Maia Abbas

The applicant requested reconsideration of a Licence Appeal Tribunal decision that denied his claims for an award and interest.

In the initial hearing, the applicant had withdrawn his substantive claim for an attendant care benefit.

The Vice-Chair dismissed the reconsideration request, finding no error of law or fact, as the Tribunal lacked jurisdiction to grant an award or interest when no substantive benefits were found to be payable.

The applicant's attempt to introduce new evidence in the form of attendant care invoices was also rejected, as it would not have affected the outcome given the withdrawal of the underlying benefit claim.

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

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

The applicant claimed a psychological impairment warranted removal from the MIG and sought an income replacement benefit (IRB) and treatment plans.

The Tribunal found the applicant did not meet the burden of proving a psychological impairment or a substantial inability to perform the essential tasks of his employment as an Uber driver.

The Tribunal concluded the applicant's injuries were predominantly minor, subject to the MIG limit, and dismissed the claims for IRB, treatment plans, interest, and an award.

The applicant sought entitlement to three physiotherapy treatment plans following a motor vehicle accident.

The respondent denied the plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The sole issue raised by the applicant was whether the respondent failed to provide adequate medical reasons for the denials under s. 38(8) of the Schedule.

The Tribunal found that the respondent complied with s. 38(8), as the denial letters clearly stated the injuries were considered minor and relied on Insurer Examination reports from a physiatrist and a psychologist.

The application was dismissed.

The applicant sought a special award and interest after withdrawing substantive claims for statutory accident benefits following a motor vehicle accident.

The Tribunal found that because the substantive claims for attendant care benefits were withdrawn and the applicant failed to prove the expenses were incurred, there was no basis to conclude the insurer unreasonably withheld or delayed payment.

The application for an award and interest was dismissed.

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

In a previous Tribunal decision, the applicant was barred from proceeding with his claim because he failed to attend a properly scheduled insurer's examination under s. 44 of the Schedule.

The applicant subsequently filed a new application raising the same substantive issues.

The Tribunal found that the doctrine of res judicata applied, as the previous decision was final and disposed of the substantive issue.

The Tribunal declined to waive res judicata, finding no fresh evidence or fairness reasons to do so, and dismissed the application.

The applicant sought statutory accident benefits for concussion-based treatment plans (vestibular and vision therapy) following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to demonstrate the treatments were reasonable and necessary.

The Tribunal preferred the insurer's neurological assessment over the applicant's, noting the applicant's assessor relied heavily on self-reporting and provided inconsistent conclusions.

The application was dismissed, and no interest was payable.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing for removal from the Minor Injury Guideline (MIG) due to chronic pain.

The Licence Appeal Tribunal found that the applicant failed to provide sufficient medical evidence of chronic pain with a functional impairment.

Relying on an insurer's examination report which concluded the injuries were minor and maximal recovery was achieved, the Tribunal held the applicant to the MIG.

Consequently, the claims for additional treatment plans, an award for unreasonable delay, and interest were dismissed.

The applicant requested a reconsideration of a decision denying her entitlement to statutory accident benefits.

The original adjudicator dismissed the claim because the applicant failed to provide written submissions, despite filing document briefs.

The applicant argued this was an error of fact and a breach of procedural fairness.

The Vice-Chair dismissed the reconsideration request, finding that the adjudicator correctly recognized the document briefs and properly concluded that documentary evidence alone, without accompanying submissions to point out key evidence, is insufficient to establish entitlement to benefits.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits and medical/rehabilitation benefits outside the Minor Injury Guideline (MIG) due to chronic pain and psychological injuries.

The Tribunal found the applicant's injuries were predominantly minor, as the evidence did not support a diagnosis of chronic pain or psychological impairment sufficient to remove him from the MIG.

Because the MIG limits were exhausted, the disputed treatment plans were not payable.

The claim for income replacement benefits was also dismissed for lack of evidence regarding the applicant's inability to perform essential employment tasks.

The applicant sought entitlement to various treatment plans and an award under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The matter proceeded to a written hearing, but the applicant failed to file any written submissions or point to evidence supporting her claims, despite filing a document brief.

The adjudicator found the applicant failed to meet her burden of proof and dismissed the claims.

The respondent's request for costs was also denied, as the applicant's failure to file submissions did not amount to serious misconduct.

The appellant sought judicial review and appealed a Licence Appeal Tribunal (LAT) decision dismissing his application for Income Replacement Benefits (IRBs) as statute-barred.

The LAT found that the insurer's May 3, 2021 letter constituted a clear and unequivocal denial of benefits, triggering the two-year limitation period under the Statutory Accident Benefits Schedule.

