Jennifer Griffiths

The applicant sought statutory accident benefits after slipping and falling on an icy sidewalk while completing a food delivery.

He had parked his vehicle, retrieved the food, and was walking to the delivery location when the incident occurred.

The Licence Appeal Tribunal held that the incident was not an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal found that the use of the vehicle ended once the applicant retrieved the food and left the parked vehicle, failing the purpose test.

Furthermore, the slip and fall on the icy surface was an intervening event that broke the chain of causation, failing the causation test.

The application was dismissed.

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

The insurer raised a preliminary issue that the applicant was barred from proceeding because he failed to notify the insurer of the accident within seven days and failed to submit the application for benefits (OCF-1) within 30 days, as required by section 32 of the Schedule.

The Tribunal found that the applicant delayed notifying the insurer for approximately 9.5 months and failed to provide a credible or reasonable explanation for the delay under section 34.

The applicant's explanation of mild symptoms and language barriers was not supported by medical records or other objective evidence.

The application was dismissed.

The applicant requested a reconsideration of a decision finding he was not 'employed' prior to the accident and therefore not entitled to income replacement benefits.

The applicant argued the adjudicator erred by considering the quantum of WSIB payments, his decision to extend a work placement, and the interpretation of a WSIB letter.

The Tribunal found no error of law or fact in the original decision, noting that the evidence was relevant to determining whether the applicant received remuneration in exchange for services provided to an employer.

The request for reconsideration was dismissed.

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

At the time of the accident, the applicant was participating in a Work Transition Plan through the WSIB and working at an architecture firm, but his WSIB payments were not contingent on providing services to the firm.

The Tribunal found that the applicant was not 'employed' under section 5(1)(1) of the Statutory Accident Benefits Schedule because he did not receive remuneration in exchange for the services he provided.

Consequently, the applicant was not entitled to income replacement benefits.

The respondent insurer requested a reconsideration of a Tribunal decision finding it failed to respond to a $3,733.86 treatment plan within the 10-day period required by s. 38(8) of the Schedule.

The insurer argued the Tribunal erred in fact regarding the submission date of the treatment plan.

The Tribunal dismissed the reconsideration request, finding that the insurer was advancing a new argument not raised at the initial hearing.

Furthermore, the Tribunal noted that even if an error of fact had been made, it would not have changed the outcome, as the original decision found no amounts were payable under the treatment plan because it was not incurred during the period of non-compliance.

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

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

The applicant sought removal from the MIG, claiming she suffered from chronic pain with a functional impairment and a psychological condition.

The Tribunal found the applicant did not meet her burden of proof.

The chiropractor's diagnosis of chronic pain was rejected as it was outside their scope of practice, and the psychological report lacked psychometric testing to substantiate its provisional diagnosis.

The application was dismissed, and the claims for a chiropractic treatment plan and interest were denied.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found he was bound by a settlement agreement and precluded from proceeding to the Tribunal.

The applicant alleged the Tribunal breached procedural fairness, demonstrated a reasonable apprehension of bias, and made errors of law regarding the statutory requirements of an accident benefits settlement.

The adjudicator dismissed the request, finding no breach of procedural fairness, no cogent evidence of bias, and no errors of law or fact, concluding that the applicant was attempting to re-litigate his case.

The respondent requested a reconsideration of a Tribunal decision finding the applicant was employed at the time of the accident and entitled to an income replacement benefit.

The respondent argued the Tribunal made errors of law and fact by failing to apply the eligibility criteria in s. 5(1) of the Schedule and failing to consider the impact of the applicant's WSIB benefits under s. 47(3)(e) of the Schedule and s. 43(3) of the Workplace Safety and Insurance Act.

The Vice-Chair agreed, finding the original decision lacked the necessary analysis of these provisions.

The request for reconsideration was granted, the original decision was cancelled, and a rehearing by written submissions before a different adjudicator was ordered.

The applicant sought statutory accident benefits following a 2000 motor vehicle accident.

The parties engaged in mediation and arbitration at FSCO, ultimately reaching a settlement in 2004.

The applicant signed the Settlement Disclosure Notice (SDN) by initialing each page but did not sign the specific acknowledgment line.

Years later, the applicant attempted to reopen the claim, arguing the settlement was invalid due to the missing signature.

The Tribunal found that a binding contract existed, the SDN substantially complied with O. Reg. 664, and the applicant failed to rescind the settlement within the two-business-day cooling-off period.

The application was dismissed.

The applicant sought statutory accident benefits after experiencing a severe psychological reaction when her vehicle's fuel tank emptied underneath her car due to a mechanical error.

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

The Licence Appeal Tribunal applied the two-part test from Caughy and found that while the purpose test was met, the causation test was not.

The Tribunal concluded that the improper installation of the fuel pump was an intervening act and the dominant feature of the injuries was observing the leak, not the use or operation of the vehicle.

