Cara Boddy

The applicant sought statutory accident benefits following a motor vehicle accident, specifically $2,200 for a psychological assessment, along with interest and an award for unreasonable delay.

The Tribunal scheduled a written hearing, but the applicant failed to file any submissions or evidence.

Pursuant to section 7(2) of the Statutory Powers Procedure Act, the Tribunal proceeded with the hearing in the applicant's absence.

As the applicant failed to meet her evidentiary burden, the application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, including funding for physiotherapy, psychological services, and a psychological assessment.

The Tribunal found that the applicant failed to prove the physiotherapy treatment plan was reasonable and necessary due to insufficient medical evidence of ongoing physical pain.

While the psychological services and assessment were deemed reasonable and necessary, the Tribunal found they were not costed in accordance with the Professional Services Guideline.

The applicant failed to prove entitlement to the disputed hourly rates and hours claimed.

The application was dismissed.

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

The matter proceeded to a written hearing, but the applicant failed to file any submissions or evidence, despite indicating an intention to withdraw the application.

The Tribunal proceeded with the hearing pursuant to s. 7(2) of the Statutory Powers Procedure Act.

As the applicant failed to meet her evidentiary burden, the application for removal from the Minor Injury Guideline, income replacement benefits, and a psychological assessment was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to various treatment plans for psychological services, occupational therapy, assistive devices, and a chronic pain assessment.

The respondent insurer denied the benefits, arguing the applicant's impairments were pre-existing and not caused or exacerbated by the accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to meet the "but for" test for causation.

The Tribunal relied on extensive pre-accident medical records and independent medical examinations demonstrating the applicant had a significant history of chronic pain, substance abuse, and psychological impairments that were unaffected by the accident.

Claims for an award for unreasonable delay and interest were also dismissed.

The applicant sought an adjournment of a videoconference hearing due to her counsel's ongoing medical condition.

The Tribunal noted this was the second adjournment request for the same reason and that counsel had sufficient time to arrange alternative representation.

Applying Rule 16 of the Licence Appeal Tribunal Rules, the adjudicator denied the adjournment.

Following the denial, the applicant's counsel withdrew the application.

The minor applicant, who suffered a catastrophic impairment in a motor vehicle accident, sought non-earner benefits (NEBs).

The insurer denied the claim, arguing NEBs are not payable until the applicant turns 18, and since he would not turn 18 within 104 weeks of the accident, he would never be entitled.

The insurer also argued the Tribunal lacked jurisdiction to order future payments.

The Tribunal held it had jurisdiction to determine entitlement because the insurer had issued a denial.

Interpreting the Schedule harmoniously, the Tribunal found the applicant was entitled to NEBs for the 104-week period following the accident, with payment deferred until he reaches 18 years of age.

An order was also granted to anonymize the minor applicant's identity.

The self-represented applicant sought a determination that she sustained a catastrophic impairment as a result of three separate motor vehicle accidents.

The Tribunal found that the applicant failed to meet her burden of proof, as she did not submit any catastrophic impairment assessments or medical reports demonstrating that she met the criteria under the Statutory Accident Benefits Schedule.

The application was dismissed.

The applicant sought various medical and rehabilitation benefits following a motor vehicle accident.

The respondent denied the benefits and raised a preliminary issue regarding the applicant's failure to attend insurer's examinations (IEs) for psychological services.

The Tribunal found the applicant was statute-barred from pursuing the psychological services claim due to non-attendance at the IEs.

The Tribunal also denied the claims for chiropractic services, a chronic pain assessment, and a physiatry assessment, finding that the applicant had reached maximum medical recovery and the treatments were not reasonable and necessary.

The applicant was injured in a motor vehicle accident and sought approval for a physiotherapy treatment plan costing $3,927.98, which the respondent insurer denied.

The respondent relied on an insurer's examination report suggesting the applicant had not responded to facility-based treatment.

The Tribunal found the treatment plan reasonable and necessary, preferring the recommendations of the applicant's treating practitioners and independent assessor who supported ongoing physical treatment.

The Tribunal ordered the respondent to pay for the treatment plan along with applicable interest.

The applicant sought an award under s. 10 of O. Reg. 664, alleging the respondent unreasonably withheld or delayed payment of a treatment plan (OCF-18) following a motor vehicle accident.

The treatment plan was initially denied based on an insurer's examination but was later approved at a case conference.

The Tribunal found that the respondent did not unreasonably withhold or delay payment, as it had relied on the medical evidence and the opinion of the insurer's examination assessor at the time of the denial.

The application for an award was dismissed.

The applicant, a pedestrian struck by a vehicle, sought statutory accident benefits for attendant care, assistive devices, and psychological and physiological treatment.

The insurer denied the claims.

The Licence Appeal Tribunal found that the applicant was entitled to the psychological treatment plan, as the evidence demonstrated that his pre-existing psychological issues were exacerbated by the accident.

