Michael Silver

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 was injured in a motor vehicle accident and sought payment for three chiropractic treatment plans under the Statutory Accident Benefits Schedule.

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

The Tribunal found that the applicant did not prove on a balance of probabilities that the treatment plans were reasonable and necessary.

The medical evidence indicated that the applicant had received extensive chiropractic treatment over several years with minimal and short-lived improvement.

Both the applicant's and respondent's medical assessors recommended alternative forms of therapy, such as aqua therapy and relaxation exercises, rather than continued chiropractic care.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his injuries warranted removal from the Minor Injury Guideline (MIG) due to a lens displacement injury and pre-existing physical and psychological conditions.

The Tribunal found insufficient evidence linking the eye injury to the accident and concluded that the applicant's pre-existing conditions did not prevent him from achieving maximal recovery under the MIG.

As the applicant's impairments were predominantly minor, he was subject to the $3,500 funding limit, and his claims for treatment plans exceeding this limit, along with claims for interest and an award, were dismissed.

The applicant sought various statutory accident benefits following a 2017 motor vehicle accident, including attendant care benefits, occupational therapy, assistive devices, and assessments.

The Licence Appeal Tribunal found that the applicant's ongoing impairments were caused by pre-existing degenerative conditions rather than the accident, relying on the respondent's orthopaedic assessment.

The Tribunal denied further attendant care benefits and most treatment plans, but approved a psychological assessment, an attendant care assessment, and an inner bathmat.

The claim for a special award was dismissed as the respondent did not act unreasonably or in bad faith.

The applicant's daughter died in a motor vehicle accident.

The applicant applied for a non-earner benefit two years later.

The respondent argued the claim was statute-barred due to the delay.

The Tribunal found that the applicant provided a reasonable explanation for the delay because the respondent failed to provide her with the required information and forms about available benefits after being notified of the accident.

The applicant was permitted to proceed with her application.

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

The respondent initially placed her in the Minor Injury Guideline (MIG) but later removed her, approving some treatment plans.

At issue was the reasonableness and necessity of several chiropractic treatment plans, a chronic pain assessment, a functional ability evaluation, and a work site assessment.

The Tribunal found the chiropractic treatments and chronic pain assessment to be reasonable and necessary, preferring the evidence of the applicant's treating practitioners and chronic pain assessor over the respondent's orthopedic IE assessor.

However, the functional ability evaluation and work site assessment were denied as the applicant failed to provide submissions or establish their goals.

Interest was awarded on the approved plans.

The applicant sought payment for a chiropractic treatment plan in the amount of $2,822.90 following a motor vehicle accident.

The respondent denied the plan based on an insurer's examination report which concluded the treatment was not reasonable and necessary.

The Tribunal found that the applicant suffered from uncomplicated soft-tissue injuries and had already received a year of similar treatment with limited progress.

The Tribunal preferred the respondent's medical evidence and dismissed the application, finding the treatment plan was not reasonable and necessary.

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

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

The applicant argued that pre-existing conditions and psychological impairments warranted removal from the MIG.

The Licence Appeal Tribunal found that the applicant failed to provide compelling evidence of a psychological impairment or that a pre-existing condition would prevent maximal recovery within the MIG limits.

However, as the MIG limit had not been exhausted, the Tribunal approved the physiotherapy treatment plan up to the remaining limit.

Claims for a psychological assessment, an award, and costs were dismissed.

The applicant was involved in two motor vehicle accidents and sought statutory accident benefits, including non-earner benefits and medical benefits.

The respondent terminated the non-earner benefits and denied several treatment plans.

The Tribunal found that the respondent breached the Statutory Accident Benefits Schedule by failing to provide proper notice when terminating the non-earner benefits, entitling the applicant to payment for the disputed period.

The Tribunal also found that the applicant's pre-existing lupus was aggravated by the accident, satisfying the causation test.

The physiotherapy treatment plans were deemed reasonable and necessary, but the claims for orthopaedic and psychological assessments were dismissed because they were incurred before the treatment plans were submitted.

The applicant's request for a special award was denied.

The applicant requested a reconsideration of a decision finding that his injuries fell within the Minor Injury Guideline (MIG) and denying disputed treatment plans.

The applicant argued the adjudicator violated procedural fairness by admitting the respondent's medical reports and excluding his affidavit, and made errors of law and fact regarding the MIG.

The Vice Chair dismissed the request, finding no jurisdictional error or procedural unfairness, as the affidavit was excluded based on a prior consent order.

The Vice Chair also found no error in the MIG analysis, noting the applicant failed to provide persuasive evidence of a psychological injury or chronic pain condition to warrant removal from the MIG.

The respondent's request for costs was denied.

The applicant sought a Non-Earner Benefit (NEB) and various medical benefits following a motor vehicle accident.

