Ulana Pahuta

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 applicant argued for removal from the MIG based on pre-existing conditions, chronic pain, and psychological impairments.

The Tribunal found the applicant failed to provide sufficient evidence to establish pre-existing impairments, accident-related chronic pain with functional limitations, or a psychological impairment warranting removal from the MIG.

As the $3,500 MIG limit was exhausted, the application for disputed treatment plans and interest was dismissed.

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

The respondent denied benefits and scheduled insurer's examinations, which the applicant failed to attend.

The respondent argued the applicant was barred from proceeding with his application under s. 55(1)2 of the Schedule.

The Tribunal found that the respondent's notices of examination did not comply with s. 44(5) of the Schedule because they failed to provide specific details about the applicant's medical condition forming the basis of the decision.

As the notices were deficient, the applicant was not barred from proceeding with his application.

The applicant sought statutory accident benefits following a motor vehicle accident on October 10, 2019.

The respondent denied benefits because the applicant failed to notify them of her intention to apply until October 14, 2021, well beyond the seven-day limit prescribed by section 32(1) of the Schedule.

The applicant did not file submissions or evidence to provide a reasonable explanation for the delay.

The Tribunal found that the applicant failed to meet her onus to establish a reasonable explanation and held that she was statute-barred from proceeding with her application under section 55(1)1 of the Schedule.

The application was dismissed.

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

The respondent insurer denied income replacement benefits, arguing the applicant was barred under s. 31(1)(b) of the Schedule for intentionally failing to notify it of his move from Kitchener to Toronto, which would have increased his premiums.

The Tribunal found that while the address change was a material risk, the respondent failed to meet its burden of proving the failure to disclose was intentional.

The applicant testified he informed his broker of the move, and the respondent provided insufficient evidence to refute this.

The applicant is not barred from proceeding with his claim.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found that his accident-related impairments fell within the Minor Injury Guideline (MIG).

The applicant argued that the adjudicator erred in law and fact by failing to properly consider medical evidence, including MRI results and clinical notes, regarding his chronic pain and physical impairments.

The Tribunal dismissed the request, finding that the applicant was attempting to re-litigate his case and reweigh evidence already considered.

The Tribunal concluded that no error of law or fact was made that would have led to a different result.

The applicant sought statutory accident benefits after allegedly falling while entering her parked motor vehicle.

The respondent denied benefits, arguing the incident was a slip and fall on ice and not an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal applied the two-part purpose and causation test, finding that while the purpose test was met, the causation test was not.

The Tribunal concluded that the slip and fall on ice was an intervening act and the dominant feature of the incident, meaning the use or operation of the vehicle did not directly cause the injuries.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a $3,518.00 physiotherapy treatment plan and removal from the Minor Injury Guideline (MIG) due to chronic pain.

The Licence Appeal Tribunal found that the applicant failed to establish chronic pain with functional impairment, noting that the medical evidence relied heavily on self-reports and contradicted the family physician's records.

As the applicant's injuries were deemed predominantly minor and the $3,500 MIG limit was exhausted, the claim for the treatment plan and interest was dismissed.

The applicant sought income replacement benefits (IRBs) for psychological impairments allegedly resulting from a motor vehicle accident involving her husband and son.

The respondent raised a preliminary issue that the applicant was barred from proceeding with her IRB claim because she failed to submit a completed Disability Certificate (OCF-3) within 104 weeks of the accident, as required by section 5(1) of the Statutory Accident Benefits Schedule.

The applicant argued that the principle of discoverability applied because her impairments developed later.

The Tribunal found that the applicant failed to provide any medical evidence to establish when her psychological impairments developed.

Consequently, the Tribunal held that the applicant was statute-barred from proceeding with her claim for IRBs.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claims for income replacement benefits, attendant care benefits, and a special award, while granting one treatment plan.

The applicant argued the Tribunal breached procedural fairness and made errors of law by disregarding viva voce evidence from the respondent's adjuster and failing to provide sufficient reasons.

The adjudicator dismissed the request, finding that the original decision provided adequate reasons and properly weighed the evidence.

Although the Tribunal erred in failing to consider a special award for the single approved treatment plan, the applicant did not establish that this error would have likely changed the outcome.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her injuries, including a partial shoulder tear and chronic pain, warranted removal from the Minor Injury Guideline (MIG).

The Tribunal found that the partial shoulder tear and soft tissue injuries fell within the MIG definition.

The Tribunal also concluded the applicant failed to establish chronic pain with functional impairment, noting inconsistencies in her medical records and giving limited weight to her physiatry assessment.

