Jessica Meyerovich

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

The respondent denied the benefits and argued the applicant was barred from proceeding because he failed to submit an application within the prescribed time limits.

The Tribunal found that the applicant failed to provide a reasonable explanation for his five-month delay in submitting the OCF-1 application.

Consequently, the application was barred under section 55(1)1 of the Schedule and dismissed.

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

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

The applicant claimed removal from the MIG based on chronic pain and psychological impairments.

The Tribunal found the applicant did not meet the burden of proof for removal, noting his return to pre-accident work and activities, and the lack of supporting documentation from treating physicians.

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

The applicant requested a reconsideration of a decision that barred him from proceeding with his application due to an eight-month delay in notifying the respondent of the accident.

The applicant argued the Tribunal erred in considering his pre-existing psychiatric condition and the reasonable explanation test, and sought to introduce new medical records.

The Tribunal dismissed the request, finding no error of law or fact in the initial decision, as the applicant's condition did not prevent him from reporting the accident.

The Tribunal also found that the new medical records post-dated the delay period and would not have affected the outcome.

The applicant, who suffered a catastrophic brain injury in a hit-and-run accident, sought an award under section 10 of Regulation 664, alleging the respondent unreasonably delayed payment of income replacement benefits.

The respondent had refused to pay the benefits because the applicant failed to submit a disability certificate (OCF-3).

The Tribunal found that the respondent did not unreasonably withhold or delay payments, as the obligation to submit the required forms rested with the applicant, and the respondent had actively adjudicated the claim and requested the missing forms.

The Tribunal also dismissed the respondent's preliminary motion on jurisdiction and the applicant's request to anonymize the decision.

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

The applicant failed to notify the insurer of the accident within the prescribed seven-day period, only submitting an application eight months later.

The applicant argued the delay was due to not receiving an application package, a pre-existing psychiatric condition, and a belief that his physical injuries would resolve.

The Tribunal found these explanations unreasonable, noting the insurer could not provide a package without notice, and medical records did not support the claim that the psychiatric condition impaired his ability to report the accident.

The application was dismissed as statute-barred.

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

The respondent insurer denied the benefits, arguing the applicant was an excluded driver under the policy pursuant to s. 31(1)(a)(iii) of the Statutory Accident Benefits Schedule.

The insurer relied on an Excluded Driver Endorsement (OPCF 28A).

The Tribunal found the signed endorsement contained multiple ambiguities, including a missing policy number, unidentified vehicles, and an inconclusive signature date.

The Tribunal concluded the insurer failed to meet its evidentiary onus to establish the applicant was an excluded driver.

The applicant was permitted to proceed with the substantive hearing for benefits.

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

The respondent insurer denied the benefits, and the applicant applied to the Licence Appeal Tribunal.

A preliminary issue hearing was held to determine if the applicant was statute-barred for failing to notify the respondent of her intention to claim benefits within seven days of the accident.

The applicant argued she was unaware she could claim benefits and had attempted home remedies.

The Tribunal found that ignorance of the law is not a reasonable explanation and noted a lack of evidence for the home remedies.

The Tribunal concluded the applicant failed to provide a reasonable explanation for the delay, prejudicing the insurer.

The application was dismissed as statute-barred.

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

The insurer denied five treatment plans, and the applicant applied to the Tribunal more than two years after the denials.

The insurer argued the claims were statute-barred under s. 56 of the Schedule.

The Tribunal found that the denial notices for three of the treatment plans were defective as they relied on vague, boilerplate language and failed to identify the applicant's medical conditions, meaning the limitation period was not triggered for those claims.

However, the denial notices for the remaining two plans were valid and clear, and the Tribunal declined to extend the limitation period for them.

The applicant was permitted to proceed to a hearing on the three plans with defective denials.

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 Tribunal found that the applicant failed to prove his pre-existing conditions, chronic pain, or psychological impairments warranted removal from the MIG.

The Tribunal also dismissed the claims for income replacement benefits, finding the applicant did not demonstrate a substantial or complete inability to perform the essential tasks of his self-employment.

Claims for attendant care benefits, treatment plans, interest, and an award were also dismissed.

The applicant sought statutory accident benefits following an alleged motor vehicle collision.

The respondent insurer denied the claim, arguing the collision was staged and the applicant wilfully misrepresented material facts.

The applicant failed to attend the hearing.

Relying on forensic engineering evidence and Event Data Recorder (EDR) data, the Tribunal found the physical evidence was highly inconsistent with the applicant's account of a T-bone collision while moving.

The Tribunal concluded the collision was staged and did not meet the definition of an "accident" under the Schedule.

The Tribunal held the applicant wilfully misrepresented material facts and ordered her to repay $50,958.56 in benefits previously paid by the respondent.

The applicant sought a special award under s. 10 of Regulation 664 and interest, alleging the respondent unreasonably delayed removing her from the Minor Injury Guideline and approving treatment plans following a motor vehicle accident.

The adjudicator dismissed the application, finding the respondent's actions were not unreasonable because the applicant failed to provide requested pre-accident and updated clinical notes and records in a timely manner.

Without these records, the respondent could not properly assess whether the applicant's psychological impairments were caused by the accident or pre-existing marital issues.

The applicant was involved in a motor vehicle accident and sought a determination of catastrophic impairment due to a mild traumatic brain injury and psychological impairments.

The Licence Appeal Tribunal found that the applicant did not meet the criteria for catastrophic impairment under Criterion 6 (Glasgow Outcome Scale) because she maintained some independence and employment.

However, the Tribunal concluded that the applicant sustained a marked impairment in adaptation under Criterion 8 due to her somatic symptom disorder and cognitive challenges.

The Tribunal awarded attendant care benefits of $1,561.89 per month, various treatment plans, and interest, but denied the claim for 24/7 attendant care and a special award under Regulation 664.

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

The respondent denied a psychological assessment and treatment plan, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered from accident-related psychological impairments, removing him from the MIG.

The Tribunal ordered the respondent to pay for the disputed psychological assessment and treatment plan, finding them reasonable and necessary, as well as the cost of damaged glasses and interest.

The applicant requested a reconsideration of a preliminary issue decision that found he failed to demonstrate his accident-related impairments warranted removal from the Minor Injury Guideline (MIG).

The applicant argued the adjudicator erred in fact and law regarding his chronic pain claim and sought to introduce a new CT scan.

The Tribunal dismissed the request, finding no error of law in referencing the AMA Guides for chronic pain in the absence of a diagnosis.

Furthermore, the new CT scan evidence was available prior to the hearing and failed to establish causation.