Ulana Pahuta

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 (MIG).

The applicant claimed entitlement to income replacement benefits, various treatment plans, and an award for unreasonable delay.

The Tribunal found that the applicant failed to establish chronic pain or psychological impairments warranting removal from the MIG.

Furthermore, the applicant did not prove a substantial inability to perform the essential tasks of her employment to qualify for income replacement benefits.

The application was dismissed in its entirety.

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

The respondent denied a treatment plan for a psychological assessment, arguing 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 the applicant failed to provide sufficient medical evidence to establish either a psychological impairment or a chronic pain condition meeting the AMA Guides criteria.

The Tribunal concluded the applicant's injuries were predominantly minor, dismissed the claim for the treatment plan, and denied the request for an award and interest.

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

The Tribunal first held that the applicant was statute-barred from disputing the denial of 14 treatment plans because he failed to apply within the two-year limitation period and did not establish grounds for an extension under s. 7 of the LAT Act.

On the substantive issues, the Tribunal found the applicant did not sustain a catastrophic impairment under Criterion 7 (falling short of the 55% whole person impairment threshold) or Criterion 8 (failing to establish marked impairments in three spheres of functioning).

The Tribunal also dismissed the claims for the remaining treatment plans, finding the applicant failed to meet his evidentiary onus to prove they were reasonable and necessary.

Claims for interest and an award were consequently dismissed.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including treatment plans for physiotherapy, psychological services, and several medical assessments.

The Licence Appeal Tribunal found the applicant was entitled to six physiotherapy treatment plans, a chronic pain assessment, and a neurological assessment, noting ongoing pain and post-concussive symptoms supported by the medical record.

Claims for a neuropsychological assessment, an MRI, transportation expenses, and an award under s. 10 of Reg. 664 were dismissed for lack of supporting evidence.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits, assistive devices, and occupational therapy services.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to prove the need for attendant care benefits and assistive devices arose from the accident, noting her extensive pre-existing medical conditions and lack of corroborating medical evidence.

The Tribunal partially allowed the claim for occupational therapy services in the amount of $948.14 to assist the applicant in re-engaging with daily tasks, plus interest.

The applicant sought statutory accident benefits for chiropractic, physiotherapy, and a psychological assessment following a motor vehicle accident.

The respondent denied the benefits.

The Tribunal found the chiropractic and physiotherapy treatment plans were reasonable and necessary to address the applicant's ongoing accident-related pain, supported by clinical notes and records.

However, the Tribunal dismissed the claim for a psychological assessment, finding insufficient medical evidence of an accident-related psychological impairment.

The applicant was awarded the physical treatment plans plus interest.

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

The applicant also claimed income replacement benefits (IRBs) and approval for several treatment plans.

The Tribunal found that the applicant failed to provide sufficient medical evidence to prove her injuries warranted removal from the MIG.

Furthermore, the applicant was not entitled to IRBs because she failed to submit a completed disability certificate (OCF-3) prior to her return to work and did not provide evidence regarding her inability to perform the essential tasks of her employment.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing her injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain and psychological impairments.

The Licence Appeal Tribunal found the applicant failed to meet her evidentiary burden, noting her medical records primarily showed soft-tissue injuries and lacked evidence of accident-related chronic pain or psychological conditions.

The Tribunal concluded the applicant's injuries were predominantly minor, dismissing her claims for treatment plans beyond the MIG limit, interest, and an award for unreasonable delay.

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

The respondent suspended income replacement benefits after the applicant failed to provide requested financial and tax documents.

The Tribunal found that the requested documents were reasonably required under s. 33(1) of the Schedule to verify pre- and post-accident income, and upheld the suspension of benefits.

The Tribunal also approved treatment plans for physiotherapy and partial payment for physiatry and neurological assessments, finding them reasonable and necessary based on the applicant's ongoing chronic pain and concussion symptoms.

The applicant's claim for a special award was dismissed as the respondent's conduct was not unreasonable.

The applicant, who sustained catastrophic impairments after being struck by a vehicle as a pedestrian, sought statutory accident benefits for alternative housing in Canada and flights from Romania to Toronto.

The applicant had moved to Romania with her parents post-accident but wished to return to Canada for rehabilitation.

The Licence Appeal Tribunal dismissed the claims, finding the applicant failed to substantiate the cost of the requested two-bedroom apartment compared to her pre-accident accommodations, and failed to establish that the flights were essential for her rehabilitation under the Statutory Accident Benefits Schedule.

Claims for an award and interest were also dismissed.

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 for removal from the MIG due to psychological impairments and chronic pain.

The Tribunal found that the applicant failed to provide sufficient medical evidence, such as a diagnosis from a treating physician or evidence satisfying the AMA Guides criteria for chronic pain, to warrant removal from the MIG.

