Ulana Pahuta

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

The respondent raised a preliminary issue, arguing the applicant was barred from proceeding to a hearing because she failed to attend scheduled insurer's examinations.

The Tribunal found the respondent's notices for two treatment plans complied with the Schedule, barring the applicant from proceeding with those claims.

However, the notices for a third treatment plan and non-earner benefits were non-compliant, allowing the applicant to proceed to a substantive hearing on those issues.

The applicant sought non-earner benefits following a motor vehicle accident, which the respondent insurer denied.

The applicant applied to the Licence Appeal Tribunal more than two years after the denial.

The Tribunal found that the respondent's denial letters were clear and unequivocal, satisfying the requirements to trigger the two-year limitation period under section 56 of the Schedule.

The Tribunal declined to extend the limitation period under section 7 of the Licence Appeal Tribunal Act, finding no bona fide intention to appeal, prejudice to the respondent, and weak merits of the claim.

The application was dismissed as statute-barred.

The respondent insurer requested a reconsideration of a Tribunal decision that found the applicant entitled to non-earner benefits.

The insurer argued the Tribunal erred in law and fact regarding the quantum of benefits, the lack of direct evidence, and the cause of the applicant's inability, and that it breached procedural fairness by relying on arguments not advanced by the parties.

The Tribunal dismissed the request, finding no material breach of procedural fairness and no error of law or fact that would have led to a different result.

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

The respondent denied benefits because the applicant failed to submit his OCF-1 application within 30 days of receiving the forms, as required by section 32(5) of the Schedule.

The applicant submitted the forms approximately 10 months late and argued he had a reasonable explanation because he was a newcomer to Canada unaware of his rights and believed his injuries would resolve.

The Tribunal found that ignorance of the law and a belief that injuries will resolve do not constitute a reasonable explanation under section 34.

The application was dismissed as statute-barred.

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

The respondent denied the claim on the basis that the applicant was entitled to income replacement benefits instead.

The applicant disputed the denial more than four years after the two-year limitation period expired.

The Tribunal found the respondent's denial was clear, unequivocal, and valid, triggering the limitation period.

The Tribunal declined to extend the limitation period under section 7 of the Licence Appeal Tribunal Act, finding no bona fide intention to appeal, substantial delay, and prejudice to the respondent.

The application was dismissed as statute-barred.

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

The insurer denied the claim for non-earner benefits on the basis that the applicant had returned to work.

The applicant filed an application with the Tribunal six years after the initial denial, well beyond the two-year limitation period under s. 56 of the Schedule.

The Tribunal found that the insurer's denial notices were valid and triggered the limitation period.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act, noting the substantial delay, lack of evidence regarding a bona fide intention to appeal, and prejudice to the insurer.

The application was dismissed.

The applicant requested a reconsideration of a previous Tribunal decision that denied entitlement to a physiotherapy treatment plan (OCF-18), medical expenses, interest, and an award.

The applicant argued the Tribunal erred in law by finding the respondent's denial notices complied with section 38 of the Statutory Accident Benefits Schedule.

The Tribunal dismissed the request, finding no error of law, as the denial notices sufficiently identified the denied services and provided adequate reasons.

The Tribunal noted the reconsideration process is not an opportunity to re-litigate disagreements with the original decision.

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

The respondent denied the benefits and raised a preliminary issue that the applicant was barred from proceeding because she failed to dispute the denial within the two-year limitation period under s. 56 of the Schedule.

The applicant argued the limitation period had not started because the respondent failed to provide a valid notice of denial or request an election of benefits.

The Tribunal found the respondent's denial notices were clear, unequivocal, and compliant with the Schedule.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act, finding no bona fide intention to appeal within the time limit, a substantial delay, and prejudice to the respondent.

The application was dismissed.

The respondent insurer raised a preliminary issue that the applicant was barred from proceeding with her application for statutory accident benefits because she failed to dispute the denial of benefits within the two-year limitation period under s. 56 of the Schedule.

The applicant argued the denial notices were invalid because the insurer failed to request an election of benefits.

The Tribunal found the denial notices were clear and unequivocal, triggering the limitation period.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act, finding a substantial delay of 24 months, prejudice to the insurer, and no evidence of a bona fide intention to appeal within the time limit.

The application was dismissed.

The applicant was injured when the pickup truck he was repairing fell on him.

He sought statutory accident benefits, which the respondent insurer denied on the basis that the incident was not an 'accident' under s. 3(1) of the Schedule.

The Tribunal applied the two-part purpose and causation test, finding that repairing a vehicle is an ordinary and well-known activity to which automobiles are put, and that the repair was the dominant feature that directly caused the injuries.

The Tribunal concluded the incident met the definition of an accident.

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

The insurer argued the applicant was statute-barred from proceeding with her claim because she failed to submit her application for benefits (OCF-1) within 30 days, as required by s. 32(5) of the Schedule.

The Tribunal found that the insurer failed to comply with its obligation to provide the forms under s. 32(2) because it sent them via email without the applicant's consent, contrary to s. 64(2)(e).

