Mariya Verkhovets

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

The Tribunal first held that the applicant was statute-barred from disputing the denial of 14 treatment plans because he failed to apply within the two-year limitation period and did not establish grounds for an extension under s. 7 of the LAT Act.

On the substantive issues, the Tribunal found the applicant did not sustain a catastrophic impairment under Criterion 7 (falling short of the 55% whole person impairment threshold) or Criterion 8 (failing to establish marked impairments in three spheres of functioning).

The Tribunal also dismissed the claims for the remaining treatment plans, finding the applicant failed to meet his evidentiary onus to prove they were reasonable and necessary.

Claims for interest and an award were consequently dismissed.

The applicant sought statutory accident benefits, including income replacement benefits (IRBs) and funding for seven physiotherapy treatment plans, following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application in its entirety.

The adjudicator found the applicant's self-reporting to medical assessors unreliable due to symptom magnification and surveillance evidence showing the applicant working long hours at a restaurant.

Consequently, the applicant failed to prove a substantial inability to perform the essential tasks of his employment for pre-104 week IRBs, or a complete inability to engage in any employment for post-104 week IRBs.

The physiotherapy plans were deemed not reasonable and necessary, as the applicant contemporaneously reported to his family doctor that the treatments were ineffective.

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

The insurer denied benefits, arguing non-compliance with an examination under oath and that the injuries fell within the Minor Injury Guideline.

The Tribunal found the insurer could not rely on the examination under oath non-compliance because it improperly sought a mixed examination.

The Tribunal removed the applicant from the Minor Injury Guideline due to an accident-related chronic pain condition, approving several physical rehabilitation and pain assessment plans.

However, claims for an income replacement benefit and various psychological and cognitive assessments were dismissed for lack of supporting evidence.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits, medical benefits, and assessments.

The adjudicator dismissed the claim for non-earner benefits, finding the applicant's reduced capacity did not amount to a complete inability to carry on a normal life.

However, the adjudicator granted the disputed treatment and assessment plans, finding them reasonable and necessary given the applicant's pre-existing conditions that were exacerbated by the accident.

The adjudicator also ordered a special award under s. 10 of O. Reg. 664, finding the insurer unreasonably delayed removing the applicant from the Minor Injury Guideline despite its own assessor's opinion supporting the exacerbation of pre-existing impairments.

The applicant sought statutory accident benefits for psychological injuries sustained after her husband was struck by a vehicle insured by the respondent.

The respondent denied the claim on the basis that the applicant was not an 'insured person' under section 3(1) of the Schedule.

The Tribunal found that the applicant was not a named insured, specified driver, or spouse of a named insured under the policy.

Furthermore, the Tribunal applied the purpose and causation tests, concluding that the applicant's injuries arose from caring for her husband rather than the direct use or operation of an automobile.

The application was dismissed.

The respondent insurer filed a Request for Reconsideration of a Licence Appeal Tribunal decision that awarded the applicant statutory accident benefits and a special award.

The insurer argued that the Tribunal violated procedural fairness by issuing summonses for third-party records in a written hearing, which delayed disclosure and prejudiced its case.

The insurer also argued the Tribunal relied on misleading log notes that actually pertained to another claimant to grant the special award.

The adjudicator granted the reconsideration, finding that the Tribunal breached its own rules and the Statutory Powers Procedure Act by issuing summonses for a written hearing.

The adjudicator also found the Tribunal made an error of fact regarding the log notes, which led to an error of law in granting the special award.

The original decision was set aside and a new hearing was ordered.

The applicant was injured in a motor vehicle accident and sought various medical benefits, including physiotherapy, occupational therapy, and psychological services, which the respondent insurer denied.

The Licence Appeal Tribunal found that the applicant's compression fracture was caused by the accident and that the disputed treatment plans were reasonable and necessary.

The Tribunal also found that the respondent unreasonably withheld benefits, particularly where its own assessors had recommended treatment, and ordered a 50% special award under s. 10 of Regulation 664 along with interest on overdue payments.

The applicant sought entitlement to an income replacement benefit, medical benefits for physiotherapy, and the costs of psychological and orthopaedic assessments following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the claims for the income replacement benefit, physiotherapy, and orthopaedic assessment, finding insufficient medical evidence for the IRB and noting that the treatment plans for physiotherapy and orthopaedics were improperly delivered to the wrong insurer.

However, the Tribunal granted the cost of the psychological assessment, finding the respondent's denial unreasonable as it relied on an unhelpful and generalized independent examination report that failed to adequately address the applicant's psychological symptoms.

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

The insurer denied various medical, rehabilitation, attendant care, and non-earner benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant failed to meet the burden of proving her injuries warranted removal from the MIG, noting that her medical evidence was unpersuasive and internally contradictory.

Furthermore, the applicant's claim for non-earner benefits was dismissed because her own statements to independent examiners demonstrated she had resumed a significant portion of her pre-accident activities.

The appeal was dismissed.

Aviva Insurance Canada requested a reconsideration of a Licence Appeal Tribunal decision which found that N.F.'s application for accident benefits was valid despite missing a police report.

Aviva argued that the application was incomplete and therefore barred.

The Executive Chair dismissed this argument, finding that under section 32(7) of the Statutory Accident Benefits Schedule, an application does not need to be perfectly complete to trigger an insurer's obligation to respond, provided it is functionally adequate.

The Tribunal's finding that Aviva was precluded from relying on the Minor Injury Guideline due to improper denial notices was upheld.

However, the Tribunal's order was varied to explicitly dismiss N.F.'s claim for a non-earner benefit due to a lack of evidence.

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

The insurer denied the claim on the basis that the application was incomplete because the applicant did not provide a police report.

The Tribunal found that the applicant was not barred from commencing the application under s. 55 of the Schedule, as she had notified the insurer as soon as practicable and a police report was not mandatory in these exceptional circumstances.

The Tribunal further held that the insurer failed to properly deny several treatment plans under s. 38(8) of the Schedule, rendering them payable.

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

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

The adjudicator found that the applicant's injuries were predominantly minor soft tissue injuries and that she had exhausted the $3,500 MIG limit, disentitling her to further medical and attendant care benefits.

The adjudicator also dismissed the claim for income replacement benefits, noting the applicant had returned to work shortly after the accident and failed to provide persuasive medical evidence demonstrating a substantial inability to perform the essential tasks of her employment.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits from the Motor Vehicle Accident Claims Fund, which later transferred the claim to the respondent insurer.

The insurer argued the application was barred under s. 55 of the Schedule because the applicant failed to notify the Fund within seven days and submitted an incomplete application lacking a police report.

The Tribunal found the applicant notified the Fund as soon as practicable and that a police report was not mandatory since the Fund had sufficient information to determine if a benefit was payable.

Furthermore, the Tribunal held that the insurer failed to provide proper notice under s. 38(8) when denying the treatment plans, as it did not provide medical reasons or state that the Minor Injury Guideline applied.

Consequently, under s. 38(11), the insurer was prohibited from applying the Minor Injury Guideline and was ordered to pay for all the disputed treatment plans.

The respondent brought a motion to dismiss the applicant's claim for statutory accident benefits after the applicant filed their written submissions late.

The applicant had requested an extension due to a power outage, which the Tribunal granted without requiring a formal notice of motion, leading to confusion for the respondent.

The adjudicator dismissed the motion to dismiss the claim, finding that the applicant should not bear the burden of the Tribunal's administrative oversight and that dismissing the claim for a one-day delay would be unfair.

The adjudicator adjusted the hearing schedule to allow the respondent to file supplementary submissions and address costs.