Ulana Pahuta

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

The respondent denied the treatment plan, arguing the applicant had not provided sufficient evidence that further facility-based treatment was beneficial more than six years post-accident.

The Tribunal found that the applicant failed to provide contemporaneous medical evidence or objective proof that the proposed treatment was reasonable and necessary.

The application for the treatment plan and interest was dismissed.

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

She failed to notify the respondent insurer of her intention to apply for benefits within the 7-day time limit prescribed by section 32(1) of the Schedule, waiting almost three months.

The respondent argued the application should be barred under section 55(1).

The Tribunal found that the applicant did not provide a reasonable explanation for the delay, noting she was aware of her injuries, was not incapacitated, and had prior experience managing an accident benefits claim.

Consequently, the applicant was statute-barred from proceeding with the substantive issues, and the application was dismissed.

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

The adjudicator found the applicant was entitled to income replacement benefits for a limited period, as well as two treatment plans for physical therapy and partial payment for prescription medication.

Claims for further income replacement benefits, a psychiatric assessment, and costs for preparing disability certificates were denied.

The applicant's motion to strike the respondent's late-filed submissions was also denied, as excluding them would be severely prejudicial.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, which the respondent denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that pre-existing psychological conditions and back pain, as well as accident-related chronic pain, warranted removal from the MIG.

The Tribunal found insufficient medical evidence linking the ongoing pain complaints to the subject accident, noting the applicant was involved in two subsequent accidents.

The Tribunal concluded the applicant's injuries were predominantly minor, and because the $3,500 MIG limit was exhausted, the disputed treatment plans and interest were denied.

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

The respondent denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on pre-existing back pain and accident-related chronic pain.

The Tribunal found the applicant failed to provide sufficient medical evidence of a pre-existing condition that precluded recovery within the MIG, or of functionally disabling chronic pain.

The applicant's motion to strike the respondent's late-filed submissions was denied, as was his request for costs.

The application was dismissed, with the applicant entitled only to any remaining amounts within the $3,500 MIG limit.

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 argued for removal from the MIG based on a pre-existing neck impairment and accident-related chronic pain.

The Tribunal found the applicant failed to provide sufficient medical evidence that his pre-existing condition precluded recovery within the MIG, or that he suffered from accident-related chronic pain.

The application was dismissed, and the applicant was limited to the remaining balance of the $3,500 MIG limit.

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 provide sufficient medical evidence to establish that her physical, chronic pain, or psychological impairments warranted removal from the MIG.

The Tribunal preferred the respondent's psychological assessment over the applicant's pre-screening report.

The applicant's claims for medical benefits beyond the MIG limit and for a special award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming $3,413.01 for a chiropractic treatment plan (OCF-18).

The respondent denied the claim, arguing the treatment was not reasonable and necessary and relying on a section 44 physiatry assessment.

The Tribunal found that while the accident exacerbated the applicant's pre-existing chronic pain, the applicant failed to provide sufficient evidence that the proposed treatment goals were being met or that he sustained any benefit from prior treatment.

The application was dismissed.

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

The Tribunal found the applicant failed to prove her injuries warranted removal from the Minor Injury Guideline.

However, due to the respondent's failure to provide compliant denial notices under the Statutory Accident Benefits Schedule, the applicant was awarded payment for a treatment plan dated March 30, 2022, and non-earner benefits for a limited period from May 7, 2020, to February 9, 2021.

The claim for a special award under O. Reg. 664 was dismissed.

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

The Tribunal found that the applicant's injuries were predominantly minor and did not warrant removal from the Minor Injury Guideline.

However, the Tribunal ordered the respondent to pay a disputed treatment plan and a portion of the claimed non-earner benefits because the respondent failed to provide compliant notices under sections 38 and 36 of the Schedule.

The claim for a special award was dismissed.

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

The respondent denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's injuries fell outside the MIG due to significant accident-related psychological impairments, relying on the evidence of her treating psychiatrist.

The Tribunal approved one treatment plan for physiotherapy services but denied the remaining plans for physical treatment, devices, and various assessments, finding them not reasonable and necessary.

The applicant's claim for a non-earner benefit was dismissed as she failed to prove a complete inability to carry on a normal life.

The claim for a special award was also dismissed.

The applicant, a self-employed auto mechanic, was injured when a vehicle he was inspecting fell from a hoist due to a mechanical failure.

