Crystal A. Schulz

The applicant, a resident of China injured in a tour bus crash in Ontario, sought various statutory accident benefits including non-earner benefits, attendant care, and multiple treatment plans.

The Licence Appeal Tribunal denied the non-earner benefits due to the applicant's failure to provide an updated disability certificate as reasonably requested by the insurer.

The Tribunal also denied the attendant care benefits and most of the treatment plans, finding the applicant failed to meet her burden of proving they were reasonable and necessary.

However, the Tribunal approved a treatment plan for psychological services, finding the applicant continued to experience significant psychological symptoms that warranted further treatment.

The claim for a bad faith award was dismissed.

The applicant sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent insurer denied the treatment plans.

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

The Tribunal preferred the evidence of the respondent's assessors, noting credibility issues and a lack of contemporaneous medical evidence supporting the applicant's assessors.

Claims for interest and an award for unreasonable delay were also dismissed.

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

The Licence Appeal Tribunal found that only the physiotherapy treatment plan was reasonable and necessary, relying on the recommendation of the applicant's family physician.

The remaining claims for massage therapy, chiropractic treatment, occupational therapy, a qEEG assessment, and various other expenses were denied due to insufficient medical evidence or because they were incurred prior to the submission of a treatment plan.

The Tribunal also awarded the applicant 10% of the amounts withheld for two psychological treatment plans, finding that the respondent unreasonably delayed funding despite having sufficient evidence to approve them.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that granted the applicant entitlement to two treatment plans.

The respondent argued that the Tribunal breached procedural fairness by relying on the applicant's affidavit evidence after the respondent had waived cross-examination under the mistaken belief that the affidavit was being withdrawn.

The Adjudicator agreed that a significant error of fact and breach of procedural fairness occurred, as the Tribunal had relied heavily on the untested affidavit in its original decision.

The reconsideration was granted, the original decision was cancelled, and a rehearing on written submissions without the affidavit was ordered.

The applicant was injured in a motor vehicle accident and sought a medical benefit for an occupational therapy treatment plan, which the respondent insurer denied.

The Tribunal found that the accident exacerbated the applicant's pre-existing chronic low back pain and caused new impairments, including neck pain and psychological symptoms.

Relying on the medical evidence, including the applicant's treating professionals and several independent assessments, the Tribunal concluded the treatment plan was reasonable and necessary to address her physical and psychological impairments.

The applicant was awarded the medical benefit and interest on overdue payments.

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

The insurer denied treatment plans for optometric services and occupational therapy.

The Tribunal found that the applicant's impairments, including post-traumatic vision syndrome and headaches, were caused by the accident.

The Tribunal held that the optometric services were reasonable and necessary.

Furthermore, the Tribunal found that the insurer failed to provide proper medical reasons for denying the occupational therapy plan, violating s. 38(8) of the Schedule, and thus was required to pay for it under s. 38(11).

Both treatment plans were approved with interest.