Emily Schatzker

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

The insurer denied the claim for non-earner benefits on the basis that the applicant had returned to work.

The applicant filed an application with the Tribunal six years after the initial denial, well beyond the two-year limitation period under s. 56 of the Schedule.

The Tribunal found that the insurer's denial notices were valid and triggered the limitation period.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act, noting the substantial delay, lack of evidence regarding a bona fide intention to appeal, and prejudice to the insurer.

The application was dismissed.

The respondent insurer raised a preliminary issue that the applicant was barred from proceeding with her application for statutory accident benefits because she failed to dispute the denial of benefits within the two-year limitation period under s. 56 of the Schedule.

The applicant argued the denial notices were invalid because the insurer failed to request an election of benefits.

The Tribunal found the denial notices were clear and unequivocal, triggering the limitation period.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act, finding a substantial delay of 24 months, prejudice to the insurer, and no evidence of a bona fide intention to appeal within the time limit.

The application was dismissed.

The insurer requested a reconsideration of a previous Licence Appeal Tribunal decision that found the claimant partially entitled to a treatment plan for catastrophic (CAT) assessments, specifically physiatry, occupational therapy, and psychological assessments, along with an overall summary.

The insurer argued that the adjudicator erred in law by not applying the doctrine of res judicata to the physiatry and occupational therapy assessments, given a prior Tribunal finding that the claimant's chronic pain and physical impairments were not caused by the accident.

The adjudicator agreed that an error of law was made in the application of issue estoppel, as the prior findings were material facts that could not be relitigated.

The adjudicator granted the reconsideration, varied the previous decision, and found that the claimant was not entitled to the physiatry and occupational therapy assessments or the overall summary analysis.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming psychological impairments that warranted removal from the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered an accident-related psychological impairment, preferring the evidence of the respondent's psychiatric assessor and the applicant's treating psychiatrist over the applicant's psychological assessor.

The Tribunal also found that the respondent's denial of a treatment plan was timely and compliant with the notice requirements under s. 38(8) of the Schedule.

The application was dismissed, and the applicant was held to the MIG limits.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing her injuries warranted removal from the Minor Injury Guideline (MIG) due to a pre-existing condition and chronic pain.

The Licence Appeal Tribunal found that the applicant failed to provide compelling medical evidence that her pre-existing neck and back pain precluded maximal recovery within the MIG.

Furthermore, the applicant did not establish chronic pain, as the independent orthopedic assessment lacked sufficient explanation and she failed to meet the criteria under the AMA Guides.

The Tribunal concluded the injuries were predominantly minor, dismissing the claims for an orthopedic assessment and interest.

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

The applicant claimed she suffered from psychological injuries and chronic pain warranting removal from the MIG.

The Tribunal found the applicant failed to establish on a balance of probabilities that she suffered a psychological injury or chronic pain with functional impairment caused by the accident.

The medical evidence, including a psychological screening report and imaging, was insufficient to support her claims.

The application was dismissed, and the applicant was found not entitled to the disputed treatment plans, interest, or an award.

The applicant sought statutory accident benefits following a motor vehicle accident, including a declaration that her injuries exceeded the Minor Injury Guideline (MIG) and entitlement to a chiropractic treatment plan.

The respondent brought a preliminary motion to dismiss the application on the basis of res judicata, arguing the MIG issue had been decided in a previous Tribunal hearing.

The Tribunal found that the preconditions for issue estoppel were met regarding the MIG issue and declined to waive the doctrine, as the applicant's new medical records did not constitute fresh evidence that would conclusively impeach the original result.

Because the applicant remained within the MIG, the Tribunal did not consider the reasonableness and necessity of the treatment plan, which proposed amounts outside the MIG limit.

Claims for an award, interest, and costs were dismissed.

The applicant insurer sought repayment of $41,212.00 in income replacement benefits paid to the respondent, alleging wilful misrepresentation of his employment status.

The respondent did not participate in the written hearing.

The Tribunal found that the respondent misrepresented his employment status by working while claiming not to be, and by failing to produce required financial documents.

The Tribunal ordered the respondent to repay the full amount of $41,212.00 plus interest pursuant to section 52 of the Statutory Accident Benefits Schedule.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming physical and psychological impairments that warranted removal from the Minor Injury Guideline (MIG) and entitlement to a non-earner benefit, a treatment plan, and an award for unreasonable delay.

The respondent denied the benefits, relying on section 44 assessments.

The Tribunal found that the applicant's physical injuries were predominantly minor sprains and strains, and that his knee pain and psychological issues were pre-existing and not aggravated by the accident.

The Tribunal concluded the applicant did not suffer a complete inability to carry on a normal life and remained subject to the MIG.

The application was dismissed in its entirety.

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

She submitted her application for benefits (OCF-1) 10 months after receiving the application package.

The respondent denied benefits and argued the application was statute-barred.

The Tribunal found that the applicant failed to provide a reasonable explanation for the delay, as her reasons regarding her son's health and family bereavements did not adequately explain the 10-month delay.

