Eric Grossman

The applicant sought statutory accident benefits following a 2014 motor vehicle accident.

The insurer denied the claims and the applicant applied to the Licence Appeal Tribunal.

The Tribunal found the applicant was barred from claiming a non-earner benefit because she failed to submit a disability certificate within 104 weeks of the accident.

The Tribunal also found the applicant was barred from claiming various treatment plans because she failed to dispute the insurer's valid denials within the two-year limitation period.

The Tribunal declined to extend the limitation period under section 7 of the Licence Appeal Tribunal Act, noting the applicant provided no evidence of an intention to appeal or explanation for the delay.

The application was dismissed.

The applicant sought a determination that he sustained a catastrophic impairment under criterion 4 of the Statutory Accident Benefits Schedule following a motor vehicle accident.

The applicant relied on a SPECT scan to demonstrate a traumatic brain injury.

The Tribunal found that a SPECT scan is not a medically recognized brain diagnostic technology, as it is not sufficiently reliable to identify a traumatic brain injury resulting from an accident.

Furthermore, the Tribunal preferred the respondent's radiological evidence, which concluded that the SPECT scan findings were nonspecific and could be explained by other etiologies, such as pre-existing psychological conditions or prior head traumas.

The application was dismissed, and no award for unreasonable delay was granted.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to two treatment plans for dental services and one for a psychological assessment.

The Licence Appeal Tribunal found that the applicant failed to prove the dental treatment plans were reasonable and necessary, noting a significant gap in treatment and lack of ongoing complaints in the clinical notes and records.

The Tribunal also denied the psychological assessment, finding the applicant's anxiety was pre-existing and adequately managed by her family doctor.

The application was dismissed in its entirety, and no interest was payable.

The applicant was injured when the pickup truck he was repairing fell on him.

He sought statutory accident benefits, which the respondent insurer denied on the basis that the incident was not an 'accident' under s. 3(1) of the Schedule.

The Tribunal applied the two-part purpose and causation test, finding that repairing a vehicle is an ordinary and well-known activity to which automobiles are put, and that the repair was the dominant feature that directly caused the injuries.

The Tribunal concluded the incident met the definition of an accident.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her non-earner benefits for a specific period due to her failure to submit a completed disability certificate (OCF-3) under s. 36(3) of the Schedule.

The applicant argued that the Tribunal erred in its strict interpretation of s. 36(3), asserting that the provision should not apply to an incapable applicant, and that the Tribunal failed to properly consider the Human Rights Code and the Charter.

The Vice-Chair dismissed the reconsideration request, finding that the applicant was attempting to re-litigate arguments made at the initial hearing and had failed to establish any error of law or fact under Rule 18.2(b).

The applicant was injured in a bicycle-automobile collision and suffered a traumatic brain injury.

She applied for a non-earner benefit but the insurer denied payment for the period before she submitted her disability certificate (OCF-3), relying on s. 36(3) of the Statutory Accident Benefits Schedule.

The applicant argued that s. 36(3) should be interpreted to exempt incapable applicants, or alternatively, that it violates the Charter and the Human Rights Code.

The Tribunal rejected the applicant's interpretation, finding the language of s. 36(3) clear and mandatory.

The Tribunal also found the applicant failed to establish a constitutional or Code violation.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought removal from the Minor Injury Guideline (MIG) due to chronic pain and a psychological condition, as well as approval for a $2,200 psychological assessment.

The Tribunal found that the applicant failed to provide compelling medical evidence of a more than minor injury, chronic pain with functional impairment, or a psychological condition warranting removal from the MIG.

The Tribunal preferred the respondent's psychological assessment over the applicant's, finding no reliable evidence of an accident-related psychological impairment.

The application was dismissed.

The applicant sought statutory accident benefits, alleging he struck his head and fell while being transported in an ambulance.

The respondent denied the claim on the basis that the applicant was not involved in an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal found that the contemporaneous medical and ambulance records did not support the applicant's assertion that he sustained a head injury during the ambulance ride, noting instead that the records described an older, scabbed wound.

The application was dismissed as the applicant failed to prove on a balance of probabilities that the use or operation of an automobile directly caused his impairment.

The applicant sought statutory accident benefits following a motor vehicle accident and applied for a catastrophic impairment determination, which the respondent insurer denied.

The respondent argued the applicant was barred from proceeding to a hearing because he failed to dispute the denial within the two-year limitation period under section 56 of the Statutory Accident Benefits Schedule.

The Tribunal found that the limitation period was not triggered because a catastrophic impairment determination is a threshold for eligibility, not a specific benefit.

The applicant was permitted to proceed to a hearing, and the respondent's request for costs was denied.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a physiotherapy treatment plan and a driver/passenger assessment.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to prove the physiotherapy treatment plan was reasonable and necessary, noting a lack of clear goals and timelines for recovery, as well as pre-existing conditions.

