Murleen McLean

The applicant requested reconsideration of a Tribunal decision that found it lacked jurisdiction to determine entitlement to a non-earner benefit because the applicant had not submitted a completed disability certificate (OCF-3).

The applicant argued that the respondent's delay in providing the application forms constituted a reasonable explanation for the delay, and that requiring the form years later was futile.

The Tribunal dismissed the reconsideration request, finding that while the delay explained the late filing, it did not excuse the ongoing failure to submit the mandatory OCF-3 once the forms were received.

As there was no completed application or denial, the Tribunal correctly concluded it had no jurisdiction under s. 280 of the Insurance Act.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and occupational therapy treatment plans for a concussion.

The respondent insurer denied the benefits, maintaining that the applicant's injuries fell within the Minor Injury Guideline (MIG) and relying on insurer's examinations.

The Tribunal found the applicant was entitled to IRBs for a limited period before they were validly suspended for non-compliance with a section 33 request.

The Tribunal also approved the occupational therapy plans in part, finding the respondent's reliance on assessors who ignored the concussion diagnosis to be unreasonable.

The Tribunal awarded a maximum 50% special award under section 10 of Regulation 664, condemning the respondent's excessive and inflexible conduct in keeping the applicant in the MIG despite clear medical evidence of a concussion.

The applicant sought non-earner benefits, reimbursement for clothing and prescription expenses, an award, and costs following a motor vehicle accident.

The Tribunal found it lacked jurisdiction to determine the non-earner benefit claim because the applicant had never submitted a disability certificate (OCF-3) and the insurer had never issued a denial.

The claims for clothing and prescription expenses were dismissed due to a lack of evidence demonstrating that the items were damaged in the accident or that the prescriptions were reasonable and necessary.

The requests for an award and costs were also dismissed.

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

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

A written hearing was scheduled, but the applicant failed to file any submissions or evidence.

As the applicant bore the onus of proving entitlement to the benefits and removal from the Minor Injury Guideline, the Tribunal found the applicant failed to meet this burden.

The application was dismissed.

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

The applicant's former counsel removed themselves from the record prior to the hearing.

The Tribunal provided the self-represented applicant with notice of the videoconference hearing and instructions on how to attend.

The applicant failed to appear at the hearing and did not respond to the Tribunal's attempts to contact her.

The adjudicator proceeded in the applicant's absence pursuant to Rule 3.7.1(a) of the Licence Appeal Tribunal Rules.

As the applicant filed no evidence and made no submissions, she failed to meet her burden of proof.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a catastrophic impairment under Criterion 7 (55% whole person impairment).

The Licence Appeal Tribunal reviewed competing medical assessments and preferred the respondent's experts, finding the applicant's combined physical and psychological impairments resulted in a 26% whole person impairment, falling short of the 55% threshold.

The Tribunal also dismissed the applicant's claim for a functional abilities evaluation, finding it was not reasonable and necessary, and consequently denied claims for interest and a special award.

The applicant sought a determination that she sustained a catastrophic impairment as a result of a 2018 motor vehicle accident, along with entitlement to a physiotherapy treatment plan, an award, and interest.

The adjudicator found that the applicant failed to prove she met the criteria for catastrophic impairment under Criteria 6 (physical), 7 (combined physical and psychological), or 8 (mental/behavioural).

The adjudicator rejected the applicant's expert evidence, finding it inconsistent with the AMA Guides and unsupported by objective medical evidence.

The claim for the physiotherapy treatment plan was also dismissed as the applicant failed to include the plan in evidence or prove it was reasonable and necessary.

Consequently, the claims for an award and interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she suffered a catastrophic impairment under Criteria 7 and 8 of the Schedule.

The Licence Appeal Tribunal found the applicant failed to establish a whole person impairment of at least 55 per cent, as the physical and psychological impairment ratings provided by her assessors were largely unsubstantiated by contemporaneous medical evidence.

The Tribunal also found the applicant failed to prove marked impairment in at least three areas of function due to a mental or behavioural disorder resulting from the accident.

The application was dismissed.

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

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

The applicant argued that he should be removed from the MIG due to accident-related psychological impairments and a pre-existing psychological condition.

The Tribunal found that the applicant's pre-accident medical records showed severe anxiety and depression, contradicting his expert's report that symptoms began after the accident.

The Tribunal concluded the applicant failed to prove that his pre-existing condition would prevent maximal recovery from his minor injuries if kept within the MIG.

The application was dismissed, with the applicant remaining subject to the $3,500 MIG limit.

The applicant, who has a pre-existing diagnosis of autism, sought statutory accident benefits following a motor vehicle accident.

She claimed entitlement to a non-earner benefit, various medical benefits including occupational therapy, physical therapy, and a chronic pain assessment, as well as an award and interest.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to establish a complete inability to carry on a normal life, as there was insufficient evidence comparing her pre- and post-accident activities.

The Tribunal preferred the respondent's expert evidence, which indicated no objective ongoing accident-related impairments and found the disputed treatment plans were either duplicative or not reasonable and necessary.

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

The Licence Appeal Tribunal considered claims for a non-earner benefit, an attendant care assessment, psychotherapy treatment, and a chronic pain assessment.

Applying the Heath test, the Tribunal found the applicant failed to establish a complete inability to carry on a normal life, noting inconsistencies in her evidence and symptom magnification identified by the respondent's psychological expert.

The Tribunal denied the non-earner benefit, attendant care assessment, and psychotherapy treatment, preferring the respondent's expert evidence.

However, the Tribunal granted the chronic pain assessment, finding it reasonable and necessary given the respondent's own medical expert's diagnosis of chronic neck and back pain.

Claims for an award under Regulation 664 were dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a non-earner benefit, various medical and rehabilitation assessments, a special award, and interest.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to prove she suffered a complete inability to carry on a normal life, as evidence showed she could perform the majority of her pre-accident activities.

The Tribunal also dismissed the claims for medical and rehabilitation benefits, finding the applicant did not provide sufficient medical evidence to prove the treatment and assessments were reasonable and necessary.

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

The plaintiff was injured in a motor vehicle accident and sued his insurer, Unifund, under the unidentified motorist provisions of his automobile insurance policy.

Unifund brought a summary judgment motion to dismiss the claim on the basis that the identity of the owner and driver of the offending vehicle were known.

The motion judge granted the order on the mistaken premise that all parties had consented to it.

The plaintiff subsequently brought a clarification motion seeking to estop the defendants from raising identity defences at trial.

The Court of Appeal allowed the plaintiff's appeal, finding that the summary judgment motion was made on an erroneous basis and that taking "no position" on a motion is fundamentally different from consenting to it.

The court set aside all orders and dismissed the summary judgment motion without prejudice to Unifund's right to renew it.