Ulana Pahuta

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.

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's physical injuries were minor soft-tissue strains and that he failed to establish any accident-related psychological impairments warranting removal from the MIG.

Because the $3,500 MIG limit was exhausted, the disputed treatment plans were not payable.

The Tribunal also dismissed the claim for non-earner benefits, finding the applicant failed to prove a complete inability to carry on a normal life, and denied the request for a special award.

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 Licence Appeal Tribunal found that the applicant failed to prove her injuries warranted removal from the MIG, as there was insufficient objective medical evidence of chronic pain.

However, the Tribunal awarded a limited period of non-earner benefits and the outstanding balance of a physiotherapy treatment plan because the respondent failed to provide compliant denial notices within the required statutory timeframes.

Claims for other treatment plans and an award for unreasonable delay were dismissed.

The respondent insurer requested a reconsideration of a Tribunal decision that removed the applicant from the Minor Injury Guideline (MIG) on psychological grounds.

The respondent argued the Tribunal made errors of fact regarding the applicant's return to driving and the characterization of medical reports, and errors of law by failing to properly assess functional limitations and the threshold of impairment.

The Tribunal dismissed the request, finding no significant errors of fact or law, and noted that the respondent was improperly attempting to re-litigate its position and raise new arguments not presented at the original hearing.

The applicant sought reimbursement for massage therapy services provided by an unlicensed service provider who was not registered with HCAI.

The respondent denied the OCF-6 expense claims because the invoices were not submitted through HCAI via an OCF-21, as required by s. 49.1 of the Schedule.

The Tribunal found that the applicant failed to comply with s. 49.1 and the applicable Guideline, which require an OCF-21 to be submitted by a Participating Facility even when services are provided by an unlicensed provider.

The application for benefits, interest, and an award was dismissed.

The applicant sought entitlement to various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident, including a functional abilities evaluation, chiropractic services, physiotherapy, massage therapy, and occupational therapy.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to meet her burden of proving the proposed treatments were reasonable and necessary.

The Tribunal relied on the respondent's section 44 medical assessments, which indicated the applicant had returned to work and was functional in her activities of daily living, and noted a lack of objective medical evidence from the applicant to support the need for ongoing passive facility-based treatment.

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

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

The applicant applied to the Licence Appeal Tribunal, arguing for removal from the MIG due to psychological impairments and chronic pain.

The Tribunal found that the applicant failed to establish accident-related psychological impairments or chronic pain warranting removal from the MIG, preferring the respondent's medical assessments which showed limited functional impairment.

As the MIG limit was exhausted, the disputed treatment plans and interest were denied.

The respondent's request for costs was also dismissed.

The applicant sought payment for a psychological treatment plan following a motor vehicle accident.

The respondent partially approved the plan but denied the balance of $4,918.00.

The Tribunal found that the applicant established the reasonableness and necessity of a sound machine and relaxation CD/DVD, awarding $188.00 plus interest.

However, the applicant failed to prove that the remaining balance, which included additional therapy session time, a CES medical device, and virtual reality sessions, was reasonable and necessary.

The applicant sought statutory accident benefits following a motor vehicle accident, including a determination of catastrophic impairment and non-earner benefits.

The Licence Appeal Tribunal found the claim for non-earner benefits was statute-barred due to the applicant's failure to submit an OCF-3 within 104 weeks of the accident.

The Tribunal also concluded the applicant did not sustain a catastrophic impairment, preferring the respondent's psychiatric assessment over the applicant's, noting the applicant's assessor failed to consider a pre-existing ADHD diagnosis.

Claims for various treatment plans and expenses were dismissed for lack of evidence establishing reasonableness and necessity.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to four treatment plans and attendant care benefits.

The Tribunal found the applicant was entitled to one treatment plan for physiotherapy services, as it was supported by contemporaneous medical records and recommended by the family physician.

The remaining treatment plans were denied because the applicant failed to prove they were reasonable and necessary, and the proposed assessments were duplicative.

