Jennifer M. Cosentino

The respondent insurer requested a reconsideration of a Tribunal decision that found the applicant entitled to an income replacement benefit.

The applicant, a pedestrian, was struck by a driver whose insurance policy with the respondent had expired.

The respondent argued the Tribunal acted outside its jurisdiction by effectively deciding a priority dispute and erred in finding the applicant was an 'insured person'.

The Tribunal dismissed the reconsideration request, finding no jurisdictional error or error of law.

It affirmed that the original decision correctly applied the 'nexus' test from Kingsway, establishing that the applicant's reliance on information that the driver was insured by the respondent created a sufficient connection to require the respondent to adjust the claim pending any priority dispute.

The applicant was struck by a vehicle as a pedestrian and applied for statutory accident benefits from the respondent, who insured the vehicle.

The respondent denied the claim on the basis that the policy had expired prior to the accident.

The Tribunal found that a sufficient nexus existed between the applicant and the respondent, requiring the respondent to adjust the claim and pay benefits pending any priority dispute.

The Tribunal awarded the applicant an income replacement benefit for the period he was off work due to his injuries, but denied his claims for chiropractic services and an ambulance fee due to insufficient evidence.

The applicant sought statutory accident benefits after an incident where her shopping cart struck a trolley of plants outside a grocery store, causing the trolley to fall.

The respondent denied benefits on the basis that the incident was not an 'accident' under s. 3(1) of the Schedule.

The Licence Appeal Tribunal found that while the applicant was using her vehicle for the ordinary purpose of grocery shopping, the use or operation of the vehicle did not directly cause her injuries.

The falling trolley was an intervening act and the dominant feature of the incident.

The application was dismissed.

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

The Licence Appeal Tribunal considered whether the applicant was entitled to psychological and physiotherapy services, interest, and an award under s. 10 of Reg. 664.

The Tribunal denied the claim for psychological services, finding the proposed treatment was not reasonable and necessary given the lack of lasting improvement.

However, the Tribunal granted the claim for physiotherapy services, noting corroborating evidence of chronic pain from treating specialists.

The claim for an award under s. 10 was dismissed as the insurer's conduct was not unreasonable.

The applicant sought entitlement to statutory accident benefits for an occupational therapy assessment, social worker counselling, and chiropractic services following a motor vehicle accident.

The applicant argued the respondent's denial notices were procedurally defective under s. 38(8) of the Schedule.

The Tribunal found that while one denial was late, the applicant failed to prove the expenses were incurred during the period of non-compliance.

The Tribunal concluded the respondent's notices provided clear medical reasons for the denials, relying on insurer's examinations.

As the applicant made no submissions on the substantive reasonableness and necessity of the treatment plans, the application was dismissed.

The applicant sought statutory accident benefits following a 2012 motor vehicle accident, claiming a catastrophic impairment due to a mental or behavioural disorder under Criterion 8 of the Schedule.

The respondent denied the claim.

The Licence Appeal Tribunal found the applicant's expert evidence unpersuasive, noting inconsistencies in the applicant's self-reporting regarding his work history, social activities, and medical history.

Preferring the respondent's multidisciplinary assessments, the Tribunal concluded the applicant suffered only mild to moderate impairments and did not meet the threshold for catastrophic impairment.

The application was dismissed.

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

The Licence Appeal Tribunal found the applicant was entitled to a driving reintegration assessment because the insurer failed to provide a clear and unequivocal denial with sufficient medical reasons, rendering the plan payable once incurred.

However, a physiotherapy treatment plan was denied as not reasonable and necessary, with the adjudicator preferring the contemporaneous medical opinion that the applicant had reached maximal medical improvement.

Additional treatment plans for chiropractic care and assistive devices were dismissed because they were properly denied under section 38(5) of the Schedule while the applicant was subject to the Minor Injury Guideline, a refusal not subject to review.

Claims for an award and interest were also dismissed.

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

The respondent denied various treatment plans, and the applicant applied to the Licence Appeal Tribunal.

The Tribunal found that the applicant's claim for a psychological assessment was statute-barred because he failed to dispute the respondent's clear and unequivocal partial denial within the two-year limitation period under s. 56 of the Schedule.

Regarding the substantive issues, the Tribunal held that the applicant failed to meet his burden of proving that the disputed treatment plans for physiotherapy, botox injections, occupational therapy, and psychological services were reasonable and necessary.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits, physiotherapy, medical cannabis, an emotional support dog, and home modifications.

The Tribunal found that the applicant was not entitled to attendant care benefits, physiotherapy, or home modifications, as they were not reasonable and necessary based on the medical evidence.

However, the Tribunal found that the applicant was entitled to reimbursement for incurred medical cannabis expenses to manage her chronic pain syndrome, and to an emotional support dog to address her accident-related anxiety, as she had already attempted frontline treatments.

The Tribunal awarded interest on the overdue payments but declined to grant an award under s. 10 of O. Reg. 664, finding no unreasonable delay by the insurer.

The applicant was injured in a rear-end motor vehicle collision and sought statutory accident benefits for a chronic pain assessment and physiotherapy.

The insurer denied the treatment plans.

The Tribunal found the chronic pain assessment was reasonable and necessary, relying on the applicant's family physician and the AMA Guide criteria for chronic pain syndrome.

