Bruce Keay

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

The Licence Appeal Tribunal held a written hearing to determine entitlement to attendant care benefits, multiple treatment plans for social worker counselling, occupational therapy, assistive devices, medical cannabis, catastrophic impairment assessments, mileage, and a special award.

The Tribunal partially granted the attendant care benefits, excluding amounts for emotional support.

Claims for social worker counselling and social rehab counselling were dismissed or reduced to align with FSCO Guidelines, particularly rejecting excessive travel time and planning fees.

The Tribunal approved occupational therapy services, assistive devices (less amounts previously settled), medical cannabis, and capped the catastrophic impairment assessments at $2,000 each.

Claims for mileage and a special award were dismissed.

Interest was awarded on overdue benefits.

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

The respondent insurer denied benefits, arguing the application was delayed without a reasonable explanation.

The Tribunal found that the applicant, being seven years old at the time of the accident and reliant on her parents, had a reasonable explanation for the delay.

The Tribunal noted the applicant's minority status, her parents' language barriers, and the lack of significant prejudice to the insurer.

The applicant was permitted to proceed with her claim.

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

The applicant also claimed entitlement to a non-earner benefit, four chiropractic treatment plans, interest, and an award for unreasonable delay.

The Tribunal found that the applicant failed to prove his physical or psychological injuries warranted removal from the MIG, noting a lack of medical evidence connecting his claimed conditions to the accident.

The Tribunal also found the insurer's denial notices complied with s. 38(8) of the Schedule.

The claim for a non-earner benefit was dismissed as the applicant provided insufficient evidence of his pre-accident activities to establish a complete inability to carry on a normal life.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a bicycle-motor vehicle collision.

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 objective medical evidence to establish that her physical or psychological injuries warranted removal from the MIG.

Furthermore, the applicant did not prove a complete inability to carry on a normal life, as she provided limited details regarding her pre- and post-accident activities.

The application for non-earner benefits, a psychological assessment, an award, and interest was dismissed.

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

The applicant argued he suffered from chronic pain and a psychological condition warranting removal from the MIG, and that the insurer's denial of a physiotherapy treatment plan was non-compliant with s. 38(8) of the Schedule.

The adjudicator found the applicant failed to meet the AMA Guides criteria for chronic pain and lacked evidence of a psychological condition.

The adjudicator also found the insurer's denial letter compliant.

The insurer's claim for repayment of an alleged Income Replacement Benefit overpayment was dismissed due to lack of evidence.

All claims were dismissed.

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

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

The Tribunal found that the applicant failed to prove his injuries, including alleged post-concussion syndrome and degenerative disc disease, warranted removal from the MIG.

The Tribunal also held that the respondent's denial notices contained sufficient medical reasons, meaning the applicant was not entitled to the plans under section 38(11) of the Schedule.

The application was dismissed.

The applicant was severely injured in a motor vehicle accident and submitted his application for accident benefits (OCF-1) nearly a year late.

The respondent denied benefits on the basis of the delay.

The Tribunal found the applicant had a reasonable explanation for the delay due to his severe brain and physical injuries, and the respondent's failure to adequately communicate the consequences of not filing or to accommodate his disabilities.

The Tribunal ordered the respondent to pay the disputed physiotherapy treatment plan, interest, and a maximum 50% special award under s. 10 of Reg. 664 for unreasonably delaying and withholding benefits.

The applicant was involved in an atypical motor vehicle accident in July 2021 but did not apply for accident benefits until April 2023, 21 months later.

The insurer denied the claim on the basis of the delay.

The Tribunal found that the applicant's explanation—that she was unaware she could apply for accident benefits until her long-term disability claim was denied and she consulted a lawyer—was credible but not reasonable, as ignorance of the law alone does not constitute a reasonable explanation.

The Tribunal concluded the applicant was barred from proceeding with her application and dismissed the matter.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including treatment plans for physiotherapy, chiropractic services, medical services, and multiple assessments (CAT, SPECT, QEEG).

The respondent denied the benefits.

The Tribunal found that the applicant was not entitled to most of the treatment plans, as some were submitted beyond the 260-week post-accident limit and others were duplicative or lacked sufficient evidence of reasonableness and necessity.

However, the Tribunal allowed $2,000 for a neurological assessment, $200 for the completion of an OCF-19, and $176 for transportation expenses, noting objective evidence of potential brain dysfunction.

The applicant was awarded interest on overdue benefits but denied an award under s. 10 of Regulation 664.

The applicant, who was struck by a car while riding his bicycle, sought $2,200 for an occupational therapy assessment and attendant care needs evaluation under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal dismissed the application, finding insufficient evidence that the treatment plan was reasonable and necessary.

The Tribunal preferred the insurer's medical evidence, noting the applicant's complex pre-existing medical history and a lack of contemporaneous medical records supporting accident-related functional impairments.