Furthermore, the Tribunal held that the applicant had a reasonable explanation for the delay due to her post-concussion syndrome, difficulties with screens, and the insurer's communications suggesting a late submission was acceptable.

The applicant was permitted to proceed with her claim.

The insurer requested a reconsideration of a previous Licence Appeal Tribunal decision that found the claimant partially entitled to a treatment plan for catastrophic (CAT) assessments, specifically physiatry, occupational therapy, and psychological assessments, along with an overall summary.

The insurer argued that the adjudicator erred in law by not applying the doctrine of res judicata to the physiatry and occupational therapy assessments, given a prior Tribunal finding that the claimant's chronic pain and physical impairments were not caused by the accident.

The adjudicator agreed that an error of law was made in the application of issue estoppel, as the prior findings were material facts that could not be relitigated.

The adjudicator granted the reconsideration, varied the previous decision, and found that the claimant was not entitled to the physiatry and occupational therapy assessments or the overall summary analysis.

The applicant was injured in a motor vehicle accident while working and initially received WSIB benefits.

He subsequently opted out of WSIB to claim statutory accident benefits and later commenced a tort action.

The insurer argued the applicant was barred under s. 61 of the Schedule because his election was made primarily to claim accident benefits.

The Tribunal agreed, finding insufficient evidence of a bona fide intention to pursue a tort claim at the time of the election.

The application for accident benefits was dismissed as statute-barred.

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

The respondent raised a preliminary issue arguing the applicant was barred from proceeding to a hearing because he failed to attend scheduled insurer's examinations (IEs) under s. 44 of the Schedule.

The Tribunal found the respondent's notices of examination were compliant and the requested IEs were reasonably necessary.

Consequently, the applicant was statute-barred from proceeding with four specific treatment plans.

However, the Tribunal exercised its discretion under s. 55(2) to allow the applicant to proceed with the remaining substantive issues, including attendant care benefits and occupational therapy, because the respondent failed to prove it had provided denial notices for those benefits prior to requesting the IEs.

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

The insurer partially denied an OCF-18 for catastrophic assessments and issued an Explanation of Benefits.

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

At a preliminary issue hearing, the applicant argued the limitation period was not triggered because the denial notice did not detail the entire dispute resolution process up to the Supreme Court of Canada or address discoverability.

The Tribunal rejected this argument, finding the denial notice was compliant with section 54 of the Schedule and the principles in Smith v. Co-operators, as it provided sufficient information for the applicant to decide whether to dispute the refusal.

As the applicant provided no submissions for an extension under section 7 of the LAT Act, the application was dismissed as statute-barred.

The applicant was injured in a motor vehicle accident while working as a truck driver.

He applied for statutory accident benefits from the respondent insurer.

The respondent argued the applicant was barred under s. 61 of the Schedule because he was entitled to benefits under an alternative workers' compensation plan provided by NAL Insurance through his employment contract.

The Tribunal found that the NAL policy constituted a workers' compensation plan under s. 61(1) and that the applicant had received benefits under it.

The Tribunal further held that the s. 61(2) exception did not apply because the applicant did not make an election under the Workplace Safety and Insurance Act.

The application was dismissed as statute-barred.

The applicant sought Income Replacement Benefits (IRBs) following a motor vehicle accident.

The respondent insurer terminated the IRBs in October 2021 and raised a preliminary issue that the applicant was barred from proceeding to a hearing because she failed to dispute the denial within the two-year limitation period.

The applicant argued she did not receive the denial letter and that the discoverability principle delayed the limitation period until she was deemed catastrophically impaired.

The Tribunal found the denial letter was received, the discoverability principle did not apply, and the applicant failed to meet the test for extending the limitation period under section 7 of the LAT Act.

The applicant was barred from proceeding with the IRB claim.

The applicant sought a catastrophic impairment determination at the Licence Appeal Tribunal following a 2010 motor vehicle accident.

The respondent raised a preliminary issue, arguing the parties had entered into a valid full and final settlement in 2013 for $90,000, and that the applicant was prohibited from applying to the Tribunal because he had not returned the settlement funds as required by section 9.1(8) of Regulation 664.

The applicant argued the settlement was invalid due to technical defects in the Settlement Disclosure Notice.

The Tribunal found that the requirement to return settlement funds under section 9.1(8) is mandatory before the Tribunal can adjudicate the validity of a settlement.

As the applicant had not returned the funds, the application was dismissed for lack of jurisdiction.

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

The respondent denied various treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant failed to provide written submissions.

The Tribunal reviewed the medical evidence and found that the applicant sustained only soft tissue injuries, contusions, and abrasions.

The Tribunal held that the applicant failed to establish a pre-existing condition, psychological impairment, or chronic pain with functional impairment sufficient to warrant removal from the MIG.

The application 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 the applicant failed to provide medical evidence to establish his injuries warranted removal from the MIG.

The Tribunal also rejected the applicant's argument that the treatment plans were payable due to non-compliant denial notices, finding the respondent's notices complied with the Schedule.

The application was dismissed.