Jessica L.J. Rogers

The applicant was injured in a motor vehicle accident and sought payment for various treatment and assessment plans, including psychological services, chiropractic services, assistive devices, an EMG assessment, and a dietary assessment.

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

The Tribunal noted issues with duplicative treatments, lack of medical evidence supporting the necessity of the plans, and non-compliance with the Professional Services Guideline.

Claims for interest and a section 10 award were also dismissed.

The applicant sought payment for the balance of three treatment plans for psychological services following a motor vehicle accident.

The respondent had partially approved the plans at an hourly rate of $99.75 for a psychotherapist, while the applicant claimed entitlement to the psychologist rate of $149.61 per hour.

The Tribunal found that the applicant failed to prove the treating qualifying registered psychotherapist provided equivalent treatment to a psychologist or required the higher rate.

The application for the balance of the treatment plans and interest was dismissed.

The applicant was injured in a motor vehicle accident and sought payment for three treatment plans for psychological services.

The respondent partially approved the plans at an hourly rate of $99.75, arguing the services were provided by a qualifying registered psychotherapist rather than a psychologist.

The applicant sought the balance, arguing the provider should be paid at the psychologist rate of $149.61 per hour.

The Tribunal found the applicant failed to prove the higher rate was reasonable and necessary, noting the provider was a qualifying psychotherapist and there was no evidence they provided the equivalent treatment as a psychologist.

The application was dismissed.

The applicant requested reconsideration of a Licence Appeal Tribunal decision that dismissed his claim for outstanding amounts for psychological services.

The applicant argued the Tribunal erred in finding he had not submitted OCF-18 forms detailing the scope of therapy, which were crucial to determining his treating psychotherapist's entitlement to a higher hourly rate.

The Vice-Chair found that the OCF-18 forms had indeed been submitted with the applicant's reply, and this error of fact likely affected the outcome.

The request for reconsideration was granted, the original decision was cancelled, and the matter was ordered to be reheard by a new adjudicator based on the existing written record.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claim for outstanding amounts for psychological services.

The applicant argued the Tribunal erred in finding she had not submitted OCF-18 forms and sought to introduce new evidence regarding her psychotherapist's qualifications.

The Vice-Chair found that the Tribunal made a factual error by overlooking the OCF-18 forms submitted with the applicant's reply, which detailed the scope of therapy.

The request for reconsideration was granted, the original decision was cancelled, and the matter was ordered to be reheard by a new adjudicator based on the original written record.

The applicant sought payment for psychological services at the psychologist rate of $149.62 per hour, while the respondent approved the services at a rate of $99.75 per hour, arguing the provider was a qualifying psychotherapist.

The Tribunal found that the applicant failed to provide evidence demonstrating that the work performed by the qualifying psychotherapist was essentially the same as that of a psychologist or that the provider was qualified to provide cognitive behavioural therapy.

The application for the disputed amounts and interest was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming the psychologist hourly rate ($149.62) for psychological treatment plans.

The respondent insurer approved the plans but only at a rate of $99.75 per hour, arguing the services were provided by a qualifying psychotherapist, not a psychologist.

The Tribunal found that the applicant failed to prove the psychotherapist was performing work essentially similar to a psychologist or was qualified to provide cognitive behavioural therapy.

The application was dismissed, and the respondent's approved rate was deemed reasonable.

The applicant sought payment for the balance of an hourly rate for psychological services under the Statutory Accident Benefits Schedule.

The insurer had approved a treatment plan for services to be provided by a psychologist at $149.61 per hour.

However, the services were actually provided by a registered social worker.

The insurer paid $100 per hour, its customary rate for a social worker.

The Tribunal found that the treatment provided was a material deviation from the approved plan and that no treatment plan had been submitted for the social worker's services.

Under s. 38(2) of the Schedule, the insurer was not liable for the additional amount.

The application was dismissed.

The applicant, who has pre-existing non-verbal autism, sought attendant care benefits following a motor vehicle accident, alleging the accident caused increased violent and unpredictable behaviour.

The respondent denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding that the incurred expenses were not for services outlined in the approved Form 1 and that the applicant failed to prove the accident caused the behavioural changes.

The Tribunal preferred the respondent's occupational therapy assessment, which was supported by contemporaneous medical and school records showing significant pre-existing behavioural issues, over the applicant's assessment.

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

The respondent denied benefits, arguing the incident did not meet the definition of an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal applied the purpose and causation tests, finding that while the purpose test was met, the causation test failed.

The Tribunal concluded that the ice was an intervening cause and the dominant feature of the injuries, not the use or operation of the automobile.

The application was dismissed.

The applicant was involved in a motor vehicle accident in 2018 while a minor but did not notify the insurer of her intention to apply for statutory accident benefits until 2022.