The applicant was found to remain within the MIG and was awarded only the remaining balance of her $3,500 limit.

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

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

The Tribunal found that the applicant's chronic back pain, which caused functional impairment, warranted removal from the MIG.

The Tribunal approved treatment plans for physiotherapy and a psychological assessment, finding them reasonable and necessary, but denied other plans for lack of evidence or because they were duplicative.

Interest was awarded on the overdue benefits.

The applicant sought statutory accident benefits after slipping and falling on ice while allegedly attempting to enter her husband's vehicle.

The respondent denied benefits on the basis that the incident was not an 'accident' under s. 3(1) of the Schedule.

At a preliminary issue hearing, the Tribunal applied the two-part test from Caughy.

While the purpose test was met, the causation test failed because the slip and fall on the ice constituted an intervening act that broke the chain of causation.

The application was dismissed.

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

The matter proceeded to a written hearing, but the applicant failed to file any submissions or evidence despite multiple opportunities and reminders from the Tribunal and the respondent.

The adjudicator dismissed the application, finding that the applicant failed to meet her evidentiary burden to establish entitlement to removal from the Minor Injury Guideline, the disputed treatment plans, an award, or interest.

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

The insurer requested an Election of Benefits form (OCF-10) because the applicant's Disability Certificate (OCF-3) indicated she met the tests for both income replacement benefits and non-earner benefits.

The applicant failed to submit the OCF-10, arguing there was no ambiguity since she was employed at the time of the accident.

The Tribunal found that the OCF-3 created ambiguity requiring an election under section 35(1) of the Schedule.

As the applicant failed to comply with the mandatory requirement to submit the OCF-10, she was barred from proceeding with her claim for income replacement benefits, and the application was dismissed.

The applicant sought medical and non-earner benefits following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that she did not meet the test for non-earner benefits.

The Tribunal found the applicant failed to prove her injuries warranted removal from the MIG, as medical evidence showed only soft tissue injuries and no chronic pain or pre-existing conditions precluding recovery.

Because the $3,500 MIG limit was exhausted, the disputed physiotherapy treatment plan was denied.

The Tribunal also dismissed the claim for non-earner benefits, finding insufficient evidence that the applicant suffered a complete inability to carry on a normal life.

The applicant sought entitlement to various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant was entitled to $1,130.00 for PRP injections and $2,200 for a psychological assessment, as these were supported by the medical evidence and treating practitioners' recommendations at the time.

However, the Tribunal denied the claims for physical therapy, a chronic pain assessment, and massage therapy, finding that the applicant failed to prove they were reasonable and necessary given the lack of objective evidence of efficacy and the duplicative nature of the chronic pain assessment.

Interest was awarded on the overdue benefits.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident.

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

The Tribunal found that the applicant failed to establish that his chronic pain, psychological impairments, or pre-existing conditions warranted removal from the MIG, noting that his chronic back pain and functional limitations pre-dated the accident and were not exacerbated by it.

The Tribunal also dismissed the claim for non-earner benefits, finding the applicant did not suffer a complete inability to carry on a normal life as his pre-accident activities were already severely limited by a prior accident.

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

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

The respondent denied the benefits and argued the applicant was barred from proceeding with several treatment plans due to her failure to attend scheduled insurer's examinations (IEs).

The Tribunal found the applicant failed to provide a reasonable explanation for her non-attendance and was therefore statute-barred under s. 55(1)2 of the Schedule from proceeding with those claims.

For the remaining treatment plans, the Tribunal found the applicant failed to adduce sufficient objective medical evidence to prove they were reasonable and necessary, preferring the evidence of the respondent's IE assessors.

The application was dismissed.

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

The respondent insurer denied several treatment plans and a non-earner benefit, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered from accident-related chronic pain with functional impairment, warranting removal from the MIG.

The Tribunal approved treatment plans for physiotherapy and psychological services, finding them reasonable and necessary.

However, the Tribunal denied the claim for an attendant care assessment, completion fees, and a non-earner benefit, as the applicant failed to prove a complete inability to carry on a normal life.

The claim for a special award was also dismissed.

The applicant sought payment of an outstanding invoice for psychological services that was approved and incurred prior to the parties reaching a full and final settlement of her accident benefits file.

The Tribunal dismissed the application, finding that the clear and unequivocal language of the settlement disclosure notice included all previously approved and incurred expenses.

The Tribunal also dismissed the applicant's claims for interest and an award, and denied the respondent's request for costs, finding the applicant's conduct in bringing the application was not vexatious or unreasonable.