Geoffrey Keating

The applicant sought statutory accident benefits after slipping and falling on black ice in a parking lot while reaching to unlock her vehicle.

The respondent brought a motion for a preliminary issue hearing to determine whether the incident constituted an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal applied the two-part purpose and causation test.

While the purpose test was conceded, the Tribunal found the incident failed the causation test.

The ice on the ground was an independent intervening event and the dominant feature of the incident, breaking the chain of causation from the use or operation of the vehicle.

The application was dismissed.

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

The insurer denied certain treatment plans and income replacement benefits (IRBs), arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's soft-tissue injuries were predominantly minor and that his reported chronic pain did not cause a functional impairment sufficient to remove him from the MIG.

Consequently, the disputed treatment plans were denied as they exceeded the MIG funding limit.

While the applicant qualified for IRBs, the claim was dismissed because he failed to provide sufficient financial documentation to calculate the quantum of the benefit.

The respondent insurer sought reconsideration of a decision finding that the applicant's injuries fell outside the Minor Injury Guideline (MIG) due to a pre-existing condition.

The insurer argued the Tribunal erred in law by failing to identify the specific accident-related minor injury and by failing to analyze how the pre-existing condition prevented maximal recovery.

The Tribunal dismissed the request, finding that the original decision adequately identified the exacerbation of a subluxated coccyx as the accident-related injury and sufficiently analyzed the evidence regarding its impact on recovery.

The applicant sought entitlement to a social work assessment and occupational therapy services following a motor vehicle accident.

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

The Tribunal preferred the respondent's psychological assessment over the applicant's physiatry report regarding the need for a social work assessment, and found insufficient evidence to support the disputed duration of occupational therapy sessions.

The applicant sought an extension of time to file a request for reconsideration of a preliminary issue decision that barred his claim for attendant care benefits.

The applicant's former counsel had removed herself from the record the day before submissions were due, leaving the applicant unrepresented and unaware of the decision.

The Tribunal granted the motion, finding that the applicant had a bona fide intention to appeal and that denying the extension would result in a denial of procedural fairness.

The applicant sought a medical benefit of $2,028.78 for physiotherapy under the Statutory Accident Benefits Schedule.

The applicant claimed he sustained a shoulder injury from providing massage and care to his wife, who was injured in an automobile accident three years prior.

The respondent denied the claim on the basis that the applicant was not involved in an accident and the treatment was not reasonable and necessary.

The Tribunal found that the applicant failed to meet the 'but for' test for causation, as his injury was not directly caused by an automobile accident.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) from the respondent insurer.

The adjudicator found that the applicant had returned to work on a full-time basis with unmodified duties prior to the start of her claim for IRBs.

The medical evidence, including the insurer's examinations, did not support a finding that the applicant suffered a substantial inability to perform the essential tasks of her employment.

The application for IRBs and interest was dismissed.

The applicant sought statutory accident benefits, including an income replacement benefit and medical/rehabilitation benefits, following a 2015 motor vehicle accident.

The Licence Appeal Tribunal found the applicant failed to prove a substantial inability to perform the essential tasks of his employment, noting he returned to work for over a year post-accident and his work stoppage coincided with the sale of his employer's business.

The Tribunal also denied the claimed medical benefits, finding the applicant's shoulder and knee issues were degenerative or unrelated to the accident, and the psychological assessment lacked evidentiary weight.

The application was dismissed in its entirety.

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

The central issue was whether the applicant's injuries fell within the Minor Injury Guideline (MIG).

The adjudicator found that the applicant's pre-existing coccygeal injury would prevent maximal recovery if limited to the MIG, thereby removing her from its limits.

The adjudicator approved three of the four proposed physiotherapy treatment plans as reasonable and necessary, noting the applicant's consistent attendance and reported improvement.

However, the claim for a psychological assessment was denied because the applicant failed to establish that her psychological impairments were caused by the accident rather than pre-existing personal and social history.

Interest was awarded on the approved treatment plans.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to dental services and psychological services.

The Licence Appeal Tribunal dismissed the application.

The Tribunal found the applicant failed to prove on a balance of probabilities that his dental issues were caused by the accident, preferring the respondent's dental assessment over the applicant's dental surgeon's letter.

The Tribunal also denied the unapproved portion of a treatment plan for psychological services, finding the respondent's approved hourly rate of $100 for a psychotherapist was reasonable and the applicant failed to justify a higher rate or the necessity of additional administrative fees.

Claims for an award and interest were consequently dismissed.

The applicant sought statutory accident benefits after slipping and falling on ice in a parking lot while in the process of exiting his vehicle.

The respondent denied the claim on the basis that the incident did not meet the definition of an 'accident' under the Statutory Accident Benefits Schedule.