The insurer denied benefits due to the delay.

The Licence Appeal Tribunal held that the Limitations Act did not apply to its proceedings and that section 7 of the Licence Appeal Tribunal Act did not apply to the notice requirement under section 32(1) of the Schedule.

Applying the Horvath factors, the Tribunal found the applicant's explanation for the delay was not credible or supported by evidence.

The application was dismissed.

The applicant sought payment for four treatment plans for chiropractic services and other goods following a motor vehicle accident.

The respondent denied the plans based on insurer's examinations concluding the applicant had reached maximum medical recovery.

The Tribunal found that one treatment plan for $1,977.05 was reasonable and necessary to determine if maximum medical recovery had been reached, noting the insurer's assessors failed to review the family physician's clinical notes.

The remaining three treatment plans were dismissed due to a lack of contemporaneous complaints of pain or insufficient evidence justifying their necessity.

The applicant sought statutory accident benefits for psychological services following a motor vehicle accident.

The insurer partially approved the treatment plans, paying an hourly rate of $100.00 for social workers instead of the requested $149.61 rate applicable to psychologists.

The applicant argued the social workers were supervised by a psychologist and specialized in cognitive behavioural therapy.

The Tribunal found insufficient evidence of supervision or specialized training to justify the higher rate.

The application was dismissed, and no interest was payable.

The applicant insurer appealed an arbitration award determining priority for Statutory Accident Benefits following a motor vehicle accident involving a catastrophically injured child.

The child's parents were separated, and the insurers disputed whether the child was principally dependent on her mother or father at the time of the accident.

The arbitrator found the child was principally dependent on her mother, utilizing a 12-month time frame for the dependency analysis rather than the 5.5-week period immediately preceding the accident when the child briefly resided with her father.

The Superior Court of Justice dismissed the appeal, finding no extricable error of law or palpable and overriding error in the arbitrator's determination of the appropriate time frame or assessment of care dependency.

The appellant appealed decisions of the Licence Appeal Tribunal denying his motion to add new issues to his hearing and dismissing his claim for chiropractic treatment benefits.

The Divisional Court dismissed the appeal, finding no error of law or denial of procedural fairness in the Tribunal's refusal to add late issues.

The Court also upheld the Tribunal's finding that the appellant was not entitled to reimbursement for chiropractic treatments because he failed to submit the required treatment plans in advance, as mandated by section 38(2) of the Statutory Accident Benefits Schedule.

The appellant insurer appealed a Licence Appeal Tribunal (LAT) decision requiring it to fund the respondent's catastrophic impairment (CAT) assessment under s. 25(1)5 of the Statutory Accident Benefits Schedule.

The insurer argued it was only required to pay for an assessment completed before the insured submitted their application.

The Divisional Court upheld the LAT's decision, finding that the preparation of an application does not cease once the formal document is submitted, and the insurer must fund any assessment necessary for determining whether the impairment is catastrophic.

The insurer requested a reconsideration of a decision awarding the insured funding for catastrophic impairment assessments.

The insurer argued the adjudicator erred in law by finding the assessments were not true rebuttal reports and were prepared for the purpose of a catastrophic application under s. 45 of the Schedule.

The adjudicator dismissed the reconsideration request, finding no errors of law that would materially affect the outcome.

The adjudicator maintained that the insured's right to be assessed for catastrophic impairment was not exhausted and that the timing of the application did not invalidate the funding request.

The insured's request for costs was also denied.

The applicant was injured in a 2005 motor vehicle accident and sought a catastrophic impairment determination in 2015.

The insurer denied the designation based on its own assessments.

The applicant sought funding for his own catastrophic assessments, which the insurer denied on the basis that the 2010 amendments to the Schedule eliminated funding for rebuttal reports.

The Tribunal held that while the 2010 amendments apply prospectively and eliminated rebuttal report funding, the applicant's requested assessments were actually his first assessments, not true rebuttals.

Denying funding would rob the applicant of his substantive right to be assessed.

The Tribunal found the assessments partially reasonable and necessary, awarding $10,500.00.

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

The respondent insurer denied certain psychological and physiotherapy treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that pre-existing conditions and accident-related psychological injuries precluded recovery within the MIG limits.

The Licence Appeal Tribunal found insufficient evidence of pre-existing conditions or accident-related psychological injuries that would warrant removing the applicant from the MIG.

The Tribunal concluded the applicant sustained predominantly minor injuries, is subject to the $3,500 funding limit, and is not entitled to the disputed benefits or interest.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits for psychological treatment and a chronic pain program.

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

The Tribunal found that the applicant suffered from chronic pain and was entitled to partial payment for both treatment plans.

The rehabilitative components and psychological services were deemed reasonable and necessary, while transportation costs, social work, education elements, and additional progress reports were denied.