The application was dismissed pursuant to section 55(1) of the Schedule.

The applicant, a cyclist intentionally struck by a vehicle, sought statutory accident benefits for occupational therapy and chiropractic services, as well as a special award for unreasonable delay.

The Licence Appeal Tribunal partially approved the occupational therapy plan, finding it reasonable and necessary based on a contemporaneous psychiatric report diagnosing severe PTSD and depression.

The chiropractic plan was denied due to a lack of corroborating contemporaneous medical evidence.

The claim for a special award was dismissed as the insurer's denial was not found to be unreasonable.

The applicant sought statutory accident benefits following a motor vehicle accident, including funding for chiropractic services, a concussion assessment, a psychological assessment, and attendant care assessments.

The insurer denied the treatment plans.

The Tribunal found that the applicant failed to prove on a balance of probabilities that the disputed treatment plans were reasonable and necessary.

The medical evidence indicated the applicant's accident-related injuries were primarily soft tissue strains that had resolved, and her ongoing complaints were attributed to a subsequent fall at home.

The application was dismissed, and claims for interest and a special award were denied.

The applicant requested a reconsideration of a previous Licence Appeal Tribunal decision that denied her entitlement to a treatment plan for vestibular physiotherapy.

The applicant argued the Tribunal erred in law by applying the incorrect legal test for res judicata.

The Adjudicator agreed, finding that the previous decision relied on an incorrect four-part test rather than the binding three-part test from the Supreme Court of Canada, and failed to properly analyze whether the same issue had been previously decided.

Upon reconsidering the merits, the Adjudicator found the applicant was partially entitled to the treatment plan in the amount of $2,697.28, as the treatment was reasonable and necessary for her accident-related post-concussion symptoms, though costs incurred prior to the plan's submission were excluded under s. 38(2) of the Schedule.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including non-earner benefits and various treatment plans.

The respondent insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant failed to establish that he suffered a concussion, a pre-existing condition, a psychological injury, or chronic pain that would warrant removal from the MIG.

The Tribunal also found that the applicant did not meet the test for non-earner benefits, as he failed to demonstrate a complete inability to carry on a normal life.

The application was dismissed.

The applicant sought $14,750.81 for a catastrophic impairment assessment following a 2019 motor vehicle accident.

The respondent denied the treatment plan and argued that the issue of the applicant's chronic pain was res judicata based on a prior Tribunal decision.

The Tribunal found that res judicata did not apply as the issues were different and the prior decision did not address the cost of a catastrophic assessment.

The Tribunal partially approved the treatment plan, finding the physiatry, psychological, and occupational therapy assessments reasonable and necessary, but denied the costs for clinic file reviews, transportation, and interpretation.

The applicant was awarded $8,400.00 plus interest, but the claim for a special award under s. 10 of Regulation 664 was dismissed.

The moving defendants sought an order requiring the plaintiff to post security for costs under Rule 56.01(1)(b) and (e) of the Rules of Civil Procedure, arguing that the plaintiff had another proceeding for the same relief pending in Ontario and that the action was frivolous and vexatious with insufficient assets to pay costs.

The court found that the plaintiff currently had sufficient assets to satisfy any costs award and dismissed the motion for security for costs.

The court also declined to consider the plaintiff’s cross-motion to strike portions of the affidavits and made no order as to costs.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing for removal from the Minor Injury Guideline (MIG) due to a psychological condition and physical injuries.

The Tribunal found that the applicant's physical injuries were minor sprains and strains.

The Tribunal also placed less weight on the applicant's psychological assessment due to inconsistencies between test scores and the severity of the diagnosis, concluding the applicant did not sustain a psychological impairment warranting removal from the MIG.

The applicant was found entitled to treatment up to the MIG limits, but claims for interest and a section 10 award were dismissed.

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

The Tribunal found that the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG), as there was insufficient evidence of chronic pain or psychological impairment.

However, the Tribunal ordered the respondent to pay a $3,782.56 treatment plan for chiropractic services because the respondent's denial notice failed to comply with s. 38(8) of the Schedule by not adequately explaining the MIG.

Claims for a $110 invoice and a section 10 award were dismissed.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident.

The respondent denied various treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued for removal from the MIG due to chronic pain and a psychological condition.

The Tribunal found insufficient medical evidence to support chronic pain with functional impairment or a psychological condition, noting a subsequent 2019 accident and a lack of continuous medical documentation.

The application was dismissed, and claims for treatment plans, a special award, and interest were denied.

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

The applicant argued he suffered from chronic pain and psychological impairments warranting removal from the MIG, relying on reports from an orthopaedic surgeon and a psychologist.

The Tribunal found the applicant did not provide compelling medical evidence to support a diagnosis of chronic pain or psychological impairment, noting that the family physician's records indicated the accident-related issues had resolved.

As the applicant's injuries were predominantly minor and the $3,500 MIG limit had been exhausted, the claims for additional treatment plans and interest were dismissed.