However, the Tribunal dismissed the claim for physiotherapy, accepting the insurer's physiatry expert opinion that the applicant had already benefitted from facility-based treatment and would benefit more from home-based exercise.

Interest was awarded on the overdue payment for the chronic pain assessment.

The applicant sought statutory accident benefits following a motor vehicle accident but failed to attend the scheduled videoconference hearing or provide any submissions or evidence.

The Licence Appeal Tribunal proceeded in the applicant's absence under the Statutory Powers Procedure Act.

Due to the lack of evidence, the applicant failed to meet his onus, and all claims for benefits were dismissed.

The Tribunal found the applicant's failure to communicate his intention to abandon the application to be unreasonable and awarded $500 in costs to the respondent.

The plaintiff brought a motion to amend her statement of claim to add a claim for punitive and aggravated damages, nearly 12 years after the motor vehicle accident and after the action had been set down for trial and case managed for two years.

The court dismissed the motion, finding that the egregious delay led to a presumption of non-compensable prejudice to the defendant, making it inappropriate to grant the amendment on the "eve of trial."

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming costs for a psychological assessment, a chronic pain assessment, and a chronic pain program.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove on a balance of probabilities that the proposed treatment plans were reasonable and necessary.

The Tribunal preferred the evidence of the insurer's experts, noting a lack of corroborative evidence for chronic pain syndrome and failure to demonstrate functional impairment under the AMA Guides.

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

The respondent initially paid benefits based on reported employment but terminated them after an insurer's examination and due to outstanding information regarding other alleged employment.

The Tribunal found that the applicant's evidence regarding his pre- and post-accident income, including tax returns and banking records, was inconsistent, unverified, and incomplete.

Preferring the evidence of the respondent's forensic accountant, the Tribunal concluded that the applicant failed to meet his onus to provide reliable information upon which an income replacement benefit could be calculated.

The application was dismissed.

The applicant sought various medical and rehabilitation benefits following a 2019 motor vehicle accident.

The Tribunal found the applicant was removed from the Minor Injury Guideline due to a psychological impairment, entitling her to an in-home assessment.

However, claims for a chronic pain assessment, physiatry assessment, and physiotherapy were dismissed as the applicant failed to prove they were reasonable and necessary, largely due to a lack of objective medical evidence and failure to produce pre-accident records.

A claim for the balance of a psychological treatment plan was also dismissed because the provider was a psychotherapist, not a psychologist, and the insurer's lower hourly rate was deemed reasonable.

Claims for an award and costs were dismissed.

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

The respondent denied medical benefits beyond the $3,500 limit, determining the injuries fell within the Minor Injury Guideline.

The applicant argued she suffered from chronic pain and psychological impairments exceeding the minor injury definition.

The Tribunal found the applicant failed to meet her evidentiary onus, as the medical evidence did not establish chronic pain or psychological impairments.

The application for treatment plans and an award for unreasonably withheld benefits was dismissed.

The applicant sought payment for three assessments (two psychological and one physiatry) following a motor vehicle accident.

The Tribunal dismissed the claims for the psychological assessments, finding them to be a duplication of services and noting the applicant failed to provide evidence or submissions demonstrating they were reasonable and necessary.

The Tribunal dismissed the claim for the physiatry assessment for lack of jurisdiction, as the treatment plan had not been submitted or denied prior to the application being filed.

Claims for interest and an award were also dismissed.

The applicant, a pedestrian struck by a vehicle in a parking lot, sought entitlement to attendant care benefits and various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal found the applicant entitled to a reduced attendant care benefit for a limited period, preferring the respondent's occupational therapy assessment which accounted for the applicant's right-hand dominance.

The Tribunal also approved treatment plans for chiropractic and physiotherapy services, finding them reasonable and necessary for pain relief.

However, claims for an orthopaedic mattress, extended psychological sessions, occupational therapy, and transportation expenses were dismissed due to non-attendance at an insurer's examination, lack of justification, and statutory limitations.

The applicant sought various statutory accident benefits following a motor vehicle accident, including attendant care benefits and multiple treatment plans for psychological and physical injuries.

The Licence Appeal Tribunal denied the claim for attendant care benefits because the applicant failed to prove the expenses were incurred.

However, the Tribunal ordered the insurer to pay for several treatment plans, including a psychological assessment and physical therapy, because the insurer failed to provide proper medical reasons for its denials as required by section 38(8) of the Schedule.

The Tribunal also approved a chronic pain assessment and shockwave therapy based on medical evidence of ongoing pain, but denied other treatment plans for lack of evidence of reasonableness and necessity.

The claim for a special award was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The parties disputed the quantum of the income replacement benefit (IRB), entitlement to various medical and rehabilitation benefits, transportation costs, and a special award.

The Tribunal determined the correct IRB quantum was $297.88 per week, finding the insurer's calculation incorrectly identified the start of the 52-week pre-accident period.

The Tribunal granted the cost of a hydrotherapy treatment plan and transportation expenses, finding them reasonable and necessary.

However, the Tribunal denied a physiotherapy treatment plan and the remainder of an in-home assessment, concluding the applicant had reached maximum medical improvement for facility-based treatment.

The claim for a special award was dismissed as the insurer did not unreasonably withhold or delay payments.