Ulana Pahuta

The applicant sought income replacement benefits (IRBs) pursuant to s. 36(6) of the Statutory Accident Benefits Schedule, arguing that the respondent insurer failed to provide a compliant denial notice under s. 36(4) after receiving an updated disability certificate.

The Tribunal found that the insurer's request for additional information, including employment and medical records, was reasonably required and compliant with s. 36(4)(c).

Furthermore, the insurer's subsequent denial letter referencing a prior denial was compliant with s. 36(4)(b).

As the insurer complied with its obligations, the applicant was not entitled to IRBs under s. 36(6), nor to interest or an award.

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

The respondent denied the claim because the applicant failed to notify the insurer of his intention to apply for benefits within seven days of the accident, as required by section 32(1) of the Schedule.

The applicant first notified the respondent nearly ten months after the accident and provided no submissions or reasonable explanation for the delay.

The Tribunal found the applicant non-compliant with section 32(1) and barred him from proceeding with the substantive issues in dispute pursuant to section 55(1) of the Schedule.

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

The respondent denied the IRBs on the basis that the applicant had returned to work and made a material misrepresentation.

The applicant filed an application with the Tribunal more than two years after the denial.

The Tribunal found that the respondent's denial letter was clear and unequivocal, triggering the two-year limitation period under s. 56 of the Schedule.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act, noting the substantial delay and surveillance evidence showing the applicant working.

The Tribunal also dismissed the claims for medical benefits, finding the applicant failed to prove they were reasonable and necessary.

The application was dismissed.

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

The matter proceeded to a written hearing.

The applicant's legal representative withdrew, and the applicant failed to file any written submissions.

The adjudicator proceeded with the hearing under s. 7(2) of the Statutory Powers Procedure Act.

As the applicant bore the onus of proof and provided no evidence, the application for removal from the Minor Injury Guideline, income replacement benefits, and treatment plans was dismissed.

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

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

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

The Tribunal also approved a treatment plan for an occupational therapy assessment as reasonable and necessary, and awarded interest on overdue payments.

The applicant's request for a special award under s. 10 of O. Reg. 664 was dismissed, as there was no evidence of unreasonable withholding or delay by the respondent.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied transportation/mileage expenses and a section 10 award.

The adjudicator granted the reconsideration in part, finding that the Tribunal erred in its application of the Transportation Expense Guideline by denying mileage expenses incurred when the applicant was transported in a rehabilitation support worker's vehicle during treatment sessions.

The adjudicator ordered the respondent to pay the denied mileage expenses plus interest.

However, the adjudicator confirmed the original decision denying a section 10 award, finding that the respondent had not unreasonably withheld benefits when it denied treatment plans after the non-catastrophic funding limit had been reached.

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 claimed entitlement to non-earner benefits and funding for psychological services, relying on a psychological assessment diagnosing him with major depressive disorder and PTSD.

The Tribunal found that the applicant failed to provide corroborating medical evidence, such as clinical notes and records, to establish non-minor physical or psychological impairments.

The Tribunal accepted the respondent's psychological assessment, which found the applicant's symptoms did not meet DSM-5 criteria.

The claim for non-earner benefits was also dismissed due to a lack of evidence regarding the applicant's pre-accident activities and objective medical evidence demonstrating a complete inability to carry on a normal life.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for various treatment plans and assessments.

The respondent denied the plans.

The Tribunal found the applicant was entitled to a functional abilities evaluation and a worksite/occupational demands assessment, as they were reasonable and necessary and not duplicative of the insurer's own assessments.

However, the Tribunal denied the plans for an in-home assessment, a chronic pain assessment, and physical therapy, finding them to be duplicative or unsupported by the medical evidence.

The claim for an award under s. 10 of Reg. 664 was dismissed.

TD General Insurance Company applied to the Licence Appeal Tribunal for a lump sum repayment of $17,581.64 in overpaid Income Replacement Benefits (IRBs) from the respondent after he was retroactively approved for Canada Pension Plan Disability benefits.

The respondent argued for repayment via ongoing IRB deductions, but his IRBs had been suspended under section 57 of the Schedule for failing to attend treatment.

The Tribunal found that because IRBs were not currently being paid, the insurer was entitled to a lump sum repayment under section 52(4) of the Schedule, along with interest under section 52(5).

The applicant sought statutory accident benefits following a rear-end collision.

The respondent denied benefits and sought repayment of previously paid benefits, alleging the accident was staged and the applicant wilfully misrepresented material facts due to inconsistencies in his testimony.

The Tribunal found that the applicant was involved in an 'accident' as defined in the Schedule, noting that the inconsistencies were minor and plausibly explained by the applicant's admitted marijuana impairment at the time.