The Tribunal found that while the applicant's life was affected by the accident, she did not suffer a 'complete inability to carry on a normal life' as she continued to engage in substantially all of her pre-accident caregiving activities, albeit with some restrictions and assistance.

The Tribunal approved two physiotherapy treatment plans and an orthopaedic assessment as reasonable and necessary, but denied a third physiotherapy plan, a psychotherapy plan, and a claim for a special award.

Interest was awarded on the approved incurred expenses.

The applicant sought payment for a psychological assessment and a chronic pain assessment following a motor vehicle accident.

The Tribunal denied the psychological assessment because the applicant incurred the cost before the treatment plan was properly submitted to the respondent, violating s. 38(2) of the Schedule.

However, the Tribunal granted the chronic pain assessment, finding it reasonable and necessary given the applicant's exacerbation of pre-existing pain and functional limitations.

The claim for an award under s. 10 of O. Reg. 664 was dismissed as the insurer's denials were not unreasonable.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied entitlement to medical benefits.

The applicant argued the Tribunal breached procedural fairness and made errors of law and fact by failing to properly consider evidence and arguments regarding the denial of treatment plans under section 38(8) of the Statutory Accident Benefits Schedule.

The adjudicator dismissed the request, finding that the Tribunal is not required to address every argument in its reasons, had provided sufficient reasons for finding the treatment plans were not reasonable and necessary, and that the respondent's section 44 reports met the requirements for denying the plans.

Both the applicant and the insurer requested reconsideration of a previous Tribunal decision.

The applicant challenged the finding that she was not entitled to income replacement benefits (IRBs) because she did not earn employment income prior to the accident.

The insurer challenged the finding that it was not entitled to repayment of $17,563.50 in IRBs because it failed to obtain explicit consent to serve the notice of repayment electronically.

The Tribunal dismissed both requests, finding no errors of law or fact in the original decision.

The applicant's request for costs was also denied.

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

The Licence Appeal Tribunal considered whether treatment plans for chiropractic care and a chronic pain assessment were reasonable and necessary.

The Tribunal found the chiropractic treatment plan was not reasonable and necessary due to minimal improvement and unchanging symptoms.

However, the Tribunal approved the chronic pain assessment, finding it reasonable and necessary given the applicant's persistent pain and the lack of success with traditional therapy.

The applicant was injured in a rear-end motor vehicle accident and sought various medical and rehabilitation benefits, including psychological, chiropractic, physiotherapy services, and a neurological assessment.

The insurer denied the benefits.

The Licence Appeal Tribunal dismissed the application in its entirety, finding that the applicant had reached maximum medical recovery for his soft tissue injuries and that the proposed psychological services could be provided at a lower hourly rate by a subordinate practitioner.

The Tribunal also found the neurological assessment was not reasonable and necessary as the applicant's headaches were not directly caused by the accident.

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

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

The Tribunal found that the applicant sustained predominantly minor injuries and failed to provide compelling evidence of pre-existing conditions, psychological impairment, or chronic pain that would warrant exclusion from the MIG.

The Tribunal denied the $3,948.91 treatment plan as not reasonable and necessary, but partially approved the $1,315.02 treatment plan in the amount of $509.26 for home exercise equipment and instruction, as recommended by the insurer's own assessor.

The applicant was injured in a motor vehicle accident and sought medical benefits for three chiropractic treatment plans.

The respondent initially denied the plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the plans were not reasonable and necessary.

At the hearing, the respondent conceded the MIG did not apply but maintained the plans were not reasonable and necessary.

The Tribunal found the treatment plans were reasonable and necessary, as the goals were reasonable, were being met to a reasonable degree, and the costs were reasonable.

The Tribunal ordered the respondent to pay for the treatment plans with interest, but denied the applicant's request for a special award, finding the respondent's initial denial was not unreasonable given its insurer examination report.

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

The respondent raised a preliminary issue, arguing the applicant should be barred from proceeding because she failed to attend an insurer examination under section 44 of the Schedule.

The Tribunal found that the respondent's notice of examination was not compliant with section 42(7) of the Schedule because it was issued without requesting a new Form 1.

Consequently, the applicant was not barred from proceeding, and the respondent was not entitled to the costs of the missed examination.

However, to ensure procedural fairness, the Tribunal ordered a timeline for the respondent to properly request an assessment and for the parties to exchange reports prior to the hearing.

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

At the time of the accident, the applicant was on an unpaid leave of absence due to a prior slip and fall and was not receiving any employment income.

The Tribunal found that the applicant did not meet the definition of "employed" under section 5 of the Statutory Accident Benefits Schedule because she was not receiving remuneration, and therefore was not entitled to IRBs.

The respondent insurer sought repayment of $17,563.50 in IRBs that were paid in error.

The Tribunal dismissed the repayment claim, finding that the insurer failed to provide proper notice under section 64(2)(e) of the Schedule because the notice was sent electronically without the applicant's consent.

The application was dismissed.