Hermina Nuric

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

The respondent denied the benefits, arguing the applicant failed to submit an application (OCF-1) within the prescribed time and that her injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant was not statute-barred, as she provided a reasonable explanation for the delay in submitting her OCF-1.

However, the Tribunal concluded that the applicant failed to prove her injuries warranted removal from the MIG, as the medical evidence did not establish that her mild degenerative changes were caused by the accident or precluded recovery within the MIG limits.

The application for disputed treatment plans was dismissed.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident.

The Tribunal found the applicant did not sustain a catastrophic impairment under Criterion 8, as his mental and behavioural impairments were moderate (Class 3) rather than marked (Class 4) in the domains of activities of daily living and social functioning.

However, the Tribunal found the applicant was entitled to a post-104-week income replacement benefit, as his combined physical and psychological impairments resulted in a complete inability to engage in suitable employment.

Claims for occupational therapy and attendant care were dismissed as non-catastrophic funding was exhausted.

The applicant was awarded interest on overdue payments but denied a special award.

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

The insurer denied a chiropractic treatment plan, determining the applicant was subject to the Minor Injury Guideline.

The applicant filed an application to the Licence Appeal Tribunal nearly eight months after the two-year limitation period expired.

The Tribunal found the insurer's denial was valid and triggered the limitation period.

As the applicant provided no submissions to justify extending the limitation period, the application was dismissed as statute-barred.

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

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

The Tribunal found the applicant demonstrated psychological impairments warranting removal from the MIG.

The applicant was awarded several physiotherapy treatment plans, a psychological assessment, and a chronic pain assessment, as well as interest on overdue payments.

However, claims for a non-earner benefit, orthopaedic, neurological, and neuropsychological assessments, and a section 10 award for unreasonable delay were dismissed.

The applicant sought attendant care benefits following a motor vehicle accident.

The insurer agreed to pay the benefits subject to proof that the expenses were incurred, but the applicant failed to provide any expense claim forms or invoices.

The applicant argued the expenses should be deemed incurred due to the insurer's delayed response to a Form 1.

The Tribunal found that the delayed response did not automatically entitle the applicant to benefits and declined to deem the expenses incurred.

The application for benefits, along with claims for an award and interest, was dismissed.

The applicant sought attendant care benefits (ACB) following a motor vehicle accident.

The insurer partially paid the submitted invoices using the ratio method from Malitskiy due to a lack of sufficient particulars regarding the services provided.

The Tribunal upheld the use of the ratio method, finding the applicant failed to prove the full balance of the invoices was incurred under s. 3(7)(e) of the Schedule.

The Tribunal awarded a minor shortfall of $86.74 in ACB with interest, but dismissed the claim for an award under s. 10 of Regulation 664, finding the insurer's conduct was not unreasonable.

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

The respondent denied certain treatment plans on the basis that the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG).

The applicant argued she suffered from chronic pain syndrome, relying on a chiropractor's diagnosis.

The Tribunal found that diagnosing chronic pain is outside a chiropractor's scope of practice and gave it no weight.

The Tribunal concluded the applicant sustained predominantly minor injuries, as she had not demonstrated functional impairment and had returned to work and daily activities.

The application for treatment plans, interest, and an award was dismissed.

The respondent insurer requested a reconsideration of a Tribunal decision that removed the applicant from the Minor Injury Guideline (MIG) on psychological grounds.

The respondent argued the Tribunal made errors of fact regarding the applicant's return to driving and the characterization of medical reports, and errors of law by failing to properly assess functional limitations and the threshold of impairment.

The Tribunal dismissed the request, finding no significant errors of fact or law, and noted that the respondent was improperly attempting to re-litigate its position and raise new arguments not presented at the original hearing.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline (MIG).

The applicant sought funding for a chronic pain assessment, a psychological assessment, and physical therapy.

The Tribunal found that the applicant failed to provide compelling medical evidence of a pre-existing condition or functional limitations that would prevent maximal recovery within the MIG.

Relying on the insurer's medical examination and the applicant's clinical records, the Tribunal concluded the injuries were minor.

As the $3,500 MIG limit was exhausted, the disputed treatment plans were not payable, and claims for interest and an award for unreasonable delay were dismissed.

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

The respondent insurer denied various treatment and assessment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been exhausted.

The Tribunal found that the applicant failed to provide compelling medical evidence of a pre-existing condition, chronic pain with functional impairment, or psychological injuries that would warrant removal from the MIG.

As the applicant's injuries were predominantly minor and the MIG limit was exhausted, the disputed treatment plans and claims for interest were dismissed.

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

The respondent denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's psychological impairments, including vehicular phobia and depressive disorder, warranted removal from the MIG.

The Tribunal approved the initial psychological assessment and the first block of psychotherapy sessions as reasonable and necessary.

