Diana Oliveira

The applicant sought a reconsideration of a Licence Appeal Tribunal decision that denied her claim for an income replacement benefit (IRB), interest, and an award under Regulation 664.

The applicant argued the Tribunal acted outside its jurisdiction, violated procedural fairness, and made errors of fact and law by conducting its own assessment of the medical evidence rather than deferring to the disability certificate or insurer's examination.

The Vice-Chair dismissed the request, finding that the Tribunal has the statutory jurisdiction to determine benefit entitlement and did not err in its weighing of the evidence.

The reconsideration request was deemed an attempt to re-litigate the original case.

The applicant was injured in a motor vehicle accident while in the course of her employment.

She applied for accident benefits, but the insurer argued she was statute-barred under s. 61 of the Statutory Accident Benefits Schedule because she was entitled to WSIB benefits.

The applicant claimed she had elected to pursue a tort action, which would allow her to claim accident benefits under the s. 61(2) exception.

The Tribunal found that the applicant's election to sue in tort was not made in good faith, noting significant delays in pursuing the tort action, failure to notify the WSIB promptly, and ongoing appeals for WSIB benefits.

The Tribunal concluded the tort election was made solely for the purpose of claiming accident benefits, rendering her statute-barred.

The application was dismissed.

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

The respondent insurer denied the benefits after an insurer's examination found no residual physical impairments.

The Tribunal found that the applicant failed to prove on a balance of probabilities that she suffered a substantial inability to perform the essential tasks of her employment as a cashier.

The Tribunal relied on the objective findings of the respondent's physiatrist and noted the applicant had returned to work and travelled extensively post-accident.

The application for IRBs, a special award, and interest was dismissed.

The respondent's request for costs was also dismissed.

The applicant was injured in a motor vehicle accident and sought payment for the balance of a physiotherapy treatment plan and a plastic surgery assessment.

The respondent denied the claims on the basis that they were not reasonable and necessary.

The Tribunal found that the balance of the physiotherapy plan, specifically for massage therapy, was reasonable and necessary for pain relief, preferring the evidence of the applicant's medical assessor.

However, the Tribunal dismissed the claim for the plastic surgery assessment, finding no compelling medical evidence to justify the referral.

Interest was awarded on the overdue physiotherapy payments.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, which the insurer denied or partially approved based on the Minor Injury Guideline.

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

The Tribunal found that the applicant was entitled to payment for a physiatry assessment, as well as interest on overdue payments for psychological and physiotherapy treatments.

Furthermore, the Tribunal awarded the applicant $1,500 under s. 10 of O. Reg. 664, finding that the insurer unreasonably withheld and delayed the payment of the applicant's income replacement benefit and psychological treatment.

The applicant brought a motion to remove an issue regarding the repayment of $7,910.00 in non-earner benefits from the hearing, arguing it should be the subject of a separate application by the respondent.

The Tribunal dismissed the motion, finding it lacked jurisdiction to set aside a Case Conference Order on a motion, and noted the proper procedure was a request for reconsideration.

However, to ensure procedural fairness, the Tribunal ordered the respondent to provide particulars regarding the limitation period and any allegations of fraud or wilful misrepresentation.