Ulana Pahuta

The applicant sought statutory accident benefits for optometric services, an eye assessment, and speech language pathology following a 2019 motor vehicle accident.

The respondent denied the treatment plans, arguing the applicant had not proven they were reasonable and necessary.

The Tribunal found that the applicant failed to provide sufficient medical evidence to support the ongoing need for the proposed treatments years after the accident, noting her high level of functioning and lack of recent complaints in clinical records.

The application was dismissed.

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

The respondent denied several treatment plans for physiotherapy and a psychological assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG because the respondent's denial notices were procedurally non-compliant under s. 38(8) of the Schedule.

The Tribunal found the denial notices were compliant, clearly identifying the missing medical evidence required.

As the applicant provided no substantive medical evidence to prove her injuries fell outside the MIG, and the $3,500 limit was exhausted, the application was dismissed.

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

The respondent insurer raised a preliminary issue, arguing the applicant was barred from proceeding because she failed to notify the insurer within seven days of the accident, as required by section 32(1) of the Schedule.

The Tribunal found that the applicant's husband had reported the accident to the insurer's property damage line on the day it occurred.

Following recent Divisional Court binding authority, the Tribunal held that reporting the accident itself constitutes sufficient notice under section 32(1), triggering the insurer's obligation to inquire about injuries and provide benefit application forms.

The applicant was therefore not barred from proceeding.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident.

The Tribunal found that the applicant's lower extremity neurological symptoms were related to a pre-existing condition and not caused by the accident.

However, the Tribunal concluded that the applicant's accident-related psychological impairments and pain in his head, neck, and shoulders resulted in a complete inability to carry on a normal life, entitling him to non-earner benefits.

Claims for attendant care benefits and various treatment plans were dismissed due to insufficient evidence that the expenses were incurred or reasonable and necessary.

The respondent insurer requested a reconsideration of a Tribunal decision that barred the applicant from proceeding with his application due to his failure to attend a properly scheduled s. 44 insurer's examination.

The respondent argued the Tribunal erred by failing to also address whether the applicant was barred for failing to dispute the denial of benefits within the two-year limitation period.

The Tribunal dismissed the request, finding that because the application was already barred under s. 55, the limitation period issue was moot and there was no error in declining to rule on it.

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

The Licence Appeal Tribunal found the applicant was barred from receiving income replacement benefits because she was driving with a suspended licence at the time of the accident, which constitutes driving without a valid licence under s. 31(1)(a)(ii) of the Schedule.

Consequently, the insurer was entitled to repayment of $9,483.76 in previously paid benefits.

The Tribunal also dismissed the applicant's claims for various medical and rehabilitation benefits, finding she failed to prove the proposed treatments were reasonable and necessary.

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

The respondent denied a $3,416.79 treatment plan for physiotherapy and a $255.00 claim for medical expenses.

The Tribunal first granted an anonymization order to protect the minor's identity.

On the preliminary issue, the Tribunal found the applicant was not statute-barred from proceeding, as he subsequently attended the rescheduled insurer's examination.

On the merits, the Tribunal found the treatment plan was not reasonable and necessary, noting a lack of recent medical evidence supporting ongoing physical therapy three years post-accident.

The claim for medical expenses was also dismissed as the respondent had not agreed they were essential.

Claims for interest and an award were consequently dismissed.

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

The respondent raised a preliminary issue that the applicant failed to attend multiple scheduled section 44 insurer's examinations.

The Tribunal found that the respondent properly scheduled the examinations and that the applicant failed to attend without a reasonable explanation.

Consequently, the applicant was statute-barred from proceeding with her application under section 55(1)2 of the Schedule, and the application was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found he was not an 'insured person' under section 3(1) of the Statutory Accident Benefits Schedule.

The applicant argued the Tribunal erred in law and exceeded its jurisdiction by encroaching on the exclusive jurisdiction of arbitrators to resolve priority disputes under O. Reg. 283/95.

The adjudicator dismissed the request, finding that determining entitlement to benefits, including the threshold definition of an 'insured person', falls squarely within the Tribunal's jurisdiction under section 280(1) of the Insurance Act.

The adjudicator also rejected the applicant's new arguments that the Motor Vehicle Accident Claims Fund is an 'insurer' for the purposes of section 3(1), concluding no error of law was made.

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, a pre-existing condition, and psychological impairment.

The Licence Appeal Tribunal found that the applicant's injuries fell within the MIG, as the medical evidence did not establish chronic pain with functional impairment, a significant aggravation of her pre-existing back pain, or a psychological impairment.

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.

The respondent's request for costs based on the applicant's prior withdrawal of a similar application was denied, as both parties had engaged in similar procedural behaviour and no bad faith was established.

The applicant requested a reconsideration of a previous Tribunal decision which found that his injuries did not remove him from the Minor Injury Guideline (MIG) and denied his claims for treatment plans and interest.

The applicant argued that the Tribunal breached procedural fairness by excluding a psychological assessment report and erred in law and fact in its interpretation of the MIG, the Schedule, and the evidence regarding his psychological impairments and chronic pain.

