Anju Sharma

The applicant sought attendant care benefits following a motor vehicle accident.

The insurer denied the benefits and scheduled insurer's examinations (IEs), which the applicant failed to attend.

The applicant appealed to the Tribunal more than two years after the initial denial.

The Tribunal held that the applicant was statute-barred from proceeding with the attendant care benefits claim because the appeal was filed outside the two-year limitation period under s. 56 of the Schedule, and declined to extend the time under s. 7 of the LAT Act.

Furthermore, the Tribunal found the applicant was statute-barred under s. 55 from proceeding with several other benefit claims due to his unjustified failure to attend properly scheduled s. 44 IEs.

The applicant sought statutory accident benefits for chiropractic treatment, hospital expenses, and a psychological assessment following a motor vehicle accident.

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

The adjudicator found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain or a psychological impairment that would take him out of the MIG.

As the applicant had already exhausted the $3,500 MIG limit, the disputed benefits were not payable.

The respondent's request for costs was also denied.

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

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

The respondent raised a preliminary issue that the claim was statute-barred under section 56 of the Statutory Accident Benefits Schedule.

The applicant requested an extension of time under section 7 of the Licence Appeal Tribunal Act.

The Tribunal found the application was filed at least two months late and the applicant failed to provide sufficient evidence or argument to satisfy the four-part test for an extension of time.

The claim for the non-earner benefit was dismissed as statute-barred.

The applicant sought medical benefits following a motor vehicle accident.

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

The Tribunal found that the applicant's physical and psychological injuries met the definition of 'minor' under the Schedule.

As the $3,500 MIG limit had already been exhausted, the applicant was not entitled to the disputed treatment plans.

The application was dismissed.

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

The respondent insurer deemed the injuries to fall within the Minor Injury Guideline (MIG), capping benefits at $3,500.

The applicant argued he should be removed from the MIG due to pre-existing conditions, chronic pain, and psychological impairment.

The Tribunal found insufficient evidence of a pre-existing condition preventing maximal recovery, and no persuasive proof of chronic pain or psychological impairment.

The Tribunal concluded the applicant's injuries were predominantly minor and subject to the MIG cap.

As the cap was exhausted, the claims for further benefits and interest were dismissed.

The appellant appealed the dismissal of her claim for statutory accident benefits by the Licence Appeal Tribunal.

The Divisional Court allowed the appeal, finding that the adjudicator erred by excluding opinion evidence from the appellant's treating family physician and by failing to properly assess the issue of causation.

The court held that the adjudicator's erroneous evidentiary ruling infected the fact-finding process and that the failure to state the proper test for causation rendered the reasons insufficient.

The decisions below were set aside and the matter was remitted to the LAT for a new hearing before a different adjudicator.

The applicant requested a reconsideration of a Tribunal decision that dismissed her application for income replacement benefits and medical benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The applicant argued that the adjudicator displayed an apprehension of bias, improperly weighed medical evidence, and failed to apply the correct legal tests.

The Tribunal dismissed the reconsideration request, finding no reasonable apprehension of bias and concluding that the adjudicator made no significant errors of law or fact.

The Tribunal also rejected the applicant's attempt to introduce new evidence that could have been obtained prior to the original hearing.

The respondent's request for costs was also dismissed.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The respondent insurer denied four treatment plans for physical rehabilitation and driving training services.

The Licence Appeal Tribunal found that the treatment plan for physical rehabilitation in the amount of $2,907.44 and the driving training services were reasonable and necessary, though the driving training fees were limited to the FSCO Fee Guideline rates.

The Tribunal denied the remaining two physical rehabilitation treatment plans as they were duplicative and lacked sufficient evidence of reasonableness and necessity.

Interest was awarded on the approved benefits.

Following an arbitration where the insurer successfully defended all claims for statutory accident benefits, the parties could not agree on expenses.

The insurer sought $39,474.46 in expenses.

The arbitrator found the insurer was entitled to expenses based on its complete success.

Applying a broad-strokes approach and a 2:1 ratio of preparation to hearing time, the arbitrator reduced the claimed amounts and awarded the insurer $10,955.87 inclusive of fees, disbursements, and HST.

The applicant sought statutory accident benefits following a motor vehicle accident, including pre- and post-104 week income replacement benefits, chiropractic treatment plans, and the cost of a disability certificate.

The adjudicator found the applicant to be an unreliable witness due to inconsistencies in her testimony and self-reporting.

The adjudicator concluded the applicant did not suffer a substantial or complete inability to perform her employment tasks, noting her physical injuries were minor exacerbations of pre-existing conditions and there was no objective evidence of psychological impairment.

The claims for income replacement benefits, treatment plans, and the disability certificate were dismissed.

The respondent's request for costs of a motion was also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of non-earner benefits and four treatment plans.

