Ulana Pahuta

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.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the denial of treatment plans for physiotherapy, psychotherapy, and multiple assessments.

The Tribunal found that the applicant failed to prove the physiotherapy and assessments were reasonable and necessary, noting a lack of clinical notes and preferring the respondent's medical assessments.

However, the Tribunal granted the outstanding balance for psychotherapy services, finding the proposed 1.5-hour sessions reasonable as recommended by the assessing psychologist.

Interest was awarded on the overdue psychotherapy benefits.

The applicant sought income replacement benefits and funding for a psychological treatment plan following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove she suffered a substantial inability to perform the essential tasks of her employment as a result of the accident.

The Tribunal preferred the respondent's independent medical examination reports, noting the applicant had stopped working prior to the accident due to stress and reduced hours.

The Tribunal also found the respondent's notices and denials substantially complied with the Statutory Accident Benefits Schedule, and denied the claims for interest and a special award.

The applicant requested a reconsideration of a preliminary issue decision which found that an incident involving a malfunctioning hoist was not an 'accident' under the Statutory Accident Benefits Schedule.

The applicant argued the Tribunal erred in finding the hoist was an intervening act rather than a foreseeable risk.

The Tribunal dismissed the reconsideration request, finding no error of law or fact and noting the applicant was attempting to relitigate the case.

The respondent's request for costs was also dismissed as the applicant's conduct was not unreasonable, frivolous, vexatious, or in bad faith.

The applicant, who was deemed catastrophically impaired following a motor vehicle accident, sought attendant care benefits and moving expenses.

The Licence Appeal Tribunal found the applicant entitled to $1,192.52 per month for attendant care, preferring the evidence of her treating occupational therapist regarding her need for emotional support and cueing.

The Tribunal denied the claim for moving expenses, finding the relocation was necessitated by the applicant's divorce rather than the accident, and thus did not qualify as a reasonable and necessary rehabilitation expense under the Schedule.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) from the respondent insurer.

The respondent stopped IRB payments in August 2022 due to a potential overpayment related to the applicant's receipt of long-term disability benefits.

The parties resolved the quantum of IRBs prior to the hearing.

The Tribunal found that the respondent unreasonably delayed the payment of IRBs by failing to reinstate payments despite having sufficient information and previously agreeing to do so.

The Tribunal ordered the respondent to pay a special award of 20% on the IRB payments withheld between August 2022 and January 2024, plus interest.

The applicant sought non-earner benefits, interest, and an award under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent denied benefits, arguing the applicant's impairments stemmed from a pre-existing condition.

The Tribunal found that the applicant sustained serious psychological and physical impairments as a result of the accident, which continuously prevented her from engaging in substantially all of her pre-accident activities.

The Tribunal ordered the respondent to pay non-earner benefits for the eligible 104-week period and interest, but denied the claim for an award as the respondent's reliance on its assessments was not unreasonable.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident, specifically claiming costs for an attendant care assessment and a physiatry assessment.

The respondent denied the benefits, arguing the applicant's knee issues were pre-existing and not accident-related.

The Tribunal found that while the accident was a necessary cause of the applicant's knee pain, the requested assessments were not reasonable and necessary.

The medical evidence and surveillance did not support ongoing accident-related functional impairments that would justify the assessments years after the accident.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident that resulted in the death of her daughter.

The applicant applied as a dependent under her parents' policy, as she did not own a vehicle.

The respondent denied the claim on the basis that the applicant was not an 'insured person' under the Schedule.

The Tribunal found that the applicant was employed, earning sufficient income to meet most of her financial needs, and was not principally dependent on her parents for financial support at the time of the accident.

The application was dismissed.

The applicant sought statutory accident benefits after slipping and falling on ice while cleaning her vehicle's windows and lights at a gas station.

The respondent insurer denied benefits, arguing the incident did not meet the definition of an 'accident' under s. 3(1) of the Schedule.

The Licence Appeal Tribunal applied the two-part test from Caughy and found that the incident arose out of the ordinary use of a vehicle and that the use of the vehicle was the dominant feature of the incident.

The Tribunal concluded the applicant was involved in an accident and is entitled to proceed with her claim.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and treatment plans for chiropractic and psychological services.

The insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that she did not meet the test for IRBs.

