Tyler Moore

The applicant sought various statutory accident benefits following a motor vehicle accident, including attendant care benefits, assistive devices, chiropractic services, and multiple assessments.

The Tribunal denied the claim for attendant care benefits, finding that the applicant's significant functional limitations were attributable to an intervening stroke rather than the accident.

The Tribunal partially approved the claim for assistive devices and fully approved the claims for chiropractic services, finding them reasonable and necessary for the applicant's accident-related neck and back injuries.

The claims for neurological, orthopaedic, attendant care, and SIE/FAE assessments were denied for lack of supporting medical evidence.

Interest was awarded on overdue payments for incurred assistive devices and chiropractic services.

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

The Tribunal found that the applicant's chronic pain condition warranted removal from the Minor Injury Guideline (MIG).

However, the applicant's claims for non-earner benefits, a psychological assessment, and a chronic pain assessment were dismissed.

The Tribunal concluded that the applicant did not suffer a complete inability to carry on a normal life, the psychological assessment was not reasonable and necessary, and the chronic pain assessment was duplicative of an OHIP-funded assessment.

Claims for interest and an award were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to physiotherapy services, assistive devices, interest, and an award for unreasonable delay under s. 10 of Regulation 664.

The Licence Appeal Tribunal found that the applicant failed to prove the disputed treatment plans were reasonable and necessary, noting a duplication of services and lack of justification for the assistive devices.

The Tribunal also dismissed the claim for a s. 10 award, finding that the insurer did not act unreasonably in delaying the catastrophic impairment determination until it received the necessary diagnostic imaging reports.

The application was dismissed in its entirety.

The applicant was struck by an unidentified vehicle in November 2018 but did not notify the respondent insurer until February 2022.

The respondent denied the claim for accident benefits on the basis that the applicant failed to provide notice within 7 days as required by section 32(1) of the Schedule.

The Tribunal found that the applicant did not have a reasonable explanation for the delay, noting she could have notified the Motor Vehicle Accident Claims Fund much earlier, as she had retained counsel and reported the accident to healthcare providers shortly after it occurred.

The application was dismissed as statute-barred.

The applicant sought various statutory accident benefits following a motor vehicle accident, including attendant care, occupational therapy, physiotherapy, chiropractic services, medical cannabis, and psychological services.

The Tribunal denied the claims for attendant care, occupational therapy, and physical therapies, finding the applicant's self-reporting unreliable and noting that physical therapies had previously plateaued without lasting benefit.

However, the Tribunal granted the treatment plans for medical cannabis and psychological services, finding them to be reasonable and necessary untrialed interventions for the applicant's accident-exacerbated chronic pain and adjustment disorder.

The applicant's request for costs was denied.

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

The insurer raised preliminary issues, arguing the applicant was statute-barred for missing the two-year limitation period and for failing to attend an insurer's examination.

The Tribunal found the application was timely because the limitation period expired on a weekend, extending it to the next business day.

The Tribunal also found the notice of examination was deficient, excusing the applicant's non-attendance.

On the substantive issues, the Tribunal denied the claim for a sleep study assessment but granted the claim for an interdisciplinary chronic pain assessment, finding it reasonable and necessary given the applicant's chronic pain and history of addictions.

Interest was awarded on the overdue payment, but a claim for a special award was dismissed.

The applicant sought statutory accident benefits after crashing his bicycle into a construction sign.

He alleged that an unidentified truck sped up behind him, forcing him to swerve and hit the sign.

The respondent denied benefits on the basis that the incident did not involve an automobile.

The Tribunal found the applicant's evidence inconsistent and unreliable, noting that hospital records and the initial police report did not mention an automobile.

The Tribunal concluded the incident did not meet the purpose test for an 'accident' under s. 3(1) of the Schedule and dismissed the application.

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

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

The Tribunal found that the applicant sustained a concussion, removing her from the MIG.

The Tribunal approved treatment plans for chiropractic services and vestibular physiotherapy, finding them reasonable and necessary based on consistent medical evidence of ongoing physical and vestibular symptoms.

However, claims for an occupational therapy assessment and a psychological assessment were dismissed, as the applicant remained independent in her activities of daily living and lacked objective evidence of a psychological injury.

Interest was awarded on the overdue benefits for incurred expenses.

The applicant sought $4,223.90 for a chiropractic treatment plan following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the proposed treatment was not reasonable and necessary.

The Tribunal accepted the respondent's medical assessment evidence, which indicated that the applicant had achieved maximum medical recovery and had normal ranges of motion, consistent with the clinical notes of the applicant's treating family physician.

Claims for interest and a special award were consequently dismissed.

