Diana Oliveira

The applicant, who was 14 years old at the time of the motor vehicle accident, sought statutory accident benefits including non-earner benefits (NEBs) and various treatment plans.

The adjudicator found that the applicant demonstrated a complete inability to carry on a normal life due to chronic pain and psychological impairments, entitling her to NEBs of $185 per week for the disputed period.

A treatment plan for psychological services was also approved as reasonable and necessary.

However, the adjudicator denied plans for an attendant care assessment and driving reintegration services, finding insufficient evidence to support them.

The claim for an award for unreasonable delay was dismissed, but interest was awarded on the payable benefits.

The applicant was involved in a motor vehicle accident in 2019 and subsequently died of a drug and alcohol overdose in 2022.

Her estate claimed Death and Funeral Benefits, arguing the accident caused a psychological downward spiral leading to her death.

The Licence Appeal Tribunal applied the 'but for' test for causation and reviewed the applicant's medical and counselling records.

The Tribunal found that while the applicant suffered an initial psychological impairment from the accident, her condition had improved significantly by mid-2021, and her subsequent relapse into substance abuse was unrelated to the accident.

The application for benefits and a special award was dismissed.

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

The adjudicator found the applicant was barred from proceeding with her claim for an income replacement benefit because she failed to dispute the denial within the two-year limitation period under section 56 of the Schedule.

Regarding medical and rehabilitation benefits, the adjudicator approved a treatment plan for Botox injections and a cold cap to treat post-traumatic headaches, finding them reasonable and necessary.

The remaining claims for various treatment plans, including occupational therapy, social work services, and delivery fees, were dismissed due to insufficient evidence, failure to prove the expenses were not administrative fees, or failure to comply with a section 33 request for information.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found she remained within the Minor Injury Guideline (MIG) and denied her claims for psychological services and assessments.

The applicant argued the adjudicator erred in framing the issues, interpreting the Statutory Accident Benefits Schedule, and weighing the evidence, particularly an independent medical examination report.

The Vice-Chair dismissed the reconsideration request, finding that while the adjudicator erred in considering the applicant's lack of objection to a non-compliant Notice of Examination, this error would not have likely changed the outcome given the weakness of the applicant's own medical evidence.

The respondent's request for costs was also denied.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit (NEB), chiropractic services, an occupational therapy assessment, and a special award for unreasonable delay.

The Tribunal found that the applicant's accident-related chronic pain and exacerbation of pre-existing Post Polio Syndrome continuously prevented him from engaging in substantially all of his pre-accident activities, entitling him to an NEB for 104 weeks.

The Tribunal also approved the treatment plans for chiropractic services and an occupational therapy assessment, preferring the evidence of the applicant's experts who considered the functional limitations caused by his pain.

The claim for a special award was dismissed as the insurer's reliance on its independent medical examinations was not unreasonable.

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

The matter proceeded to a written hearing.

The applicant failed to file any submissions or evidence, and did not respond to the Tribunal's inquiries or file a Notice of Withdrawal.

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

As the applicant bore the onus of demonstrating entitlement to the disputed medical benefits and provided no evidence, the application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a psychological impairment warranting removal from the Minor Injury Guideline (MIG).

The respondent denied the treatment plans for a psychological assessment and psychological services.

The Tribunal found that the applicant failed to provide objective medical evidence to corroborate her self-reported psychological symptoms, assigning little weight to her psychological associate's report and preferring the respondent's s. 44 psychological assessment.

The Tribunal concluded the applicant's injuries were predominantly minor and subject to the $3,500 MIG limit.

The Tribunal also found the respondent's denial notices complied with s. 38(8) of the Schedule, dismissing the claims for the treatment plans, interest, and an award.

The applicant sought non-earner benefits and funding for a psychological assessment following a motor vehicle accident.

The Tribunal found the claim for non-earner benefits was statute-barred under s. 36 of the Schedule because the applicant failed to submit a completed disability certificate (OCF-3).

The Tribunal also denied the remaining $1,000 for the psychological assessment treatment plan, finding the applicant failed to prove the document support fee for a medical file review was reasonable and necessary.

Claims for interest and an award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including removal from the Minor Injury Guideline (MIG), income replacement benefits (IRBs), and approval of treatment plans.

The Licence Appeal Tribunal found that the applicant failed to prove his injuries, including alleged chronic pain and psychological impairments, warranted removal from the MIG.

As the $3,500 MIG limit was exhausted, the disputed treatment plans were not payable.

The Tribunal also dismissed the claim for IRBs, finding insufficient evidence that the applicant suffered a substantial inability to perform the essential tasks of his pre-accident employment as a warehouse worker.

Claims for interest and an award were consequently dismissed.

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

The matter proceeded to a written hearing.

The applicant failed to file any submissions or evidence by the deadline and did not respond to the Tribunal's follow-up communications.