The adjudicator found that the applicant's claim for non-earner benefits was time-barred under section 56(1) of the Schedule, as the application was filed more than five years after the respondent's clear refusal to pay.

Regarding the treatment plans, the adjudicator concluded that the applicant failed to prove his physical or psychological injuries fell outside the Minor Injury Guideline (MIG).

The adjudicator placed little weight on the applicant's psychological assessment conducted nearly five years post-accident, noting a lack of contemporaneous complaints to his family physician.

As the applicant had exhausted the $3,500 MIG cap, the disputed treatment plans were denied.

The respondent's request for costs was also dismissed.

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

The respondent insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit was exhausted.

The Licence Appeal Tribunal found that the applicant had a pre-existing elbow condition that was exacerbated by the accident, preventing him from achieving maximal recovery within the MIG limits.

The Tribunal also found the disputed treatment plans for chiropractic, physiotherapy, and a psychological assessment to be reasonable and necessary, ordering the insurer to pay the benefits with interest.

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

The parties were unable to resolve their disputes through mediation, and the applicant applied for arbitration.

The applicant's legal counsel was removed from the record due to a breakdown in the solicitor-client relationship.

The applicant failed to attend the scheduled arbitration hearing.

The arbitrator dismissed the application for arbitration as an abuse of process due to the applicant's non-participation and failure to meet the onus of proving entitlement to the claimed benefits.

The insurer was awarded expenses in the amount of $3,243.61.

The applicant was injured in a motor vehicle accident and sought payment for two physiotherapy treatment plans.

The respondent insurer denied payment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the monetary limit had been reached.

The applicant argued the MIG did not apply due to a pre-existing medical condition and chronic pain.

The adjudicator found insufficient evidence to prove the pre-existing condition prevented maximal medical recovery under the MIG, and preferred the respondent's independent medical examination over the applicant's orthopaedic surgeon's report regarding chronic pain.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, which the respondent denied on the basis that the injuries fell within the Minor Injury Guideline.

The Tribunal found that the applicant's psychological impairments, including adjustment disorder and specific phobia, removed her from the Guideline.

The Tribunal preferred the evidence of the applicant's psychologist over the respondent's assessor, noting the respondent's own testing showed the applicant tended to minimize her distress.

The Tribunal awarded the costs of examinations for psychological and chronic pain assessments, along with interest, but denied the claims for physiotherapy treatment plans as the applicant failed to prove they were reasonable and necessary.

The claim for costs was also denied.

The applicant sought to introduce an expert orthopaedic report two days before a written hearing, well past the deadline set by the Tribunal's order and the LAT Rules.

The respondent objected to the late submission.

The Tribunal found that while the late submission prejudiced the respondent, the report was relevant and necessary to determine the issues in dispute.

Applying Rule 3.1 to facilitate a fair process, the Tribunal admitted the report but granted the respondent 30 days to submit responding material and rescheduled the hearing.

The applicant sought a special award in an arbitration for statutory accident benefits, but the insurer prevailed.

The parties could not agree on expenses.

The arbitrator applied the criteria under section 12 of Regulation 664 and found the insurer was entitled to its expenses.

The arbitrator awarded the insurer $5,738.05, calculating the fees based on Legal Aid Rates and allowing for two days of hearing and preparation, noting the hearing was prolonged by the inexperience of the applicant's representatives.

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

The parties settled the claims for income replacement and medical benefits, leaving only the issue of whether the applicant was entitled to a Special Award under s. 282(10) of the Insurance Act for the insurer's initial denial of benefits.

The arbitrator found that the insurer acted reasonably at all relevant times based on the medical information available, which supported a theory that the applicant's impairments were due to pre-existing degenerative disc disease rather than the accident.

The claim for a Special Award was dismissed.

The applicant was injured in a motor vehicle accident and sought ongoing Income Replacement Benefits (IRBs), medical and rehabilitation benefits outside the Minor Injury Guideline (MIG), and a Special Award.

The arbitrator found that the applicant suffered a substantial inability to perform his pre-accident employment for the first 104 weeks, entitling him to IRBs for that period.

However, the applicant failed to prove a complete inability to engage in any suitable employment beyond the two-year mark.

The arbitrator also concluded that the applicant's injuries, including alleged chronic pain and psychological impairments, did not remove him from the MIG, as the insurer's medical evidence demonstrating no objective impairment was preferred.

The claims for additional treatment plans and a Special Award were dismissed.

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

The insurer denied the claim, arguing the applicant's policy had been cancelled for non-payment of premiums prior to the accident.

The arbitrator found that the insurer's cancellation notice was defective because it failed to provide a cash payment option as required by section 11(1.3) of O. Reg. 777/93.

As a result, the policy was not validly cancelled, and the applicant was not excluded from receiving benefits under section 31(1)(a) of the Schedule.