The Tribunal found that while the incident satisfied the purpose test, it failed the causation test because the icy parking lot was an intervening act and not a foreseeable risk of motoring.

As the incident was not an accident, the applicant was not entitled to benefits or an award for unreasonable delay.

The application was dismissed.

The applicant sought reconsideration of a LAT decision that denied her claims for psychological, chiropractic, and massage therapy benefits.

She argued the adjudicator erred in fact and law, violated procedural fairness, and sought to introduce a new letter from her supervising psychologist to validate her psychological assessment report.

The adjudicator waived the late filing of the reconsideration request but dismissed it on the merits.

The adjudicator found the new letter did not meet the test for new evidence and would not have changed the outcome, as the original decision reasonably relied on the applicant's own statements to the insurer's assessor that she did not want or need the claimed treatments.

The applicant insurer sought repayment of $3,408.40 in medical and rehabilitation benefits paid to the respondent following a motor vehicle accident.

The insurer argued the respondent made a willful misrepresentation by failing to disclose that the accident occurred during the course of her employment, which would have entitled her to WSIB benefits instead.

The respondent also failed to commence a third-party action after electing to do so, which would have exempted her from the WSIB requirement.

The Tribunal found the respondent made willful misrepresentations and ordered her to repay the benefits with interest.

The insurer's request for costs was denied as the respondent's non-participation did not frustrate the proceedings.

The respondent insurer requested a reconsideration of a previous Tribunal decision that awarded the applicant various medical and rehabilitation benefits, including physical therapy, a chronic pain assessment, a chronic pain program, and a disability certificate.

The insurer alleged several factual and legal errors, including the Tribunal's treatment of expert evidence and the legal test applied.

The adjudicator dismissed the request, finding that while there were minor errors in the original decision, none were significant enough that they would have likely led to a different result.

The adjudicator also clarified that under s. 25(1) of the Schedule, an insurer is not required to request a disability certificate before it becomes payable.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming for dietician services, rehabilitation support worker services, and physiotherapy.

The insurer denied the benefits based on an insurer's examination concluding the applicant had reached maximum medical improvement.

The Licence Appeal Tribunal found the insurer's medical evidence flawed and accepted the applicant's evidence that accident-related weight gain was a barrier to recovery, granting the dietician and physiotherapy claims.

The claim for a rehabilitation support worker was dismissed as the proposed services were not clearly linked to the expert's recommendations.

The applicant sought medical benefits for chiropractic and physiotherapy treatment plans following a motor vehicle accident.

The applicant argued the insurer failed to provide proper notice of denial under s. 38(8) of the Statutory Accident Benefits Schedule.

The Tribunal found the insurer's denials were timely and contained sufficient medical reasons.

On the merits, the Tribunal held the applicant failed to meet his evidentiary burden to establish the treatment plans were reasonable and necessary, noting a lack of medical evidence and a failure to account for a post-accident shoulder fracture.

The claims for benefits, an award, and costs were dismissed.

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

The respondent denied certain treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit was exhausted.

The applicant argued his injuries were outside the MIG due to a concussion and chronic pain syndrome.

The Tribunal found the medical evidence did not support a diagnosis of concussion or chronic pain syndrome, preferring the evidence of neurologists over the family physician.

The Tribunal concluded the applicant sustained predominantly minor injuries, and since the MIG limit was exhausted, the disputed treatment plans were not payable.

The application was dismissed.

The applicant sought payment for a physiotherapy treatment plan in the amount of $2,580.63 following a motor vehicle accident.

The respondent denied the benefit, stating that the injuries should have reached maximum medical recovery after two years.

The Tribunal found that the respondent's denial did not provide proper medical reasons as required by s. 38(8) of the Schedule.

Consequently, under s. 38(11), the respondent was ordered to pay for the treatment plan.

The Tribunal also awarded $250.00 under s. 10 of O. Reg. 664 for the respondent's unreasonable delay and deficient notice.

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

The respondent initially denied several treatment plans but reversed its decision prior to the hearing.

The sole issue at the hearing was whether the applicant was entitled to an award under Ontario Regulation 664 for unreasonable delay or withholding of payments.

The Tribunal found that the respondent's reliance on medical assessments and subsequent reversal of its position did not constitute unreasonable behaviour.

The application for an award was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found his psychological injuries fell outside the Minor Injury Guideline (MIG) but denied funding for physical treatment plans.

The applicant argued the adjudicator erred in law and fact by omitting evidence and misinterpreting statutory requirements.

The adjudicator dismissed the reconsideration request, finding no error of law or fact.

The applicant had failed to meet his onus to prove entitlement to the physical treatment plans, as he did not identify specific components of the plans or submit them for the hearing.