The Divisional Court upheld the LAT's decision, finding no error in its application of the limitation period or its refusal to extend the time to appeal.

The court also rejected the appellant's arguments regarding discoverability and the impact of subsequent correspondence from the insurer.

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 claimed he suffered from chronic pain with a functional impairment, warranting removal from the MIG.

The Tribunal found the applicant failed to provide objective medical evidence to substantiate his claim, while the respondent provided a physiatry examination indicating the injuries were minor and the applicant had no functional impairment.

The Tribunal concluded the applicant remains in the MIG and dismissed the claims for additional treatment plans.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits and various treatment plans for occupational therapy, physiotherapy, social work, and a psychological assessment.

The Licence Appeal Tribunal denied the claim for attendant care, finding the applicant failed to prove an ongoing need.

However, the Tribunal approved several of the treatment plans, either in whole or in part, finding them reasonable and necessary.

The Tribunal also granted an award under s. 10 of O. Reg. 664, ordering the respondent to pay $600 (15% of the denied occupational therapy benefits) because it unreasonably maintained its denial despite its own assessor recommending the treatment.

Preliminary motions regarding page limits and striking portions of the applicant's reply submissions were also addressed.

The respondent insurer requested a reconsideration of a Tribunal decision that barred the applicant from proceeding with his application due to his failure to attend a properly scheduled s. 44 insurer's examination.

The respondent argued the Tribunal erred by failing to also address whether the applicant was barred for failing to dispute the denial of benefits within the two-year limitation period.

The Tribunal dismissed the request, finding that because the application was already barred under s. 55, the limitation period issue was moot and there was no error in declining to rule on it.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her pre-existing chronic mechanical low back pain warranted removal from the Minor Injury Guideline (MIG) and that she was entitled to a non-earner benefit (NEB).

The Tribunal found the applicant failed to provide compelling medical evidence that her pre-existing condition precluded maximal recovery within the MIG.

Furthermore, the Tribunal held the applicant did not suffer a complete inability to carry on a normal life, relying on functional assessments showing she retained significant independence and mobility.

The application was dismissed, and the applicant remained subject to the MIG limits.

The applicant requested a reconsideration of a preliminary issue decision which found his claim for Income Replacement Benefits (IRBs) was statute-barred.

The applicant argued the adjudicator erred in finding the insurer's denial letter was clear and unequivocal, and in refusing to extend the limitation period under section 7 of the Licence Appeal Tribunal Act.

The Tribunal dismissed the request, finding the applicant was attempting to relitigate the initial decision and failed to establish any errors of law or fact that would have changed the outcome.

The Tribunal also rejected the applicant's attempt to introduce an undated resignation letter as new evidence.

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

The applicant claimed entitlement to medical and rehabilitation benefits, an income replacement benefit (IRB), and interest.

The Tribunal found that the applicant failed to prove his physical or psychological injuries warranted removal from the MIG, noting a lack of corroborating medical evidence for his psychological claims and finding his physical injuries consistent with soft-tissue minor injuries.

The applicant also failed to provide evidence or submissions to support his IRB claim.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident and disputed the denial of income replacement benefits.

The respondent raised a preliminary issue that the applicant was barred from proceeding because he failed to attend a scheduled psychological insurer's examination under s. 44 of the Schedule.

The Tribunal found that the requested examination was reasonably necessary given a new psychological diagnosis by another assessor, and that the applicant did not have a reasonable explanation for non-attendance.

Consequently, the applicant is barred from proceeding with his application under s. 55 of the Schedule.

The applicant was involved in a motor vehicle accident on December 29, 2022, but did not notify the respondent insurer of his intention to claim accident benefits until May 3, 2023.

The respondent denied benefits on the basis of late notification.

The Tribunal held a preliminary issue hearing to determine if the applicant was statute-barred.

The Tribunal found that the applicant failed to provide a reasonable explanation for the delay, as the only evidence submitted was an incomplete disability certificate that did not identify specific injuries or explain how they prevented timely notification.

The application was dismissed as statute-barred pursuant to section 55(1)1 of the Schedule.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including attendant care benefits (ACBs), medical benefits, and cost of examination expenses.

The respondent denied the benefits.

The Tribunal found that the applicant established entitlement to ACBs in the amount of $1,446.57 per month but was not entitled to payment because she failed to prove the expenses were 'incurred' under s. 3(7)(e) of the Schedule.

The Tribunal approved medical benefits for assistive devices and cost of examination expenses for a nutritional assessment and a psychological assessment, finding them reasonable and necessary.

The remaining claims for medical benefits, a chronic pain assessment, and an MRI were dismissed as the applicant failed to meet her evidentiary burden or the services were duplicative or covered by OHIP.

Interest was awarded on the approved benefits.