Mirsa Duka

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 matter proceeded to a written hearing.

The applicant's counsel previously withdrew, and the applicant failed to file any submissions or evidence despite receiving proper notice.

The Tribunal dismissed the application, finding the applicant failed to meet his evidentiary burden to demonstrate entitlement to removal from the MIG, non-earner benefits, the disputed treatment plan, or interest.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing her placement in the Minor Injury Guideline (MIG) and claiming entitlement to income replacement benefits (IRBs), attendant care benefits (ACBs), and specific treatment plans.

The Tribunal found that the applicant's injuries were predominantly minor, rejecting claims of an accident-related concussion and chronic pain syndrome due to a lack of contemporaneous and consistent medical evidence.

The Tribunal also dismissed the claims for IRBs and ACBs, finding the applicant did not demonstrate a substantial inability to perform her pre-accident employment tasks or a functional need for attendant care.

The application was dismissed in its entirety.

The applicant was involved in a motor vehicle accident and reported property damage to his insurer on the same day, explicitly denying any injuries.

Over seven months later, he notified the insurer of his intention to claim accident benefits.

The insurer denied the claim for non-compliance with the 7-day notice requirement under s. 32(1) of the Schedule.

The Tribunal found that the applicant failed to provide a credible or reasonable explanation for the delay, noting he had a prior accident benefits claim and his evidence regarding his lack of knowledge was unpersuasive.

The application was dismissed as the applicant was barred from proceeding under s. 55(1) of the Schedule.

The applicant sought statutory accident benefits following a motor vehicle accident but failed to notify the insurer or submit an application within the time limits prescribed by section 32(1) of the Schedule.

The insurer raised a preliminary issue that the claim was statute-barred.

The Tribunal found that the applicant's ignorance of the law did not constitute a reasonable explanation for the five-month delay, and that the delay prejudiced the insurer's ability to investigate the claim contemporaneously.

The application was dismissed as statute-barred.

The applicant sought statutory accident benefits following a motor vehicle accident involving a school bus.

The Tribunal found that while the applicant's physical injuries fell within the Minor Injury Guideline (MIG), she was entitled to be removed from the MIG due to a psychological impairment, specifically post-traumatic stress disorder.

The applicant's claim for a non-earner benefit was dismissed as she failed to demonstrate a complete inability to carry on a normal life, with evidence showing no significant difference in her pre- and post-accident activities.

The Tribunal approved a treatment plan for psychological services but denied other plans for chiropractic and orthopaedic assessments due to a lack of supporting evidence.

A claim for a special award under Regulation 664 was also dismissed.

The applicant sought removal from the Minor Injury Guideline (MIG) and payment for various psychological and physiotherapy treatment plans following a motor vehicle accident.

The applicant relied on psychological assessments diagnosing trauma-related disorders.

The Tribunal gave little weight to the psychological reports as they relied entirely on uncorroborated self-reporting and lacked contemporaneous medical documentation.

The Tribunal found the applicant failed to prove his injuries fell outside the MIG.

As the MIG limits were exhausted, all claims for treatment plans, interest, and an award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident but was denied by the respondent on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The matter proceeded to a written hearing before the Licence Appeal Tribunal.

The applicant failed to file any written submissions or evidence.

Consequently, the Tribunal found that the applicant failed to meet their onus to demonstrate entitlement to removal from the MIG or to the disputed medical benefits.

The application was dismissed.

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

After the applicant's representative withdrew, the applicant failed to file any written submissions or evidence for the scheduled written hearing.

The Licence Appeal Tribunal proceeded with the hearing pursuant to s. 7(2) of the Statutory Powers Procedure Act.

The Tribunal found that the applicant failed to meet his evidentiary burden to prove entitlement to the claimed benefits, removal from the Minor Injury Guideline, or an award.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, which the respondent denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG due to chronic pain and a psychological condition.

The Tribunal found that the medical evidence, including clinical notes from the applicant's family doctor and a psychological assessment, did not support the presence of chronic pain with functional impairment or a psychological condition caused by the accident.

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

The insurer applied to the Licence Appeal Tribunal for repayment of $15,764.81 in medical and rehabilitation benefits paid to the respondent, alleging the subject accident was staged.

In a previous preliminary issue decision, the Tribunal found the accident was staged and excluded from the definition of an accident under the Schedule.

Relying on this finding, the Tribunal concluded the respondent wilfully misrepresented the facts of the accident to receive benefits.

The Tribunal ordered the respondent to repay the benefits in full, plus applicable interest.

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

The applicant claimed physical injuries including whiplash and soft tissue sprains, as well as psychological impairments such as an adjustment disorder.

The Licence Appeal Tribunal found that the applicant's physical injuries were captured by the minor injury definition and that he failed to provide compelling medical evidence of a pre-existing condition or a psychological impairment warranting removal from the MIG.

Consequently, the applicant was held to the $3,500 MIG limit and denied the disputed treatment plans beyond that cap, though he was awarded interest on any overdue payments within the limit.

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

She failed to notify the insurer of her intention to apply within the required seven days, waiting nearly two months.

The insurer raised a preliminary issue that she was statute-barred from proceeding.

The Tribunal found that the applicant's explanations for the delay—that her ex-husband withheld policy information and that she had a language barrier—were not credible or worthy of belief.

Consequently, the applicant failed to establish a reasonable explanation for the delay under section 34 of the Schedule and is barred from proceeding with her application.

The applicant was struck by a vehicle in April 2021 and sought statutory accident benefits.

She did not submit her application for benefits (OCF-1) until April 2022, well beyond the 30-day time limit prescribed by section 32(5) of the Schedule.

The applicant argued she had a reasonable explanation for the delay due to being overwhelmed and unaware of the severity of her psychological injuries until a subsequent accident.

The Tribunal rejected this explanation, noting she had successfully applied for EI and WSIB during the same period and returned to full-time work.

The Tribunal found the applicant was statute-barred from proceeding with her claim under section 55(1)1 of the Schedule.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her physical and psychological injuries warranted removal from the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's physical injuries, including a right shin contusion, fell within the minor injury definition, and her pre-existing osteoarthritis did not preclude recovery.

The Tribunal rejected the applicant's psychological assessment as unpersuasive, preferring the insurer's examination and family doctor records which showed no psychological complaints.

As the applicant remained within the MIG and the $3,500 limit was exhausted, all disputed treatment plans, interest, and an award were denied.

The applicant was involved in a motor vehicle accident in October 2019 but did not notify the respondent insurer or submit an application for accident benefits until September 2021.

The respondent raised a preliminary issue that the applicant was barred from proceeding due to his failure to comply with the timelines in s. 32 of the Statutory Accident Benefits Schedule and his failure to provide a reasonable explanation for the delay under s. 34.

The applicant argued he did not receive the application forms and was confused about which of his multiple accidents caused his impairments.

The Tribunal rejected this explanation, noting the insurer could not have sent forms without first being notified of the accident.

The Tribunal found the applicant failed to provide a reasonable explanation for the delay and dismissed the application pursuant to s. 55(1) of the Schedule.