Ulana Pahuta

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 claimed entitlement to a $2,200 psychological treatment plan, arguing he suffered from accident-related psychological impairments.

The Tribunal found the applicant failed to meet his burden of proving his injuries warranted removal from the MIG, relying on the respondent's psychological assessment which found no impairment.

The Tribunal also rejected the applicant's procedural argument that the respondent's denial notice was non-compliant.

The application was dismissed.

The applicant, who was catastrophically impaired in a motor vehicle accident, sought payment for outstanding balances on five treatment plans (OCF-18s) that were partially denied by the respondent insurer.

The Tribunal found the applicant was entitled to the full $200 form completion fees for case management, occupational therapy, and social work plans, as well as the outstanding balance for laser therapy and acupuncture due to the respondent's failure to provide proper medical reasons for denial under s. 38(8) of the Schedule.

However, the Tribunal dismissed the claims for transportation costs and additional social work session time, finding the applicant failed to meet his burden of proof.

The applicant's request for a special award under s. 10 of Regulation 664 was also dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The respondent denied various benefits, including non-earner benefits and several treatment plans, and raised a preliminary issue that the applicant was barred from proceeding due to non-attendance at an insurer's examination.

The Tribunal found the applicant was not statute-barred because the missed examination had been rescheduled.

On the merits, the Tribunal awarded non-earner benefits for a closed period, finding the applicant's pain practically prevented her from engaging in her nursing studies and pre-accident activities until she successfully resumed a full course load.

The Tribunal also partially approved several treatment plans for physiotherapy, chiropractic, massage, and occupational therapy assessments, while denying others for lack of evidence.

Interest was awarded on overdue payments, but the claim for a special award was dismissed.

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

The Tribunal found that the applicant failed to establish a psychological impairment warranting removal from the Minor Injury Guideline, as the medical evidence showed only intermittent symptoms without a formal diagnosis or ongoing treatment.

The applicant also failed to prove a substantive inability to perform the essential tasks of her employment to qualify for income replacement benefits.

However, because the insurer delayed issuing a denial after the applicant complied with section 33 requests, income replacement benefits were payable for a four-month period due to procedural non-compliance.

Claims for disputed treatment plans and an award were dismissed.

The applicant, a pedestrian struck by a motor vehicle, sought a catastrophic impairment designation under Criterion 4 of the Statutory Accident Benefits Schedule for a traumatic brain injury.

The applicant relied on a GOS-E rating of Severe Disability provided by the respondent's occupational therapist.

The Tribunal found that under section 45(2) of the Schedule, a GOS-E assessment must be conducted by a physician or neuropsychologist.

Because the applicant did not provide a qualifying medical opinion to support the occupational therapist's findings, and the respondent's neurologist found a 'good recovery', the applicant failed to meet his onus.

The application was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her entitlement to income replacement benefits and found her claim remained within the Minor Injury Guideline.

The applicant argued the Tribunal made errors of law regarding the interpretation of the Statutory Accident Benefits Schedule and the evidentiary value of an OCF-3.

The adjudicator dismissed the request, finding no errors of law and noting that the applicant was improperly attempting to re-litigate issues already decided.

The respondent's request for costs was also denied, as seeking reconsideration is a procedural right and not vexatious conduct.

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

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

The Tribunal found that the applicant sustained a head injury, removing him from the MIG.

The Tribunal further held that several treatment plans were payable because the respondent failed to provide compliant denial notices under s. 38(8) of the Schedule, and others were substantively reasonable and necessary.

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

The applicant requested a reconsideration of a previous Tribunal decision which found that her accident-related impairments did not warrant removal from the Minor Injury Guideline (MIG).

The applicant argued that the Tribunal erred in law or fact by failing to find that her pre-existing sciatica and thoracolumbar scoliosis were aggravated by the accident and prevented her recovery within the MIG.

The Tribunal dismissed the request, finding that the applicant was attempting to re-litigate arguments already addressed in the initial hearing and failed to establish any error of law or fact that would have led to a different result.

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

The respondent insurer denied certain benefits and argued at a preliminary issue hearing that the applicant was barred from claiming accident benefits under s. 61 of the Schedule because the accident occurred in the course of his employment, entitling him to WSIB benefits.

The Tribunal found that the respondent failed to meet its burden of proving the accident occurred in the course of employment, as the applicant's sworn testimony indicated he was returning from a social visit.

The Tribunal held the applicant was not statute-barred and could proceed with his application.

The applicant sought non-earner benefits and an award under Regulation 664 following a motor vehicle accident.

The Tribunal found that the respondent insurer failed to provide compliant notices under section 36(4) of the Statutory Accident Benefits Schedule, as its denial letters either failed to make a determination on entitlement or failed to provide medical reasons.

Consequently, under section 36(6), the applicant was entitled to non-earner benefits from the date the disability certificate was submitted until the 104-week mark, plus interest.

The claim for a special award was dismissed as the applicant did not establish substantive entitlement or unreasonable delay.

The applicant sought statutory accident benefits following a motor vehicle accident and disputed the denial of income replacement benefits.