The claim for attendant care benefits was denied because the applicant failed to provide evidence that the expenses were incurred.

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

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

The Tribunal found that the applicant failed to establish that his physical or psychological impairments warranted removal from the MIG.

The Tribunal also found that the respondent was compliant with the response requirements under s. 38 of the Schedule.

The application for disputed treatment plans, interest, and an award was dismissed.

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

The matter proceeded to a written hearing, but neither party filed submissions or evidence.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to meet his evidentiary burden to establish that the claimed treatment plans and assessments were reasonable and necessary.

The applicant insurer sought repayment of $233,243.50 in income replacement benefits (IRBs) paid to the respondent pursuant to a 2010 interim order by the Financial Services Commission of Ontario (FSCO).

The respondent did not participate in the written hearing.

The Tribunal dismissed the application, finding it lacked jurisdiction to order repayment of interim benefits granted under the repealed section 279(4.1) of the Insurance Act or to vary a FSCO order.

In the alternative, the Tribunal held that the insurer failed to meet its evidentiary burden, as it provided no objective proof of the IRB payments made and failed to adequately explain the 12-year delay in the proceedings.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits and several treatment plans.

The Licence Appeal Tribunal denied the attendant care benefits, finding the applicant failed to prove the expenses were incurred, noting contradictory evidence and a lack of detailed invoices.

The Tribunal also denied treatment plans for physiotherapy, occupational therapy, and life skills training, as the applicant failed to establish they were reasonable and necessary or payable due to insurer non-compliance.

However, the Tribunal granted the treatment plan for psychological services, finding it reasonable and necessary based on the applicant's progress and ongoing symptoms.

The claim for a special award was dismissed.

The applicant was involved in a motor vehicle accident and received income replacement benefits from the respondent insurer.

The respondent later discovered evidence suggesting the applicant was not employed at the time of the accident and sought repayment of $20,400.00, alleging wilful misrepresentation.

The applicant failed to participate in the written hearing.

The Tribunal found that the applicant wilfully misrepresented his pre-accident employment status, noting contradictory pay stubs, admissions of non-employment, and failure to provide requested financial disclosure.

The Tribunal ordered the applicant to repay the $20,400.00 plus interest.

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

The respondent did not attend the case conference or provide submissions for the written hearing.

The Tribunal found that the respondent willfully misrepresented her post-accident employment status by working for multiple employers while receiving IRBs and failing to disclose this to the insurer.

The Tribunal ordered the respondent to repay $13,947.79, the amount specified in the insurer's notice of repayment, along with applicable interest.

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

The respondent denied the benefits and raised a preliminary issue that the applicant was statute-barred from proceeding due to her failure to attend scheduled insurer's examinations.

The Tribunal found that the applicant failed to provide a reasonable explanation for her non-attendance and that the respondent's notices were compliant.

Consequently, the applicant was barred from proceeding with most of her claims.

For the remaining claim for physiotherapy services, the Tribunal found the applicant failed to establish the treatment was reasonable and necessary.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to treatment plans for physiotherapy, an orthopaedic assessment, and a chronic pain assessment outside the Minor Injury Guideline (MIG).

The applicant argued that a lumbar disc protrusion and chronic pain warranted removal from the MIG.

The Tribunal found that the applicant failed to establish non-minor physical impairments or chronic pain, noting the lack of an in-person physical examination by the applicant's assessor and the respondent's assessor's findings of normal range of motion.

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

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his physical and psychological impairments, along with pre-existing conditions, warranted removal from the Minor Injury Guideline (MIG).

The respondent denied the benefits, maintaining the injuries were minor.

The Tribunal found the applicant failed to provide compelling medical evidence of non-minor physical or psychological impairments, or that pre-existing conditions precluded his recovery within the MIG.

As the MIG limits were exhausted, the claims for additional treatment plans, interest, and an award for unreasonable delay were dismissed.