The Tribunal also found the driver/passenger assessment was not reasonable and necessary, as a psychological progress report indicated the applicant felt she could manage on her own.

The claims for an award and interest were also dismissed.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident.

The respondent denied treatment plans for chronic pain and psychological assessments, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant suffered from chronic pain syndrome with functional impairment, removing him from the MIG.

The Tribunal ordered the respondent to pay for the chronic pain and psychological assessments, plus interest, finding them reasonable and necessary.

The applicant's claim for an award for unreasonable delay was dismissed, as the respondent had relied on its section 44 assessors.

The applicant sought various statutory accident benefits after being struck by a detached tire while walking.

The Licence Appeal Tribunal dismissed the application in its entirety, finding that the applicant had fully recovered from his physical injuries and was engaging in 'learned helplessness'.

The Tribunal denied claims for attendant care, assistive devices, occupational therapy, and chiropractic treatments, noting inconsistencies in the applicant's expert evidence and exaggerated assessment fees.

The claim for non-earner benefits was dismissed as time-barred and substantively unproven.

Claims for a special award and interest were also dismissed.

The applicant requested a reconsideration of a decision finding her injuries were predominantly minor and subject to the Minor Injury Guideline limit.

She argued the Tribunal erred by failing to consider a psychological assessment report.

The Tribunal dismissed the request, finding no error in not explicitly referencing every piece of evidence.

The Tribunal noted that even if the report had been explicitly analyzed, it would not have changed the conclusion that the applicant's psychological issues were related to the COVID-19 pandemic and job loss, rather than the accident.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claims for income replacement benefits and various medical and rehabilitation benefits following a motor vehicle accident.

The applicant argued the Tribunal made errors of fact and law in assessing her pre-104 week disability test.

The adjudicator dismissed the request, finding that the applicant was merely attempting to relitigate the original hearing by asking the Tribunal to re-evaluate the same evidence.

The adjudicator confirmed that the original decision properly weighed the evidence, including functional capacity assessments and medical reports, and found no significant legal or evidentiary mistake.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of three treatment plans for chiropractic, massage, and psychological services.

The Tribunal found that the first treatment plan for physical therapy was reasonable and necessary given the applicant's accident-related sprains and strains.

However, the Tribunal dismissed the remaining treatment plans, finding insufficient evidence to link the ongoing symptoms to the accident rather than pre-existing conditions, and a lack of explanation for additional psychological planning fees.

The applicant was awarded $2,575.22 for the first treatment plan plus interest.

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

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

The Tribunal found that the applicant failed to prove her physical or psychological injuries warranted removal from the MIG.

The medical evidence did not establish chronic pain syndrome or a psychological condition directly caused by the accident.

Consequently, the disputed treatment plans were deemed not reasonable and necessary, and no interest was payable.

The respondent insurer requested a reconsideration of a decision awarding the applicant a psychiatric assessment and a chronic pain assessment.

The insurer argued the Tribunal erred by not requiring the applicant to first seek OHIP funding and by failing to apply the statutory monetary caps to the psychiatric assessment.

The Tribunal dismissed the OHIP argument as it was not raised at the initial hearing.

However, the Tribunal agreed it erred in law by not applying the statutory maximums under the Schedule and Guidelines.

The reconsideration was partially granted, and the amount payable for the psychiatric assessment was reduced to $2,200.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claim for a $2,738.00 medical benefit for chiropractic services.

The applicant argued the Tribunal failed to consider important medical evidence and erred in fact by suggesting chiropractic treatment was not recommended.

The Vice Chair found no errors of law or fact in the original decision, noting the adjudicator properly considered and weighed the medical evidence.

The request for reconsideration was dismissed.

The applicant sought statutory accident benefits for the prescription medication Saxenda, arguing that her type 1 diabetes was triggered by emotional stress following a motor vehicle accident.

The adjudicator found that the applicant failed to prove on a balance of probabilities that the accident caused her diabetes, as her own medical expert could not determine the exact initiation of the condition.

In the alternative, the adjudicator held that the applicant failed to prove the medication was reasonable and necessary, noting it was an off-label treatment for weight loss and no evidence of her body mass index was provided.

The application was dismissed.

The applicant sought statutory accident benefits after slipping and falling on ice in a parking lot after exiting a borrowed minivan.

The respondent insurer denied the claim on the basis that the incident was not an 'accident' under the Statutory Accident Benefits Schedule.

The Tribunal applied the purpose and causation tests to determine if the injuries arose out of the use or operation of an automobile.

The Tribunal found that the applicant had completed his use of the vehicle and was walking away when he fell, failing the purpose test.

Furthermore, the slip and fall on the icy parking lot constituted an intervening act that broke the chain of causation.

The application was dismissed.