As the applicant bore the onus of proving entitlement to the disputed benefits, the Tribunal found the applicant failed to meet this burden.

The application was dismissed.

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

The central issue was the calculation of the IRB quantum for a self-employed individual.

The adjudicator determined that the applicant's IRB must be calculated based on her last completed taxation year prior to the accident, resulting in a quantum of $38.00 per week.

The adjudicator also found that the respondent failed to pay the benefit within the required time after receiving the disability certificate, entitling the applicant to interest on the overdue payments.

However, the applicant's claim for a special award under s. 10 of Reg. 664 was dismissed, as the respondent's delay was not found to be excessive or imprudent.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to a physiotherapy treatment plan and an attendant care assessment.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the treatments were reasonable and necessary.

The Tribunal relied on the respondent's insurer examination reports, which concluded the applicant sustained only minor injuries and did not require further assessment or physiotherapy.

Claims for interest and a special award were consequently dismissed.

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

The respondent denied a treatment plan for physiotherapy services.

The applicant applied to the Licence Appeal Tribunal to dispute the denial.

The Tribunal found that the applicant failed to commence the application within the two-year limitation period under s. 56 of the Schedule, as the limitation period was triggered by the initial clear and unequivocal denial, not a subsequent explanation of benefits following insurer's examinations.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act.

Consequently, the claim for the treatment plan was statute-barred, rendering the issue of the Minor Injury Guideline moot and disentitling the applicant to interest.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, specifically non-earner benefits.

The respondent insurer raised a preliminary issue, arguing the applicant was barred from proceeding because he failed to submit an Election of Income Replacement, Non-Earner or Caregiver Benefit form (OCF-10).

The applicant argued that the OCF-1 and OCF-3 provided sufficient information to show he was only eligible for non-earner benefits, making an OCF-10 unnecessary.

The Tribunal found that there was sufficient ambiguity regarding the applicant's potential entitlement to different benefits, making the insurer's request for an OCF-10 valid.

Because the applicant failed to make an election pursuant to section 35 of the Schedule, there was no valid dispute.

The application 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 the applicant failed to establish a psychological impairment warranting removal from the MIG.

The Tribunal also found the applicant did not establish substantive entitlement to non-earner benefits (NEBs) as she failed to demonstrate a complete inability to carry on a normal life.

However, the Tribunal awarded NEBs for a limited period (September 29 to November 20, 2022) due to the respondent's procedural non-compliance with s. 36(4) of the Schedule.

Claims for an award and further interest were dismissed.

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

The insurer raised two preliminary issues: whether the applicant was barred from claiming a non-earner benefit for failing to submit an OCF-10 election, and whether he was barred from all claims for failing to attend an insurer's examination.

The Tribunal held the applicant was barred from pursuing the non-earner benefit because the OCF-1 and OCF-3 indicated potential entitlement to multiple benefits, making the OCF-10 mandatory.

However, the applicant was not barred from pursuing the remaining claims because the insurer's notice of examination failed to provide sufficient medical reasons, rendering it non-compliant with section 44(5) of the Schedule.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found his injuries fell within the Minor Injury Guideline (MIG) and denied his claim for a non-earner benefit (NEB).

The applicant argued the adjudicator made errors of law and acted outside their jurisdiction.

The Tribunal dismissed the request, finding no error of law regarding the evidentiary burden for the NEB claim and refusing to consider a new jurisdictional argument regarding the MIG that was not raised at the original hearing.

The respondent's request for costs was also denied.

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

The respondent denied benefits on the basis that the applicant was in the course of his employment at the time of the accident and was entitled to WSIB benefits.

The applicant failed to file submissions or evidence for the written hearing.

The Tribunal found that the applicant was deemed an employee by the WSIB, had not opted out of WSIB benefits to pursue a tort claim, and was therefore precluded from receiving accident benefits under s. 61 of the Schedule.

The application was dismissed.

The applicant requested a reconsideration of a preliminary issue decision that found her application for accident benefits statute-barred under s. 61 of the Schedule.

The applicant argued the Tribunal made errors of law and fact regarding her employment status at the time of the accident and her entitlement to WSIB benefits.

The Tribunal dismissed the request, finding that the applicant was attempting to re-argue her case and failed to establish any errors of law or fact under Rule 18.2.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries—including chronic pain and psychological impairments—warranted removal from the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found the applicant's evidence, which relied heavily on subjective self-reporting without sufficient objective medical documentation or validity testing, failed to establish chronic pain or severe psychological injury.

The Tribunal concluded the injuries were predominantly minor and subject to the $3,500 MIG limit.

The disputed treatment plans were deemed reasonable and necessary only up to the remaining MIG limit.

The claim for a special award was dismissed as there was no evidence the insurer acted unreasonably.