Consequently, the disputed treatment plans, interest, and a claim for an award were dismissed.

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

The respondent argued the applicant was barred from proceeding because she failed to submit her application for benefits (OCF-1) within 30 days of receiving the forms, as required by section 32(5) of the Schedule.

The Tribunal found that while the application was submitted late, the applicant had a reasonable explanation for the delay under section 34, citing her post-accident concussion symptoms, chronic pain, and significant stress related to a potential eviction.

The Tribunal concluded the hardship to the applicant outweighed any prejudice to the respondent, allowing the application to proceed.

The applicant was injured in a bicycle accident in April 2023 but did not submit an Application for Accident Benefits (OCF-1) to the respondent insurer until January 2025.

The respondent argued the applicant was barred from proceeding due to the delay.

The Tribunal found that the applicant failed to comply with the seven-day notice requirement under section 32 of the Schedule and did not provide a reasonable explanation for the delay.

Ignorance of the law and a subjective belief that injuries would resolve through OHIP care were not accepted as reasonable explanations.

The application was dismissed as statute-barred.

The applicant was injured in a motor vehicle accident while in the course of his employment.

He applied for statutory accident benefits but was denied by the respondent insurer, who argued he was barred under s. 61 of the Schedule because he was entitled to WSIB benefits and his election to opt out of WSIB was made primarily to claim accident benefits, not to pursue a tort claim.

The Licence Appeal Tribunal found that the applicant failed to establish a bona fide intention to commence a tort action at the time of his election, noting the significant delay in issuing a Statement of Claim and the lack of evidence regarding steps taken to pursue the tort claim.

Consequently, the applicant was found to be statute-barred from proceeding with his accident benefits application, and the application was dismissed.

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

The respondent insurer argued the applicant was barred from proceeding because she failed to submit her application for benefits (OCF-1) within the 30-day time limit prescribed by section 32(5) of the Schedule.

The Tribunal found that while the application was submitted late, the applicant had a reasonable explanation for the delay under section 34, citing her post-accident concussion symptoms, chronic pain, and significant stress related to a potential eviction.

The Tribunal concluded the hardship to the applicant outweighed any prejudice to the respondent, allowing the claim to proceed.

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

The insurer denied the benefits, and the applicant applied to the Licence Appeal Tribunal outside the two-year limitation period under s. 56 of the Schedule.

The Tribunal considered whether to extend the limitation period under s. 7 of the LAT Act using the Manuel factors.

Finding no bona fide intention to appeal within the limitation period and no medical evidence to support the merits of the claim, the Tribunal declined to extend the limitation period and dismissed the application as statute-barred.

The applicant requested reconsideration of a preliminary issue decision which found him statute-barred from proceeding with his application for accident benefits under s. 61 of the Schedule.

The applicant argued the Tribunal made errors of fact regarding the NAL policy, errors of law in failing to consider cited caselaw, and breached procedural fairness by providing insufficient reasons regarding an affidavit.

The Tribunal dismissed the request, finding no errors of fact or law, and concluding that the original decision provided sufficient reasons and met the threshold for procedural fairness.

The applicant sought statutory accident benefits following an incident where he tripped while exiting an Uber.

The respondent insurer denied the claim, arguing the applicant was barred from proceeding because he failed to notify them within seven days of the accident, as required by section 32(1) of the Schedule.

The Tribunal found that while the applicant missed the seven-day deadline by notifying the insurer 45 days later, he had a reasonable explanation under section 34.

The applicant was initially uncertain if the incident qualified as an accident and had mistakenly notified a different insurer first.

Given the short delay and lack of prejudice to the insurer, the Tribunal allowed the application to proceed.

The applicant requested a reconsideration of a preliminary issue decision which dismissed his application for lack of jurisdiction because he had not returned $90,000 in settlement funds as required by s. 9.1(8) of Regulation 664.

The applicant argued the adjudicator erred in law by not first determining if the settlement was valid and breached procedural fairness by not ruling on a motion to strike reply submissions.

The Tribunal dismissed the reconsideration request, finding no error of law or breach of procedural fairness, as the return of settlement funds is a mandatory precondition to disputing a settlement's validity.

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

The respondent insurer denied benefits, arguing the applicant failed to notify it of the accident within seven days as required by s. 32(1) of the Schedule, and failed to submit the application within 30 days under s. 32(5).

The Tribunal found that the applicant had informed the insurer of the accident and property damage within seven days, which, following binding Divisional Court authority, was sufficient notice of an intention to seek benefits.

The insurer failed to prove it provided the required application forms, so the 30-day limit under s. 32(5) was not triggered.

The applicant was permitted to proceed to a substantive hearing.