The Tribunal dismissed the respondent's claim for repayment, finding no wilful misrepresentation.

The applicant requested a reconsideration of a Tribunal decision that found he remained within the Minor Injury Guideline (MIG) and was not entitled to disputed treatment plans.

The applicant argued the adjudicator erred in fact and law by failing to find he suffered a neurocognitive disorder or psychological impairment, and sought to introduce new evidence of a concussion.

The Tribunal dismissed the request, finding the applicant was attempting to re-litigate the case and re-weigh evidence.

The Tribunal held that the adjudicator provided comprehensive reasons for rejecting the applicant's evidence, and the new evidence did not meet the test for reconsideration.

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

The respondent denied the benefits, arguing the applicant was statute-barred for submitting her application seven months late and that her injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant had a reasonable explanation for the delay due to documented cognitive and psychological challenges.

However, on the substantive issues, the Tribunal concluded the applicant failed to establish that her chronic pain and psychological impairments were caused by the accident rather than pre-existing conditions.

The application for removal from the MIG, non-earner benefits, and treatment plans was dismissed.

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

The applicant sought payment for a psychological treatment plan and argued the respondent's denial notices were non-compliant with s. 38(8) of the Schedule, thereby barring the respondent from relying on the MIG.

The Tribunal found the denial notices were compliant and provided principled medical reasons based on insurer's examinations.

As the applicant provided no substantive medical evidence or submissions to prove his injuries warranted removal from the MIG, the application for the treatment plan, interest, and an award was 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 provide medical evidence or submissions to support removal from the MIG.

The Tribunal also rejected the applicant's argument that the treatment plans were payable due to the respondent's alleged non-compliance with the notice requirements under s. 38(8) of the Schedule, finding the respondent's denial letters were compliant.

The application was dismissed.

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 the applicant's pre-existing lower back pain and sciatica prevented her from achieving maximal recovery within the MIG, warranting removal.

The Tribunal granted entitlement to physiotherapy treatment plans, a chronic pain assessment, and a neurological assessment, finding them reasonable and necessary.

However, claims for chronic pain treatment, psychological services, and certain medical devices were dismissed for lack of supporting medical evidence.

Interest was awarded on the approved plans.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of several treatment plans for physiotherapy and occupational therapy, as well as attendant care benefits.

The Tribunal found the applicant partially entitled to one physiotherapy treatment plan and one occupational therapy plan, noting that a compression fracture was linked to the accident and justified further treatment.

The Tribunal also found the applicant entitled to attendant care benefits of $1,034.58 per month due to chronic pain limitations, but held they were not yet payable because the applicant failed to prove the expenses had been incurred.

The claim for a special award was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing that his injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain.

The Licence Appeal Tribunal found that the applicant failed to prove he suffered from chronic pain causing functional impairment as a result of the accident, noting a lack of persistent pain reports to his family doctor and a subsequent workplace injury.

The Tribunal concluded the applicant's injuries were predominantly minor and subject to the $3,500 MIG limit, dismissing his claims for disputed treatment plans and interest.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied an adjournment request and dismissed her application for catastrophic impairment benefits.

The applicant argued that the denial of the adjournment was a material breach of procedural fairness, as her newly retained counsel had identified a potential conflict of interest with her litigation guardian on the eve of the hearing, alongside ongoing capacity concerns.

Applying the Divisional Court's reasoning in Riddell regarding the need for flexibility in complex catastrophic impairment cases, the Tribunal found that the combination of the potential conflict, capacity issues, and recently retained counsel constituted compelling circumstances.

The Tribunal concluded that denying the short adjournment was a material breach of procedural fairness, cancelled the initial decision, and ordered a rehearing before a new adjudicator.

The applicant requested reconsideration of a decision that denied an oral adjournment request and dismissed her application for catastrophic impairment determination.

The applicant argued that her newly retained counsel had identified a potential conflict of interest with her litigation guardian on the eve of the hearing, alongside concerns about her capacity.

The Tribunal found that denying the adjournment in these complex circumstances constituted a material breach of procedural fairness.

The reconsideration request was granted, the initial decision was cancelled, and a rehearing was directed.

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

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

The Tribunal found the applicant's accident-related psychological impairments, including a diagnosis of PTSD by his family physician, warranted removal from the MIG.

The Tribunal approved the disputed treatment plans for physiotherapy and a psychological assessment, as well as medication expenses, finding them reasonable and necessary.

However, the applicant's claim for income replacement benefits was dismissed due to non-compliance with s. 33 requests for financial information and evidence indicating he had returned to work.

The applicant was awarded interest on overdue payments but denied a special award under s. 10 of Reg. 664.