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

The Tribunal found that while the purpose test was met, the causation test failed because the malfunctioning hoist was an intervening act that broke the chain of causation.

The application was dismissed.

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

The respondent insurer denied benefits and requested the applicant attend several insurer's examinations (IEs) to determine entitlement to various treatment plans.

The applicant failed to attend the scheduled IEs, arguing that the insurer's notices of examination (NOEs) did not comply with s. 44(5) of the Statutory Accident Benefits Schedule by failing to provide sufficient medical reasons.

The Tribunal found that the NOEs for five of the treatment plans were compliant, and thus the applicant was barred from proceeding with those claims under s. 55(1)2.

However, the NOEs for two physical therapy treatment plans were found to be vague and non-compliant, allowing the applicant to proceed to a substantive hearing on those issues.

The Tribunal declined to grant relief from non-compliance under s. 55(2).

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

The respondent denied benefits and requested the applicant attend several insurer's examinations (IEs).

The applicant failed to attend the scheduled IEs, arguing the notices were deficient.

The Tribunal found the notices complied with s. 44(5) of the Schedule and the applicant failed to provide a reasonable explanation for her non-attendance.

Consequently, the applicant is statute-barred from proceeding with her application under s. 55(1)2 of the Schedule.

The application was dismissed.

The applicant requested a reconsideration of a preliminary issue decision which found him statute-barred from proceeding with his application for accident benefits due to an unexplained delay.

The applicant argued the Tribunal breached procedural fairness and erred in law by failing to properly assess the credibility and reasonableness of his explanation for the delay.

The Tribunal dismissed the request, finding no evidence of procedural irregularities and concluding that the adjudicator correctly applied the legal test in determining the applicant's explanation was not credible.

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

The respondent denied several treatment plans, and the applicant applied to the Tribunal to dispute the denials.

The respondent argued the application was barred by the two-year limitation period under s. 56 of the Schedule.

The applicant contended the limitation period was not triggered because the denial notices lacked valid medical reasons.

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

The Tribunal also declined to extend the limitation period under s. 7 of the LAT Act, as the applicant failed to establish a bona fide intention to appeal within the time limit or address the other Manuel factors.

The application was dismissed as statute-barred.

The applicant was struck by a vehicle in April 2021 and sought statutory accident benefits.

She did not submit her application for benefits (OCF-1) until April 2022, well beyond the 30-day time limit prescribed by section 32(5) of the Schedule.

The applicant argued she had a reasonable explanation for the delay due to being overwhelmed and unaware of the severity of her psychological injuries until a subsequent accident.

The Tribunal rejected this explanation, noting she had successfully applied for EI and WSIB during the same period and returned to full-time work.

The Tribunal found the applicant was statute-barred from proceeding with her claim under section 55(1)1 of the Schedule.

The applicant was injured in a motor vehicle accident during the course of her employment and applied for statutory accident benefits.

The insurer denied benefits, arguing the applicant was required to claim WSIB benefits and that her election to pursue a tort claim under s. 61(2) of the Schedule was made primarily to obtain accident benefits.

The Tribunal found that the applicant failed to demonstrate a bona fide intention to pursue a tort action, noting her significant delay in issuing a Statement of Claim until after the limitation period expired.

Consequently, the Tribunal held the applicant was statute-barred under s. 61 of the Schedule and dismissed the application.

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

The respondent denied various treatment plans in 2018 and 2019.

The applicant submitted her application to the Tribunal in 2023, beyond the two-year limitation period under s. 56 of the Schedule.

The applicant argued the denials were invalid for failing to provide medical reasons.

The Tribunal found the respondent's Explanation of Benefits provided clear and unequivocal denials with sufficient reasons, triggering the limitation period.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act, finding the applicant failed to demonstrate a bona fide intention to appeal, and the delay was significant.

The application was dismissed as statute-barred.

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

She failed to submit her OCF-1 application within the 30-day time limit prescribed by the Schedule, submitting it nearly two years later.

The respondent argued she was statute-barred from proceeding.

The Tribunal found the applicant had a reasonable explanation for the delay, citing her psychological and cognitive impairments, her mistaken belief that a previous law firm had submitted the form, and confusion caused by the respondent's partial approval of a treatment plan.

The Tribunal concluded the applicant could proceed with her application to a substantive hearing.