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

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

The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from a psychological injury or chronic pain with functional impairment that would warrant removal from the MIG.

The Tribunal also dismissed the claims for income replacement benefits, treatment plans, and a doctor's visit expense, finding insufficient objective medical evidence to support the claims.

Consequently, claims for interest and an award were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that their injuries fell within the Minor Injury Guideline.

The matter proceeded to a written hearing.

The applicant failed to file any written submissions or evidence by the deadline and did not seek an extension.

Consequently, the Tribunal found the applicant failed to meet their onus to demonstrate removal from the Minor Injury Guideline or entitlement to the disputed medical benefits, interest, and award.

The application was dismissed.

The applicant sought income replacement benefits (IRBs) and medical benefits following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove a substantial inability to perform the essential tasks of his employment as an Uber driver, noting he continued to work full-time.

The Tribunal also held that the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG) limit of $3,500.

The applicant failed to establish that his pre-existing chronic pain or alleged psychological injuries warranted removal from the MIG.

Consequently, the claims for IRBs, disputed treatment plans, and interest were dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for occupational therapy and a driver re-integration assessment.

The respondent denied the benefits, relying on independent medical examinations.

The Tribunal found the occupational therapy assessment and a portion of the occupational therapy services were reasonable and necessary, given the applicant's ongoing functional limitations.

However, the in-vehicle driver assessment was denied because the applicant's passenger anxiety had already been diagnosed and could be addressed through previously approved cognitive behavioural therapy.

Claims for a special award and costs were dismissed, but interest on overdue payments was granted.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming for dental services, prescription glasses, a special award, and costs.

The Tribunal found the applicant entitled to $9,509.40 for incurred dental services, which the respondent had previously approved.

The claim for prescription glasses was denied as the applicant failed to prove they were damaged in the accident.

Claims for a special award and costs were also dismissed, though interest was awarded on the overdue dental payment.

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

The Tribunal found that the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG) limit of $3,500, which had been exhausted.

The applicant failed to establish chronic pain or a psychological condition warranting removal from the MIG.

The Tribunal denied the disputed physiotherapy treatment plan.

However, the Tribunal found the applicant was entitled to income replacement benefits from November 6, 2020, to May 16, 2021, as she suffered a substantial inability to perform the essential tasks of her pre-accident employment during that period.

Claims for an award under s. 10 of Reg. 664 were dismissed.

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

The Tribunal scheduled a written hearing, but neither party filed submissions.

As the applicant bore the onus of demonstrating removal from the Minor Injury Guideline and entitlement to the disputed benefits, the Tribunal dismissed the application due to the lack of evidence and submissions.

The applicant insurer sought repayment of an Income Replacement Benefit (IRB) overpayment of $742.84 from the respondent insured, who had returned to work.

The respondent failed to participate in the written hearing.

The Tribunal found that it had met its notice obligations and proceeded in the respondent's absence.

The Tribunal ordered the respondent to repay the outstanding balance of $742.84 plus applicable interest pursuant to section 52 of the Schedule.

The applicant was involved in a motor vehicle accident on June 13, 2021, but did not submit an application for accident benefits (OCF-1) until at least February 2023.

The respondent denied benefits on the basis that the application was submitted outside the time limits prescribed by the Statutory Accident Benefits Schedule.

The applicant argued she had a reasonable explanation for the delay, citing her unsophistication, substance abuse issues, and the other driver's refusal to provide insurance information.

The Tribunal found the applicant's explanation lacked credibility due to inconsistencies between her examination under oath and her representative's submissions.

The Tribunal also noted she had successfully applied for benefits following a separate accident in May 2021.

The Tribunal concluded the applicant failed to provide a reasonable explanation for the delay and is statute-barred from proceeding with her application.

The applicant sought accident benefits following a motor vehicle accident, arguing her injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain, a pre-existing condition, and psychological injuries.

The Tribunal found the applicant did not meet the burden of proving her injuries warranted removal from the MIG, noting her continued ability to work full-time and lack of compelling medical evidence.

As the applicant was subject to the MIG and the funding limit was exhausted, the claim for a chiropractic treatment plan and interest was dismissed.

The applicant sought non-earner benefits and funding for two chiropractic treatment plans following a motor vehicle accident.

The Tribunal found the applicant did not meet the test for non-earner benefits, as medical assessments demonstrated her daily routine remained largely unchanged and her impairments were largely attributable to pre-existing musculoskeletal conditions.

The Tribunal lacked jurisdiction over the first treatment plan because it was not properly submitted or denied.

The second treatment plan was denied because the applicant failed to provide objective medical evidence that the treatment was reasonable and necessary for accident-related injuries.

The application was dismissed.