Danielle Lecours

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

He notified the insurer of his intention to apply four months after the accident and submitted his application (OCF-1) fourteen months after the accident.

The insurer denied the claim due to non-compliance with the time limits in section 32 of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal found that the applicant failed to provide a reasonable explanation for the delays, noting a lack of medical evidence to support his claims of cognitive impairment and finding his assertions regarding the insurer's lack of guidance not credible.

The application was statute-barred under section 55(1)1 of the Schedule.

The applicant sought income replacement benefits (IRBs) and a special award following a motor vehicle accident.

The respondent brought a motion to strike new evidence introduced in the applicant's reply submissions, which the Tribunal granted, finding the late introduction prejudicial.

On the merits, the Tribunal dismissed the application for IRBs, finding the applicant failed to prove she was employed at the time of the accident or establish the essential tasks of her alleged employment.

The Tribunal also found insufficient evidence to support a complete inability to work post-104 weeks.

The claims for interest and a special award were dismissed.

The applicant sought an income replacement benefit following a motor vehicle accident, which the respondent insurer denied.

The respondent raised a preliminary issue arguing the applicant was statute-barred for failing to dispute the denial within the two-year limitation period.

The Tribunal found that the insurer's Explanation of Benefits was defective because it failed to provide clear medical reasons for the denial, as required by the principles in Smith v. Co-operators.

Consequently, the defective notice did not trigger the limitation period, and the applicant was permitted to proceed with her application.

The applicant, who sustained a catastrophic impairment in a motor vehicle accident, sought attendant care benefits (ACB) of $4,339.71 per month and assistive devices.

The respondent insurer had reduced her ACB to $1,040.10 per month.

The Tribunal found that the applicant's claim was not statute-barred because the insurer failed to provide proper medical reasons for its refusal, meaning the limitation period had not commenced.

On the merits, the Tribunal accepted the applicant's need for daytime cueing and mobility assistance but rejected the need for nighttime supervisory care, awarding ACB at $1,630.72 per month.

The Tribunal declined to deem the expenses incurred, as the insurer had paid all submitted invoices and did not unreasonably delay payment.

Claims for assistive baby devices and a special award under Regulation 664 were dismissed.

The applicant sought statutory accident benefits for lost educational expenses after a motor vehicle accident prevented her from continuing her college program.

She claimed $15,153.00, primarily related to OSAP grants that were converted to loans when she withdrew.

The Licence Appeal Tribunal found that the applicant met the criteria for being unable to continue her program due to her injuries.

However, the Tribunal held that lost educational expenses are confined to expenses incurred before the accident for the specific term in which she was enrolled.

The Tribunal denied the claims for tuition, internet, telephone, and food, but awarded $862.69 for room and board (rent) incurred for January 2019 prior to the accident, plus interest.

The applicant sought a non-earner benefit following a motor vehicle accident.

The insurer requested the applicant elect between an income replacement benefit and a non-earner benefit.

The applicant filed an application with the Licence Appeal Tribunal before making an election or receiving a denial from the insurer.

The Tribunal held it lacked jurisdiction to adjudicate the claim because, under section 280 of the Insurance Act, there can be no dispute until a claim is denied by the insurer.

The application was dismissed.

The respondent insurer requested a reconsideration of a Tribunal decision which found that catastrophic impairment (CAT) assessments are not medical benefits subject to the $50,000 limit under s. 18 of the Schedule.

The adjudicator dismissed the reconsideration request, finding that the insurer merely repeated arguments already decided and failed to demonstrate any material error of fact or law.

The adjudicator also granted the applicant $100 in costs, concluding that the insurer's reconsideration request was frivolous and lacked supporting evidence or argument.

The applicant sought reconsideration of a decision dismissing his appeal for a non-earner benefit as being outside the two-year limitation period.

The applicant argued the adjudicator breached natural justice, committed errors of law, and failed to consider extending the time under s. 7 of the LAT Act.

The Vice-Chair dismissed the reconsideration request, finding no breach of natural justice or error of law.

Applying the four-factor test from Manuel, the Vice-Chair declined to exercise discretion to extend the limitation period, noting the applicant's failure to explain a five-month delay and lack of evidence regarding prejudice to the respondent.

The applicant requested a reconsideration of a Tribunal decision that denied entitlement to a chronic pain program and assistive devices following a motor vehicle accident.

The applicant argued the Tribunal made significant errors of law and fact, including misapprehending medical evidence regarding maximum medical recovery, misapplying the test for reasonable and necessary treatment, and ignoring relevant case law.

The adjudicator dismissed the request, finding that the original Tribunal decision was based on a reasonable interpretation of the medical evidence, applied the correct legal tests under the Statutory Accident Benefits Schedule, and properly exercised its discretion in weighing the evidence.

The original decision was confirmed.

The applicant sought statutory accident benefits for a chronic pain program and assistive devices (a lawn mower and snow blower) following a motor vehicle accident.

The Tribunal found that the chronic pain program was not reasonable and necessary, relying on insurer's examinations indicating the applicant had reached maximum medical recovery and was an adaptive pain coper.

The Tribunal also denied the assistive devices, noting the applicant's pre-accident inability to perform lawn care and snow removal tasks.

The application was dismissed.

The applicant sought entitlement to a treatment plan for physiotherapy and massage therapy in the amount of $1,849.55 following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to provide contemporaneous medical evidence to support the necessity of the treatment plan.

Relying on the respondent's physiatry examination report, which concluded the applicant had reached maximum therapeutic benefit, the Tribunal held that the treatment plan was not reasonable and necessary.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits for a chiropractic treatment plan.

The respondent initially denied the plan but paid it after the applicant filed an appeal with the Licence Appeal Tribunal.

The applicant subsequently sought costs of the proceeding and a special award, alleging the respondent unreasonably withheld payment.

The Tribunal dismissed both claims, finding the respondent's initial denial and request for updated medical records was not unreasonable given the prior medical evidence indicating the applicant had recovered.

The Tribunal also found no evidence of unreasonable or bad faith conduct during the proceeding to justify a costs award.

The plaintiff, Timothy Watkins, brought two actions against his mother's insurer, Western Assurance Company: an accident benefits claim and a derivative claim.

Western Assurance brought two motions seeking to dismiss these actions.

The court granted summary judgment, dismissing the accident benefits claim due to the plaintiff's failure to submit an application for benefits and the expiry of the limitation period.

However, the court dismissed Western Assurance's motion to strike the derivative claim, finding it was not plain and obvious that this claim, which included contractual claims as an unnamed insured, was certain to fail.

The applicant sought a non-earner benefit following a motor vehicle accident, arguing the insurer failed to respond to an amended Disability Certificate (OCF-3) under section 36 of the Statutory Accident Benefits Schedule.

The Tribunal found the insurer did not receive the amended OCF-3 and had properly responded to the initial OCF-3.

Applying the Heath test, the Tribunal concluded the applicant failed to provide sufficient evidence, such as a detailed comparison of pre- and post-accident activities, to prove a complete inability to carry on a normal life.

The claims for the non-earner benefit, an award under Ontario Regulation 664, and interest were dismissed.