The respondent raised a preliminary issue that the applicant was barred from proceeding because he failed to attend a scheduled psychological insurer's examination under s. 44 of the Schedule.

The Tribunal found that the requested examination was reasonably necessary given a new psychological diagnosis by another assessor, and that the applicant did not have a reasonable explanation for non-attendance.

Consequently, the applicant is barred from proceeding with his application under s. 55 of the Schedule.

The applicant sought accident benefits for a physiotherapy treatment plan following a motor vehicle accident.

The respondent denied the treatment plan, and the applicant argued the denial notice was non-compliant with s. 38(8) of the Schedule because it was late and lacked sufficient medical reasons.

The Tribunal found that while the notice was one day late, it provided sufficient medical reasons.

Applying the Divisional Court's decision in Catic, the Tribunal held the treatment plan was not payable under s. 38(11) because the expenses were not incurred during the one-day period of non-compliance.

The application was dismissed.

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

The respondent insurer denied the claim on the basis that the applicant's policy had lapsed prior to the accident.

The Licence Appeal Tribunal found that the applicant was not an 'insured person' under section 3(1) of the Schedule because no active automobile insurance policy was in place at the time of the accident.

The Tribunal also held that the respondent was not required to accept the application pending a priority dispute under O. Reg. 283/95, as the applicant was not entitled to benefits.

The application was dismissed.

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

The respondent denied several treatment plans for physiotherapy 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 argued that the MIG no longer applied because the treatment plans were submitted outside the 12-week timeframe, and alternatively, that he should be removed from the MIG due to chronic pain and psychological impairments.

The Tribunal found that the applicant failed to establish accident-related impairments warranting removal from the MIG.

The Tribunal also rejected the applicant's argument that the respondent's initial non-compliant notices rendered the treatment plans payable, as the respondent subsequently provided a compliant notice and no services were incurred during the period of non-compliance.

The application was dismissed.

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

The Tribunal found the applicant failed to establish impairments outside the MIG, as his self-reports were not corroborated by his family physician's clinical notes and records.

However, the Tribunal ordered the respondent to pay the outstanding balance of one treatment plan due to its failure to provide a compliant notice under s. 38(8) of the Schedule.

The claims for other treatment plans and an award were dismissed.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident.

The Licence Appeal Tribunal found the applicant was entitled to a $1,796.00 treatment plan for physiotherapy services, less any amounts available under his parents' collateral benefits coverage, as the medical evidence supported an ongoing need for treatment of chronic back pain.

However, the Tribunal dismissed the claims for occupational therapy services, finding insufficient evidence of accident-related cognitive or learning challenges.

The Tribunal also dismissed a claim for physiotherapy expenses incurred prior to the submission of a treatment plan, and denied the applicant's request for a special award under s. 10 of Regulation 664.

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

The applicant claimed entitlement to income replacement benefits (IRBs) and various treatment plans, arguing that chronic pain and psychological impairments warranted removal from the MIG.

The Tribunal found that the applicant failed to establish chronic pain or psychological impairments sufficient to remove him from the MIG, relying on the clinical notes of his treating physician and the respondent's section 44 assessments.

The Tribunal also dismissed the claim for IRBs, finding insufficient evidence that the applicant suffered a substantial inability to perform the essential tasks of his employment.

The application was dismissed.

The applicant sought non-earner benefits and a determination that his injuries fell outside the Minor Injury Guideline (MIG) following a 2019 motor vehicle accident.

The Tribunal found it lacked jurisdiction to determine MIG status as a standalone issue without an underlying dispute over medical or rehabilitation benefits.

On the substantive claim, the Tribunal dismissed the application for non-earner benefits, finding the applicant failed to provide sufficient evidence comparing his pre- and post-accident activities or objective medical evidence demonstrating a complete inability to carry on a normal life.

The Tribunal also rejected the applicant's argument that the insurer failed to comply with procedural notice requirements under s. 36(4) of the Schedule, noting the applicant failed to provide requested medical documentation.

Claims for interest and an award were consequently dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including removal from the Minor Injury Guideline (MIG), non-earner benefits, and funding for physiotherapy and a psychological assessment.

The Licence Appeal Tribunal found that the applicant failed to provide sufficient medical evidence to establish chronic pain or a psychological impairment warranting removal from the MIG.

As the $3,500 MIG limit was exhausted, the treatment plans were denied.

The Tribunal also dismissed the claim for non-earner benefits, finding the applicant failed to demonstrate a complete inability to carry on a normal life, and denied the request for a section 10 award.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident that occurred while he was being transported in a correctional vehicle.

He claimed entitlement to two neuropsychological assessments and physiotherapy services, as well as an award for unreasonable delay.

The Tribunal found the applicant was entitled to partial payment of $2,200 for the initial neuropsychological assessment, as there was a reasonable possibility of cognitive impairment stemming from accident-related chronic pain.

However, the Tribunal dismissed the claims for the subsequent neuropsychological assessment and physiotherapy services due to insufficient evidence of reasonableness and necessity.

The claim for a special award was also dismissed.