The application was dismissed.

The self-represented applicant sought a determination that she sustained a catastrophic impairment as a result of three separate motor vehicle accidents.

The Tribunal found that the applicant failed to meet her burden of proof, as she did not submit any catastrophic impairment assessments or medical reports demonstrating that she met the criteria under the Statutory Accident Benefits Schedule.

The application was dismissed.

The applicant was catastrophically injured in a motor vehicle accident and sought Income Replacement Benefits (IRB).

Prior to the accident, the applicant was participating in a Work Transition Program through the WSIB, which included a work placement.

The insurer denied IRB, arguing the applicant was not employed but receiving disability benefits.

The Tribunal found that the work placement created an employer/employee relationship, as the applicant was required to perform specific duties and report to a supervisor.

The Tribunal concluded the applicant was employed at the time of the accident and entitled to IRB.

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

The respondent paid a portion of the claimed expenses but denied the remainder, arguing they were not incurred.

The Tribunal preferred the respondent's occupational therapy assessments, finding the applicant's condition had improved and she did not require the level of care claimed, particularly for night-time emergencies.

The Tribunal concluded the applicant was not entitled to any attendant care benefits beyond what the respondent had already paid, as the additional expenses did not meet the definition of an 'incurred expense' under section 3(7)(e) of the Schedule and could not be deemed incurred.

The applicant sought non-earner benefits following a motor vehicle accident.

The insurer raised a preliminary issue, arguing the applicant was barred from proceeding because the submitted Disability Certificate (OCF-3) indicated he did not suffer a complete inability to carry on a normal life, and was therefore not 'completed' under the Schedule.

The Tribunal found that an OCF-3 is 'completed' if it is filled out, dated, and signed by a regulated healthcare professional, even if it does not support the claim for the specified benefit.

The applicant was permitted to proceed with his application on the merits.

The applicant was injured in a motor vehicle accident in 2000 and commenced an arbitration proceeding at FSCO in 2002.

A settlement was reached in 2004.

Fifteen years later, the applicant sought to rescind the settlement and continue the arbitration at FSCO.

The insurer argued that under the transitional provisions of O. Reg. 664, the proceeding was extinguished at FSCO and any new application must be brought before the Licence Appeal Tribunal (LAT).

The arbitrator held that pursuant to section 22(2) of O. Reg. 664, the proceeding was extinguished at FSCO because a settlement had been entered into, and directed that either party could reapply at the LAT.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) from the respondent.

The respondent later denied post-104-week IRBs based on several Insurer's Examinations.

The applicant applied to the Tribunal but withdrew the claim pending a catastrophic assessment, and the parties agreed to toll the limitation period.

The applicant failed to recommence the application before the tolling period expired.

The applicant argued the initial denial was invalid because the respondent failed to provide all examination reports to her treating practitioner under section 37(5) of the Schedule.

The Tribunal found the denial was clear and unequivocal, triggering the limitation period.

The Tribunal declined to extend the limitation period under section 7 of the LAT Act, finding the applicant was statute-barred from proceeding.

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

The respondent brought a preliminary issue to determine whether the applicant was entitled to apply for an attendant care benefit, arguing she failed to submit the required Form 1.

The adjudicator found that while the application was incomplete due to non-compliance with section 42(1) of the Schedule, this was a procedural technicality.

The adjudicator deferred the decision on the technical non-compliance to the hearing adjudicator who will determine entitlement and quantum.

The applicant requested a reconsideration of a Tribunal decision finding that she was not entitled to case management services under s. 17(1)(b) of the Statutory Accident Benefits Schedule.

The applicant argued that purchasing the optional catastrophic impairment benefit under s. 28(1)5 was sufficient to trigger entitlement, even without a catastrophic impairment designation.

The Associate Chair confirmed the Tribunal's decision, applying principles of statutory interpretation to conclude that the optional benefit is only 'available' if the insured person actually sustains a catastrophic impairment.

The applicant sought case management services following a motor vehicle accident, relying on the purchase of an optional catastrophic impairment benefit under s. 28(1) 5 of the Statutory Accident Benefits Schedule.

The applicant had not been deemed catastrophically impaired.

The Licence Appeal Tribunal held that the plain language of s. 17(1)(b) read with s. 28(1) 5 requires both the purchase of the optional benefit and a catastrophic impairment designation to trigger entitlement to case management services.

The preliminary issue was resolved in favour of the respondent.

The applicant, who suffered catastrophic impairment in a motor vehicle accident, sought a rehabilitation benefit of $6,698.64 for travel expenses to visit family in Iran, accompanied by an attendant care provider.

The insurer denied the claim.

The Licence Appeal Tribunal dismissed the application, finding that the travel was not a necessary expense under section 16 of the Statutory Accident Benefits Schedule, nor was it a permitted type of travel expense, as it did not have a counselling or training purpose.

Claims for interest and costs were also dismissed.