The applicant sought payment for occupational therapy and life skills training following a motor vehicle accident.

The adjudicator found the treatment plans were not reasonable and necessary, noting that the applicant had continued to work in a physically demanding job as a server, which contradicted the functional limitations reported by the occupational therapist.

The application for benefits and interest was dismissed.

The applicant sought statutory accident benefits after slipping and falling on an icy driveway while loading the trunk of his parked vehicle.

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

The Tribunal applied the two-part test from Chisholm and Greenhalgh, finding that loading a trunk is an ordinary use of an automobile and that this use directly caused the applicant's injuries.

The Tribunal concluded the incident was an accident and ordered the application to proceed to a hearing on the substantive issues.

The applicant sought statutory accident benefits following a 2013 motor vehicle accident where he was struck while riding a bicycle.

The respondent denied the benefits, arguing the applicant's current physical and psychological impairments were not caused by the subject accident, but rather by prior and subsequent accidents.

The Tribunal applied the 'but for' and material contribution tests for causation and found the applicant failed to establish that the 2013 accident caused his impairments, noting a lack of contemporaneous medical evidence of injury.

Furthermore, the applicant failed to demonstrate that his pre-existing conditions prevented maximal medical recovery under the Minor Injury Guideline (MIG).

Consequently, the claims for medical and rehabilitation benefits, interest, and a special award were dismissed.

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

The respondent insurer brought a motion to dismiss the application under s. 55(1)2 of the Statutory Accident Benefits Schedule, arguing the applicant was statute-barred for failing to attend three scheduled insurer examinations.

The applicant argued the notices of examination were non-compliant and that his medical conditions prevented his attendance.

The Tribunal found the notices were compliant and the requested examinations were reasonably necessary.

However, the Tribunal concluded that dismissing the application would be unduly prejudicial.

Instead, the Tribunal denied the motion to dismiss and ordered a 120-day stay of proceedings to allow the respondent to conduct the outstanding examinations with appropriate accommodations.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found a settlement agreement between the applicant and the respondent insurer was valid and not void ab initio.

The applicant argued the adjudicator acted outside their jurisdiction, violated procedural fairness, and made errors of law and fact, including failing to consider the insurer's duty of good faith and the consumer protection nature of the Statutory Accident Benefits Schedule.

The Vice-Chair dismissed the request, finding no violation of procedural fairness and no errors of law or fact that would have changed the outcome.

The Vice-Chair held that the applicant had a full opportunity to be heard and that the original decision correctly distinguished the case law on mistake.

The applicant requested a reconsideration of a decision denying him non-earner benefits.

He argued the Tribunal erred in fact and law by rejecting certain medical evidence, including a letter from Dr. Galley, and by accepting the evidence of Dr. Dessouki despite alleged procedural flaws.

The Adjudicator dismissed the request, finding that the Tribunal properly weighed the evidence, including the applicant's own testimony and family evidence, and correctly applied the legal test for non-earner benefits.

No error of law or fact was established.

The applicant sought to dispute the denial of a chiropractic treatment plan, income replacement benefits (IRBs), and attendant care benefits (ACBs) more than two years after the initial denials.

The Licence Appeal Tribunal found the applicant was statute-barred from disputing the chiropractic treatment plan under section 56 of the Schedule.

However, applying the Manuel factors, the Tribunal exercised its discretion under section 7 of the LAT Act to extend the limitation period for the IRBs.

For the ACBs, the Tribunal found the limitation clock had not started because there was no formal refusal to pay, and directed the parties to address whether section 55 of the Schedule barred the claim at a subsequent case conference.

The applicant sought payment for a chiropractic treatment plan in the amount of $2,670.00 following a motor vehicle accident.

The insurer denied the claim based on a section 44 assessment indicating that further passive facility-based treatment was not reasonable and necessary.

The Tribunal found that the applicant failed to meet her burden of proof, noting her significant pre-accident history of chronic pain and the lack of evidence showing the proposed treatment provided benefit.

The claims for the treatment plan, interest, and an award for unreasonable delay were dismissed.

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

The insurer denied the benefits on the basis that the applicant failed to submit her application within the 30-day time limit prescribed by section 32 of the Statutory Accident Benefits Schedule.

The applicant submitted her application nearly a year after receiving the forms, explaining that she 'takes her time doing things.' The adjudicator found that the applicant did not provide a reasonable explanation for the delay under section 34 of the Schedule.

Consequently, the application was dismissed as statute-barred under section 55.

The applicant was struck by a vehicle while riding his bicycle in 2013 but did not apply for statutory accident benefits until 2019.

The insurer denied the claim on the basis that the applicant failed to notify it of the accident and apply for benefits within the prescribed time limits.

The Tribunal found that the applicant's transient circumstances, including periods of incarceration, homelessness, severe mental illness, and addiction, provided a reasonable explanation for the delay under section 34 of the Schedule.

The applicant was permitted to proceed with his application.