Louise Kanary

The applicant requested reconsideration of a Licence Appeal Tribunal decision that dismissed his claims for accident benefits on the basis that he failed to file submissions or evidence.

The applicant provided proof that his representative had emailed the written submissions and document brief to the Tribunal and the respondent on the due date.

The respondent confirmed receipt.

The Vice-Chair found that the Tribunal made an error of fact by not considering the filed materials, satisfying the grounds for reconsideration under Rule 18.2(b).

The original decision was cancelled and the matter was ordered to be reheard by a new adjudicator based on the previously filed materials.

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

She failed to notify the respondent insurer of her intention to apply for benefits within the 7-day time limit prescribed by section 32(1) of the Schedule, waiting almost three months.

The respondent argued the application should be barred under section 55(1).

The Tribunal found that the applicant did not provide a reasonable explanation for the delay, noting she was aware of her injuries, was not incapacitated, and had prior experience managing an accident benefits claim.

Consequently, the applicant was statute-barred from proceeding with the substantive issues, and the application was dismissed.

The applicant sought entitlement to a chiropractic treatment plan in the amount of $4,656.71 and interest under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Tribunal found that the applicant failed to prove on a balance of probabilities that the proposed treatment was reasonable and necessary.

The Tribunal placed significant weight on the respondent's physical medicine and rehabilitation specialist, who concluded that the applicant had reached maximum medical improvement and required no further formal physical intervention.

The application was dismissed.

The applicant sought payment of $503.90, representing the denied balance of a $2,200.00 psychological assessment proposed following a motor vehicle accident.

The respondent had partially approved the treatment plan based on a paper review by its psychological expert, who opined that the proposed cost was excessive and that the assessment could be completed for $1,696.10.

The Tribunal found that the applicant failed to discharge the onus of proving the full amount claimed was reasonable and necessary, as no particulars were provided to justify the maximum fee.

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

The applicant sought non-earner benefits, attendant care benefits, and medical benefits following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove she suffered a complete inability to carry on a normal life, as her self-reported activities and the medical evidence indicated she had resumed many pre-accident activities.

The Tribunal also denied attendant care benefits, finding they were not reasonable, necessary, or incurred.

Claims for physiotherapy and assistive devices were dismissed for lack of supporting medical evidence.

The application was dismissed in its entirety.

The applicant, who was injured when his skateboard impacted a motor vehicle, sought non-earner benefits, attendant care benefits, and medical benefits under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove a complete inability to carry on a normal life, as he had returned to full-time university studies and resumed sports.

The Tribunal also found that the attendant care benefits were not proven to be incurred or reasonable and necessary, and that the disputed portions of the occupational therapy and psychological treatment plans were not established as reasonable and necessary.

The insurer sought reconsideration of a decision ordering it to pay a $1,500 special award on two files for unreasonably withholding or delaying payment of attendant care benefits.

The insurer argued that the previous reconsideration decision did not explicitly order payment and that it was simply following the Tribunal's procedure to determine the final quantum.

The Vice-Chair dismissed the request, finding that the previous decision had settled a minimum amount due, which the insurer accepted and failed to pay for 10 months.

The Tribunal held that in the context of consumer protection legislation, it was unreasonable for the insurer to delay paying the undisputed minimum amount while litigating a minor remaining difference.

The applicant was involved in a rear-end motor vehicle accident and sought statutory accident benefits for a chronic pain assessment.

The respondent insurer denied the benefit, arguing the applicant's ongoing impairments were related to pre-accident workplace injuries.

The Tribunal found that the accident materially contributed to the applicant's impairments and that the chronic pain assessment was reasonable and necessary to determine if the applicant suffered from chronic pain syndrome.

The Tribunal ordered the respondent to pay the $2,010.10 cost of the assessment plus interest.

The applicant sought attendant care benefits, interest, and an award under s. 10 of O. Reg. 664 following a motor vehicle accident.

The Tribunal found that the applicant failed to prove the attendant care services were reasonable and necessary, noting a lack of detail in the invoices and a nearly year-long gap before services were allegedly incurred.

As no benefits were payable, the claims for interest and a bad faith award were also dismissed.

The applicant sought statutory accident benefits following a single-vehicle motorcycle accident.

The insurer denied the benefits, arguing the applicant sustained no injuries and provided inconsistent accounts of the accident.

The Tribunal found the applicant's contemporaneous reports to first responders, which indicated a low-speed departure into a field without physical injury, to be the most reliable.

Consequently, claims for attendant care, physiotherapy, and an attendant care assessment were dismissed.