However, the claims for attendant care and assistive devices were dismissed because the applicant failed to prove they were reasonable and necessary, and failed to provide evidence that the expenses were incurred.

A claim for a special award was also dismissed, as the insurer's denials were not improper.

The respondent insurer requested a reconsideration of a decision granting the applicant funding for a multi-disciplinary catastrophic impairment assessment.

The insurer argued the Tribunal erred in law by applying the 'reasonable and necessary' test under section 15 of the Statutory Accident Benefits Schedule instead of section 25, and by relying on procedural fairness to justify the funding.

The Tribunal dismissed the request, finding that while referencing section 15 was an error, it was not significant enough to change the outcome because section 25 still requires assessments to be necessary and costs to be reasonable.

The Tribunal also held that denying the applicant her first set of catastrophic assessments would be procedurally unfair, as it would leave her with no evidence to challenge the insurer's denial.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, arguing her injuries were not predominantly minor due to chronic pain, a psychological condition, and a pre-existing condition.

The Licence Appeal Tribunal found that the applicant's physical injuries were predominantly minor (sprains, strains, whiplash).

The tribunal rejected the applicant's evidence of chronic pain syndrome and found her mild psychological condition did not inhibit useful functioning.

Furthermore, there was insufficient evidence of a pre-existing condition that would prevent maximal recovery.

Consequently, the applicant was subject to the $3,500 treatment limit, and her claims for further benefits and interest were dismissed.

The applicant, injured in a motor vehicle accident, sought non-earner benefits from the respondent insurer.

The Licence Appeal Tribunal applied the Heath test to compare the applicant's pre- and post-accident activities.

The Tribunal found that the applicant's post-accident activities, including caring for his daughters, cleaning, and watching movies, were not so significantly restricted as to constitute a complete inability to carry on a normal life.

The application for non-earner benefits, interest, and costs was dismissed.

The applicant was injured in a motor vehicle accident and sought payment for the cost of examinations to determine catastrophic impairment.

The respondent denied the request, arguing that its own catastrophic examinations had already been completed and that the applicant's request was not for the purpose of preparing an application under section 45 of the Schedule.

The Tribunal found that the applicant was not precluded from seeking funding for her own examinations after submitting an OCF-19 application, as this ensures procedural fairness.

The Tribunal partially approved the treatment plan, finding that certain psychological and cognitive assessments, as well as a WPI rating assessment, were reasonable and necessary, while others were duplicative or unnecessary.

The applicant was also awarded interest on the overdue payments.

The applicant sought funding for a multidisciplinary catastrophic impairment assessment after exhausting the $50,000 non-catastrophic limit for medical and rehabilitation benefits.

The respondent insurer denied the treatment plan, arguing that the non-catastrophic limit applied and that sufficient medical documentation already existed.

The Tribunal held that the cost of catastrophic assessments is not subject to the $50,000 non-catastrophic limit under section 18(3) of the Schedule, but rather falls under section 25.

The Tribunal found the requested assessments reasonable and necessary, but denied the separate fees for file and medical document review, finding them to be an inherent component of the assessments subject to the $2,000 cap per assessment.

The applicant, a tow truck driver, sought statutory accident benefits after sustaining injuries while opening a garage bay door at a mechanic's shop.

The respondent denied benefits, arguing the incident was not an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal applied the purpose and causation tests, finding that the use of the tow truck had ended prior to the incident and did not directly cause the impairment.

The Tribunal concluded the applicant was not involved in an accident and dismissed the appeal.

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

After disputes arose, she applied for arbitration but subsequently failed to communicate with her counsel or attend the hearing.

At the hearing, the applicant's counsel successfully moved to be removed from the record due to a breakdown in the solicitor-client relationship.

The insurer then moved to dismiss the application with costs.

The arbitrator granted the dismissal, finding the applicant had abandoned her claim, and ordered her to pay $1,000 in costs to the insurer.

The Applicant sought accident benefits for two separate motor vehicle accidents (1990 and 1996).

In a preliminary issue hearing, the Arbitrator determined whether the arbitrations could proceed.

For the 1990 accident, the Arbitrator found that the arbitration was barred because the Applicant had signed a Full and Final Release in 2003 to settle a related civil action, and the right to rescind under the Settlement Regulation did not apply to settlements reached in court proceedings.

For the 1996 accident, the Arbitrator found that the claim for income replacement benefits was not time-barred because the Insurer's termination notice failed to clearly and unequivocally inform the Applicant of the dispute resolution process and time limits, as required by the Smith v. Co-operators test.

The insured was injured in a motor vehicle accident and sought a determination of catastrophic impairment.

The insurer denied the designation, and the insured filed an Application for Mediation.

Before the 60-day mediation period expired and before mediation had failed, the insured filed an Application for Arbitration.

The insurer requested a preliminary issue hearing to determine if the arbitrator had jurisdiction.

The arbitrator held that the Application for Arbitration was barred because the statutory pre-condition of a failed mediation under s. 281(2) of the Insurance Act had not been met at the time the application was filed.