Geoffrey L. Keating

The applicant, a pedestrian struck by a vehicle in 2014, sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule after being denied by the respondent insurer.

The Licence Appeal Tribunal found that further physical treatments, including occupational therapy, physiotherapy, and chiropractic services, were not reasonable and necessary, as the applicant had largely recovered from her physical injuries and could manage residual pain with self-directed exercises.

Claims for orthopaedic, neurocognitive, and certain psychological assessments were dismissed as statute-barred under s. 38(2) because they were incurred before the treatment plans were submitted.

However, the Tribunal granted entitlement to a psychological assessment and psychological services, preferring the applicant's expert evidence that she continued to suffer from somatic symptom disorder and adjustment disorder.

Claims for an award and costs were denied due to a lack of submissions.

The applicant sought a determination of catastrophic impairment under criterion 8 of the Schedule following a motor vehicle accident.

The respondent conceded the applicant was catastrophically impaired but argued the impairments pre-dated the accident.

Applying the 'but for' test for causation, the Tribunal found that while the applicant had pre-existing physical limitations and transient depression, he maintained a high level of mental and behavioural functioning and worked full-time prior to the accident.

The Tribunal preferred the evidence of the applicant's treating physician and assessing psychiatrist, concluding the accident triggered a significant decline in function.

The Tribunal held the applicant sustained a catastrophic impairment as a result of the accident.

The applicant sought a $2,200 psychological assessment following a motor vehicle accident, arguing his injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain and psychological impairments.

The Tribunal found the applicant's physical injuries were minor soft tissue injuries that resolved within months, and that his subsequent pain complaints were related to a second accident and a fall.

The Tribunal also rejected the applicant's psychological claims, finding his symptoms arose nearly two years post-accident and were likely caused by situational stressors rather than the subject accident.

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

The applicant sought a non-earner benefit, a special award, and interest following a motor vehicle accident.

The Tribunal applied the test for a complete inability to carry on a normal life, comparing the applicant's pre- and post-accident activities.

Despite some reported pain and adjustments to her routine, the Tribunal found the applicant was still capable of performing most of her pre-accident activities, including working, studying, and personal care.

The Tribunal concluded the applicant did not suffer a complete inability to carry on a normal life and dismissed the application for the non-earner benefit, the special award, and interest.

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

The Tribunal found the applicant was not entitled to IRBs, as she failed to prove a substantial inability to perform the essential tasks of her pre-accident employment.

However, the Tribunal concluded the applicant's injuries fell outside the MIG due to a psychological impairment, preferring the evidence of the applicant's psychologist over the respondent's assessor.

The Tribunal approved a psychological assessment but denied the chiropractic and physiotherapy treatment plans, noting the applicant had previously discontinued such treatments because they were unhelpful.

The applicant sought statutory accident benefits after slipping and falling on ice while exiting her vehicle at a cemetery.

The respondent insurer paid benefits for several years before bringing a motion to determine whether the incident met the definition of an "accident" under s. 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal found that the respondent failed to raise the preliminary issue in a timely manner, as it did not request further information or deny the claim within the timelines prescribed by s. 32 of the Schedule.

In any event, applying the Greenhalgh framework, the Tribunal concluded that the incident was an "accident" because the ongoing activity of exiting the vehicle and the icy conditions were equally dominant features that directly caused the applicant's injuries.

The applicant was involved in a motor vehicle accident and sought various statutory accident benefits from the respondent, including income replacement, medical rehabilitation, and other expenses.

The parties attended a videoconference hearing before the Licence Appeal Tribunal.

At the hearing, the parties settled the issues in dispute on a full and final basis.

The Tribunal closed the file, noting that either party could request to re-open it if the settlement fell through.

The applicant sought additional interest on income replacement benefits and a special award following a motor vehicle accident.

The insurer had paid the benefits and calculated interest at $25.22.

The applicant claimed $50.80 in interest but provided no basis for the calculation.

The Tribunal found no grounds to interfere with the insurer's interest calculation and dismissed the claim for a special award, noting that a one-day delay in responding to a form was not unreasonable.

The insurer's request for costs was also dismissed, as the applicant's failure to produce documents did not amount to unreasonable, frivolous, or vexatious behaviour.

The applicant requested a reconsideration of a Tribunal decision which found she was not involved in an accident.

The applicant argued the Tribunal violated procedural fairness by allowing a preliminary issue hearing and erred in law by improperly applying the causation test.

The adjudicator dismissed the request, finding no exceptional circumstances to permit new arguments regarding procedural fairness and concluding that the original decision correctly applied binding jurisprudence on causation.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of several treatment plans (OCF-18s) for chiropractic and psychological treatment.

The adjudicator found that the applicant failed to prove the treatment plans were reasonable and necessary.

Medical evidence, including records from the applicant's family physician and an insurer's examination, indicated the physical injuries had resolved.

For the psychological treatment, the adjudicator found the requested re-assessments and administrative costs were not justified by the evidence or the FSCO Professional Services Guideline.

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

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 applicant sought reconsideration of a preliminary issue decision that found his claims for attendant care benefits were statute-barred under s. 56 of the Schedule.

The applicant argued he was denied procedural fairness because his former counsel abandoned him right before the hearing and failed to file submissions.

The Tribunal granted the reconsideration, finding that the applicant was unable to participate through no fault of his own.

Furthermore, the Tribunal found it was an error of law to statute-bar the claims, as the pre-emptive denial of benefits before the applicant's condition deteriorated engaged the doctrine of discoverability as set out in Tomec.

The preliminary decision was set aside, and the applicant was permitted to proceed with his claim at a substantive hearing.

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 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 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 attendant care benefits following two motor vehicle accidents.

The insurer denied the claims, and the applicant filed appeals with the Tribunal three and five years later, respectively.

The insurer raised a preliminary issue that the claims were barred by the two-year limitation period under s. 56 of the Schedule.

The applicant's counsel withdrew before submissions were due, and the applicant failed to file any materials.

The Tribunal found the claims were limitation-barred and declined to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act, as the applicant provided no evidence or submissions to support an extension.