The Tribunal dismissed the request, finding that the applicant was attempting to re-litigate his position and raise new arguments not presented at the initial hearing, and that he failed to establish any errors of law or fact or a breach of procedural fairness.

The applicant sought $14,750.81 for a catastrophic impairment assessment following a 2019 motor vehicle accident.

The respondent denied the treatment plan and argued that the issue of the applicant's chronic pain was res judicata based on a prior Tribunal decision.

The Tribunal found that res judicata did not apply as the issues were different and the prior decision did not address the cost of a catastrophic assessment.

The Tribunal partially approved the treatment plan, finding the physiatry, psychological, and occupational therapy assessments reasonable and necessary, but denied the costs for clinic file reviews, transportation, and interpretation.

The applicant was awarded $8,400.00 plus interest, but the claim for a special award under s. 10 of Regulation 664 was dismissed.

The applicant sought statutory accident benefits following an alleged motor vehicle accident where she claimed to be struck as a pedestrian.

The respondent denied benefits and sought repayment, arguing the applicant materially misrepresented being involved in an accident due to inconsistent statements and a complex medical history.

The Tribunal found the applicant was involved in an accident and provided reasonable explanations for minor inconsistencies, dismissing the respondent's claim for repayment.

However, the Tribunal held that the applicant's substantive claims for benefits were statute-barred under s. 56 of the Schedule, as she failed to dispute the denials within the two-year limitation period and did not provide evidence to justify an extension under s. 7 of the LAT Act.

The application was dismissed.

The applicant requested a reconsideration of a Tribunal decision that found his injuries fell within the Minor Injury Guideline and denied several treatment plans.

The applicant argued the Tribunal erred by relying on the respondent's psychological assessment, which referenced outdated DSM-IV criteria, and by finding the respondent's denial notice compliant with section 38(8) of the Schedule.

The Tribunal dismissed the request, finding no error of law or fact, as both parties' assessors referenced DSM-IV criteria and the denial notice provided detailed medical reasons.

The respondent insurer requested a reconsideration of a LAT decision that awarded the applicant income replacement benefits (IRBs) and approved treatment plans for a functional abilities examination, chronic pain assessment, and psychological services.

The respondent argued the adjudicator erred in law and fact, including failing to address causation for the applicant's physical impairments.

The adjudicator granted the reconsideration in part, acknowledging the failure to address physical causation in the original decision.

However, upon reviewing the medical evidence, the adjudicator found the accident was a necessary cause of the applicant's ongoing neck pain.

The original decision was confirmed in its entirety, and the remaining grounds for reconsideration were 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 applicant sought removal from the MIG on the basis of psychological impairment, chronic pain, and pre-existing conditions.

The Tribunal found the applicant failed to establish a psychological impairment, preferring the respondent's psychological assessment over the applicant's pre-screening report.

The Tribunal also found insufficient evidence of accident-related chronic pain or that pre-existing conditions prevented recovery within the MIG.

The application for disputed treatment plans and interest was dismissed.

The applicant was struck by a vehicle as a pedestrian and sought statutory accident benefits, including non-earner benefits, attendant care benefits, and various treatment plans.

The respondent denied the benefits, arguing that the applicant's cognitive impairments were due to a recent multiple sclerosis diagnosis rather than the accident.

The Tribunal found that the accident was a necessary cause of the applicant's concussion and related impairments.

The Tribunal awarded non-earner benefits, finding the applicant was practically prevented from engaging in her pre-accident activities, including her university studies.

The Tribunal also found the applicant required $83.00 per month in attendant care services, but held they were not payable as they had not been incurred.

Several treatment plans were approved, some due to the respondent's failure to provide clear reasons for denial under s. 38(8) of the Schedule.

The claim for an award under Regulation 664 was dismissed.

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

The respondent denied the benefits, arguing the applicant failed to submit an application (OCF-1) within the prescribed time and that her injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant was not statute-barred, as she provided a reasonable explanation for the delay in submitting her OCF-1.

However, the Tribunal concluded that the applicant failed to prove her injuries warranted removal from the MIG, as the medical evidence did not establish that her mild degenerative changes were caused by the accident or precluded recovery within the MIG limits.

The application for disputed treatment plans was dismissed.

The applicant's estate sought statutory accident benefits following a 2018 motor vehicle accident, including a catastrophic impairment designation and chiropractic treatment plans.

The Licence Appeal Tribunal found it lacked jurisdiction to adjudicate the catastrophic impairment claim and a $20,000 treatment plan because the required OCF-19 and OCF-18 forms were never submitted to the insurer.

The Tribunal also dismissed the claim for a $2,825 chiropractic treatment plan, finding the applicant failed to provide medical evidence proving the treatment was reasonable and necessary.

Claims for interest and a special award were consequently dismissed.

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

The Tribunal found that the applicant's chronic pain and functional restrictions warranted removal from the Minor Injury Guideline.

The applicant was awarded income replacement benefits for the period she was unable to perform the essential tasks of her employment as a pharmacy assistant.

The Tribunal also approved several treatment plans for physiotherapy and assessments, noting the insurer's failure to provide compliant medical reasons for denying the assessments.

Claims for attendant care benefits and a special award were dismissed.