However, the Tribunal approved psychological treatment by a psychotherapist at a rate of $146.91 per hour, finding the insurer could not unilaterally impose a lower rate for an unregulated provider under the Guidelines.

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

The respondent insurer removed the applicant from the Minor Injury Guideline (MIG) due to psychological impairments but denied several treatment plans.

The Tribunal found that the physical treatment plans were not reasonable and necessary as the physical injuries were predominantly minor.

However, the Tribunal approved the psychological treatment and assessments at reduced rates in accordance with the Professional Fee Guideline, and approved a chronic pain assessment to investigate the connection between the applicant's subjective pain and psychological diagnoses.

The applicant was injured in a motor vehicle accident and sought a medical benefit of $2,314.48 for a physiotherapy treatment plan.

The respondent denied the claim.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment was reasonable and necessary, noting that her treating physicians had not recently recommended passive therapy and an insurer's examination concluded she had reached maximum therapeutic improvement.

The application was dismissed and no interest was awarded.

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

The applicant failed to provide any submissions or evidence for the written hearing and did not respond to correspondence from the Tribunal or the respondent.

The Tribunal found that the applicant had not met the evidentiary burden to prove entitlement to the claimed benefits and dismissed the application.

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

The insurer subsequently determined the applicant had been working while receiving IRBs and sought repayment of an overpayment totaling $6,578.67.

As a preliminary issue, the applicant argued the insurer was barred from claiming repayment because it failed to provide notice within 12 months of the first payment, pursuant to section 52(3) of the Schedule.

The Tribunal found that the insurer provided notice within 12 months after the overpayment was made, which satisfied the statutory requirement.

The Tribunal held the insurer was not barred from claiming repayment and ordered a case conference to address the substantive issues.

The applicant was injured in a motor vehicle accident and sought medical benefits and the cost of a chronic pain assessment from the respondent insurer.

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

The Tribunal found that the applicant failed to provide compelling evidence of chronic pain or a psychological impairment that would remove him from the MIG.

The application was dismissed.

The respondent insurer requested a reconsideration of a Tribunal decision that found the applicant was entitled to the costs of a psychological assessment.

The insurer argued the Tribunal referred to evidence not before it, mischaracterized the dispute as one regarding hourly rates, improperly placed the onus on the respondent, and failed to adhere to case law.

The Adjudicator dismissed the request, finding that while the original decision used imprecise language regarding invoices, it did not constitute an error of fact.

The Adjudicator also found no error in the weighing of evidence regarding the time required to complete the assessment and report, and distinguished the case law relied upon by the insurer.

The request for reconsideration was denied.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically disputing the insurer's denial of attendant care benefits and transportation expenses.

The Licence Appeal Tribunal reviewed competing occupational therapy assessments to determine the appropriate level of attendant care over several periods.

The Tribunal awarded attendant care benefits at varying rates for different periods based on the most persuasive assessments, ultimately finding no entitlement beyond August 10, 2017.

The Tribunal also awarded transportation expenses limited to the amounts indicated on the submitted treatment plans, along with interest on overdue payments, but denied the claim for a special award.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and medical benefits beyond the Minor Injury Guideline (MIG) limit.

The Licence Appeal Tribunal found that the applicant's physical injuries were soft tissue injuries falling within the MIG.

While the applicant suffered from major depression and PTSD, the Tribunal concluded these psychological impairments were caused by his difficult experiences as a refugee from Albania, not the accident.

Consequently, the applicant did not suffer a complete inability to carry on a normal life as a result of the accident.

The application was dismissed.

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

The insurer initially placed the applicant in the Minor Injury Guideline (MIG) but later removed her.

The applicant sought payment for a partially denied physiotherapy treatment plan, ongoing income replacement benefits (IRBs), and an award for unreasonable withholding of benefits.

The Tribunal found the treatment plan was reasonable and necessary, ordering payment with interest.

However, the Tribunal dismissed the claim for IRBs, finding the applicant's soft tissue injuries did not cause a substantial inability to perform the essential tasks of her sedentary employment.

The claim for an award was also dismissed.

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

The respondent argued the applicant was barred from claiming non-earner benefits because he was eligible for income replacement benefits.

The Tribunal found the applicant was not barred, as the respondent failed to provide an election form and the applicant did not ultimately qualify for income replacement benefits.

However, the Tribunal dismissed the claim for non-earner benefits, finding the applicant's medical evidence failed to establish a complete inability to carry on a normal life under the Heath test.