However, subsequent treatment plans for additional psychotherapy were denied because the applicant had already made substantial gains and the new plans did not reflect his improved condition.

The applicant was injured in a motor vehicle accident while driving his employer's vehicle.

He elected to claim accident benefits and pursue a tort action against the at-fault driver, rather than claiming WSIB benefits.

The respondent insurer brought a motion arguing the applicant was not entitled to accident benefits because his election under section 61(2) of the Schedule was made primarily for the purpose of claiming those benefits, noting he failed to commence a tort action within the limitation period.

The Tribunal dismissed the respondent's motion, finding that at the time of the election, the applicant had a bona fide intention to pursue a tort action, and thus met the requirements of the section 61(2) exception.

The respondent insurer requested a reconsideration of a previous Licence Appeal Tribunal decision, arguing the Tribunal erred in fact and law and exceeded its jurisdiction by adjudicating the applicant's entitlement to and quantum of income replacement benefits (IRB) at and beyond age 65.

The Tribunal agreed, finding that IRB entitlement was never in dispute and that the insurer had not yet made a determination on post-65 benefits.

The Tribunal granted the reconsideration, varying the previous decision to remove references to entitlement and post-65 IRB, while maintaining the applicant's ongoing IRB entitlement subject to the Insurance Act.

The applicant insurer sought repayment of $8,909.00 from the respondent, alleging the motor vehicle incident was staged and the respondent wilfully misrepresented the facts to claim statutory accident benefits.

The respondent did not participate in the hearing.

The Tribunal found that the incident was staged based on the respondent's own admission during an Examination Under Oath and a forensic reconstruction report.

Consequently, the respondent was not involved in an 'accident' and engaged in wilful misrepresentation.

However, the Tribunal held that the insurer's investigative fees did not constitute 'benefits' under s. 52 of the Schedule and were not subject to repayment.

The respondent was ordered to repay only $200.00 for form completion costs.

The insurer's request for costs was denied.

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

The respondent determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and capped medical and rehabilitation benefits at $3,500.

The applicant applied to the Licence Appeal Tribunal, arguing that pre-existing conditions, chronic pain, and psychological impairments warranted removal from the MIG.

The Tribunal found insufficient evidence to support the applicant's claims, preferring the respondent's independent medical examination reports over the applicant's orthopaedic expert.

The Tribunal concluded the applicant sustained minor injuries, and having exhausted the $3,500 limit, was not entitled to further chiropractic benefits, interest, or an award.

The applicant was catastrophically impaired in a motor vehicle accident and sought income replacement benefits (IRB).

The parties disputed the quantum of the IRB, specifically whether collateral benefits (STD, LTD, CPP-D) should be deducted on a gross or net basis, and the calculation of post-65 IRB.

The Tribunal held that deductions for collateral benefits under s. 4 of the Schedule are based on gross income, not net.

The Tribunal ordered the applicant to repay $4,872.90 in overpaid IRB.

Furthermore, the Tribunal found that the applicant's post-65 IRB should be calculated based on the base amount of $400 per week before the ramp-down formula in s. 8(1) is applied, resulting in $122.00 per week, rejecting the insurer's argument that it should be reduced to zero.

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

The insurer denied the benefits on the basis that the applicant's injuries were predominantly minor and subject to the $3,500 limit under the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing that pre-existing conditions, psychological impairments, and chronic pain warranted removal from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence that her pre-existing diabetes and hypertension prevented her recovery, or that she suffered from chronic pain or psychological impairments outside the MIG.

The application was dismissed.

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

The respondent denied a physiotherapy treatment plan and a chronic pain assessment.

The Tribunal found the physiotherapy treatment was reasonable and necessary, preferring the clinical records of the treating physician over the insurer's examiner.

However, the claim for the chronic pain assessment was dismissed because the applicant incurred the expense before submitting the treatment plan, contrary to section 38(2) of the Schedule.

The applicant sought attendant care benefits and transportation costs for a psychological assessment following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide any proof that the attendant care expenses were actually incurred as required by section 3(7)(e) of the Schedule.

The claim for transportation costs was also dismissed as the applicant provided no evidence that the expense was reasonable and necessary.

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

The applicant was injured in a motor vehicle accident and applied for an income replacement benefit.

The respondent denied the benefit, arguing the applicant was self-employed as a partner in her husband's television and stereo repair shop.

The Tribunal held a preliminary issue hearing to determine her employment status.

Applying the test for partnership from Backman v. Canada, the Tribunal found no evidence of a partnership agreement or intention to carry on business in common.

The official corporate records, tax filings, and payroll deductions supported the applicant's position that she was an employee.

The Tribunal concluded the applicant was employed, not self-employed, at the time of the accident.