissed the request, finding no breach of procedural fairness, no error of law or fact, and that the allegedly new evidence was either already in the record or could have been obtained previously.

The applicant insurer sought repayment of income replacement benefits (IRBs) paid to the respondent following a motor vehicle accident, alleging wilful misrepresentation.

The Tribunal found that the respondent wilfully misrepresented her employment status and income at the time of the accident, as evidence showed she was not employed or self-employed in the months prior.

The Tribunal ordered the respondent to repay $4,369.52 in overpaid IRBs pursuant to s. 52 of the Statutory Accident Benefits Schedule, plus interest.