Geoffrey L. Keating

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.

The applicant sought entitlement to statutory accident benefits for psychological services, massage therapy, and chiropractic treatment following a motor vehicle accident.

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

The psychological assessment relied upon by the applicant was given little weight because it was unclear whether the supervising psychologist or the psychometrist conducted the clinical interview and made the diagnosis.

The respondent's psychological assessment, which found no impairment warranting a diagnosis, was preferred.

The claims for massage and chiropractic treatment were also dismissed as there was insufficient evidence they would provide relief comparable to physiotherapy.

The application was dismissed.

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

The respondent insurer limited the applicant to the $3,500 Minor Injury Guideline (MIG) funding limit.

The Tribunal found that the applicant suffered accident-related psychological injuries, including depression and anxiety, which removed him from the MIG.

The Tribunal ordered the respondent to pay for a psychological assessment and a psychological treatment plan, plus interest on the incurred assessment, but denied the remaining disputed treatment plans as the applicant failed to prove they were reasonable and necessary.

The applicant, a minor, was injured in a motor vehicle accident and sought medical benefits for occupational therapy, an orthopaedic assessment, and chiropractic services under the Statutory Accident Benefits Schedule.

The respondent insurer denied the treatment plans, arguing the applicant's physical impairments had fully healed.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, noting inconsistencies in the medical evidence and relying on an insurer's examination which concluded the physical impairments had resolved.

The application was dismissed.

The applicant sought a non-earner benefit and a medical benefit following a motor vehicle accident.

The Tribunal found that the insurer failed to provide a compliant denial notice for the non-earner benefit until November 26, 2016, and ordered payment of the benefit from the end of the 26-week deductible period until that date.

However, the Tribunal dismissed the claim for ongoing non-earner benefits, finding the applicant did not suffer a complete inability to carry on a normal life.

The claim for a medical benefit was also dismissed as the proposed treatment was not reasonable and necessary, given the applicant's extensive pre-existing back issues.

A claim for a special award under O. Reg 664 was dismissed.

The applicant sought Non-Earner Benefits (NEBs) and medical benefits following a motor vehicle accident.

The Tribunal found the applicant was not entitled to NEBs because he failed to demonstrate a complete inability to carry on a normal life, as medical evidence showed he continued to participate in substantially all pre-accident activities.

The Tribunal approved a treatment plan for relaxation CDs but denied plans for chiropractic services, finding the latter were not reasonable and necessary given the minimal and short-lasting relief reported.

The claim for an award for unreasonably withheld payments was dismissed.

The applicant sought an income replacement benefit (IRB) and medical benefits for chiropractic services following a motor vehicle accident.

The insurer denied the IRB on the basis that the applicant was not substantially unable to perform his essential work tasks and had not declared income.

The insurer also determined the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant failed to prove entitlement to an IRB, as he provided no medical evidence of inability to work and no financial documentation of pre-accident income.

The Tribunal also held the applicant's injuries were predominantly minor and that he failed to prove the disputed treatment plans were reasonable and necessary.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits from her insurer under the Statutory Accident Benefits Schedule.

The insurer denied several treatment plans, including physiotherapy, psychological and neurological assessments, and a chronic pain program.

The Licence Appeal Tribunal found that the applicant continued to suffer from significant accident-related pain and granted entitlement to the physiotherapy, neurological assessment, disability certificate, chronic pain assessment, chronic pain program, and a portion of the shockwave therapy.

Claims for further psychological assessment and treatment were denied as duplicative or unnecessary given previously approved funding.

The Tribunal declined to order a special award or costs, finding the insurer's adjusting of the file was reasonable.

The respondent insurer requested a reconsideration of a Tribunal decision that removed the applicant from the Minor Injury Guideline (MIG) and awarded various statutory accident benefits, including non-earner benefits (NEBs) and treatment plans.

The insurer argued the Tribunal erred in fact and law on several grounds, including the applicant's failure to attend insurer examinations, the finding of chronic pain, and the start date for NEBs.

The Vice-Chair granted the reconsideration in part, expunging an erroneously awarded expense for clinical notes and records that had been resolved prior to the hearing, and amending the start date for NEBs to six months post-accident based on the applicable pre-June 1, 2016 Schedule.

The request for reconsideration was dismissed on all other grounds, as the insurer was primarily seeking to re-weigh the evidence.