The Tribunal dismissed the application, finding the applicant failed to provide medical evidence to prove substantive entitlement to IRBs or to establish impairments warranting removal from the MIG.

The Tribunal also rejected the applicant's procedural arguments that the insurer's denial notices were non-compliant with the Schedule.

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 establish that his psychological impairments, chronic pain, or physical injuries warranted removal from the MIG.

The applicant also failed to provide submissions or evidence to establish entitlement to an income replacement benefit.

The application was dismissed.

The applicant sought income replacement benefits following a 2017 motor vehicle accident.

The insurer denied the benefits in June 2018 after the applicant returned to work and submitted a disability certificate indicating she did not suffer a substantial inability to perform her employment tasks.

The applicant filed a Tribunal application in September 2023, five years after the denial.

The Tribunal found the insurer's 2018 correspondence was a clear and unequivocal denial that triggered the two-year limitation period under section 56 of the Schedule.

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

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) and that the dispute for certain treatment plans was time-barred.

The Tribunal found the limitation period was not triggered because the respondent's denial notices were procedurally non-compliant.

While the applicant failed to prove her injuries warranted removal from the MIG, the Tribunal awarded two physiotherapy treatment plans and a limited period of non-earner benefits solely due to the respondent's failure to provide compliant notices under the Schedule.

Claims for an award and remaining benefits were dismissed.

The applicant sought statutory accident benefits following a 2019 motor vehicle accident, including non-earner benefits, medical benefits for chiropractic and psychological treatment, and a special award.

The Licence Appeal Tribunal dismissed the application in its entirety.

The adjudicator found the applicant failed to establish a complete inability to carry on a normal life, noting a lack of contemporaneous medical evidence and details regarding pre-accident activities.

The claims for medical benefits and assessments were also dismissed as the applicant failed to prove they were reasonable and necessary, with several claims lacking any supporting submissions or evidence.

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

The Tribunal found the applicant was removed from the Minor Injury Guideline due to a concussion diagnosis supported by medical evidence.

The applicant was awarded several treatment plans, including chiropractic services, psychological assessments, and a post-concussion syndrome workshop, as they were deemed reasonable and necessary.

The Tribunal also found the applicant entitled to pre-104 week income replacement benefits, as he suffered a substantial inability to perform the essential tasks of his employment as a heavy machine operator.

However, claims for post-104 week income replacement benefits, an award for unreasonable delay, and costs were dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs).

The respondent initially paid IRBs but later claimed an overpayment and reduced the quantum to nil after the applicant received a retroactive lump sum payment from a successful wrongful termination grievance and began receiving long-term disability and CPP Disability benefits.

The Tribunal found that the retroactive lump sum payment constituted gross employment income under the Schedule, not an award of damages.

Consequently, the applicant's pre-accident income was sufficient to maintain his IRB entitlement at $400.00 per week despite the receipt of collateral benefits.

The Tribunal ordered the respondent to pay the withheld IRBs with interest and dismissed the respondent's claim for repayment of the alleged overpayment.

The applicant's claim for an award under s. 10 of Regulation 664 was dismissed due to lack of submissions.

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

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

The applicant argued for removal from the MIG due to psychological impairments, pre-existing sciatica and scoliosis, and chronic pain.

The Tribunal found insufficient medical evidence to support removal from the MIG, preferring the respondent's assessments which aligned with the family physician's clinical notes.

The application for treatment plans, interest, and a special award was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including two treatment plans for chiropractic services and the outstanding balance for a catastrophic assessment.

The Tribunal found the chiropractic treatment plans reasonable and necessary to address the applicant's ongoing back pain, despite the presence of a non-cancerous tumour.

The Tribunal denied the outstanding balance for the catastrophic assessment, finding that individual file review costs are subsumed within the $2,000 funding limit.

The applicant's request for an award for unreasonable delay was dismissed, but interest was awarded on the approved treatment plans.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to psychological assessments and treatment outside the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on psychological impairments and chronic pain.

The Tribunal found the applicant's evidence insufficient, preferring the respondent's psychological assessments which found only subclinical symptoms.

The Tribunal also found the applicant did not meet the criteria for chronic pain.

The application was dismissed, with the applicant remaining subject to the $3,500 MIG limit.