Nathalie Rosenthall

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

The Tribunal found the applicant did not meet the burden to be removed from the Minor Injury Guideline (MIG).

The applicant was awarded a non-earner benefit for a limited period due to the insurer's non-compliant denial notice under s. 36 of the Schedule.

One treatment plan for a psychological assessment was deemed payable due to a non-compliant denial notice under s. 38(8), while other treatment plans were denied.

Claims for an award were dismissed.

The applicant and the respondent insurer, Aviva, both requested reconsideration of a Licence Appeal Tribunal decision regarding statutory accident benefits.

The applicant alleged procedural fairness breaches and errors of law regarding the denial of attendant care benefits and the reliance on an untested expert report.

The Tribunal dismissed the applicant's request, finding no procedural unfairness as the applicant had not properly summonsed the expert, and no error in the adjudicator's requirement for detailed invoices to prove expenses were incurred.

Aviva's request for reconsideration was granted in part to correct a mathematical error in the calculation of a bad faith award, reducing the quantum to $7,263.45.

The applicant's request for costs was denied.

The applicant, an Uber driver, sought statutory accident benefits after another individual shone a green laser into his eye while he was delivering food.

The respondent denied benefits on the basis that the incident was not an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal applied the two-part purpose and causation test from Greenhalgh.

While the purpose test was met, the causation test failed because the deliberate shining of the laser was an unexpected intervening act, and the use or operation of the vehicle was not the dominant feature of the injuries.

The application was dismissed.

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 Tribunal found that the applicant failed to establish chronic pain with functional impairment or a psychological condition warranting removal from the MIG, noting inconsistencies in his self-reporting and preferring the insurer's psychological assessment.

The Tribunal also dismissed the claim for an income replacement benefit due to a lack of evidence regarding the applicant's employment and functional limitations.

The application was dismissed in its entirety.

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

The respondent denied the claim because the applicant failed to notify it within seven days and submitted her OCF-1 application one and a half years late.

The Tribunal found that the applicant's ignorance of the law did not constitute a reasonable explanation for the delay.

As a result, the applicant is barred from proceeding with her application before the Tribunal.

The applicant, who sustained a catastrophic impairment in a 2017 motor vehicle accident, sought attendant care benefits (ACBs) and various medical and rehabilitation benefits.

The Tribunal found the applicant entitled to ACBs for specific periods based on his psychological impairments, but held the benefits were not payable because the applicant failed to prove they were incurred.

The Tribunal partially approved treatment plans for social work, aquatherapy, concussion treatment, and a home renovation assessment, while denying others that were reasonably available through OHIP.

The Tribunal ordered Aviva to pay a special award of $9,041.12 under s. 10 of Regulation 664, finding that the insurer acted unreasonably and in bad faith by pre-emptively denying treatment plans and failing to comply with procedural timelines.

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

The issues in dispute included entitlement to attendant care benefits, an award for unreasonable delay, interest, and costs.

The adjudicator found the applicant entitled to attendant care benefits at the maximum hourly rate permitted by the Guideline, totaling $745.00, rather than the higher rate claimed.

The claim for an award under s. 10 of Regulation 664 was dismissed, as the insurer's partial payment in accordance with the Guideline was not unreasonable or inflexible.

The respondent's request for costs was also dismissed, as there was no evidence the applicant acted frivolously or vexatiously.

The applicant, who was catastrophically impaired in a motor vehicle accident, sought payment for outstanding balances on five treatment plans (OCF-18s) that were partially denied by the respondent insurer.

The Tribunal found the applicant was entitled to the full $200 form completion fees for case management, occupational therapy, and social work plans, as well as the outstanding balance for laser therapy and acupuncture due to the respondent's failure to provide proper medical reasons for denial under s. 38(8) of the Schedule.

However, the Tribunal dismissed the claims for transportation costs and additional social work session time, finding the applicant failed to meet his burden of proof.

The applicant's request for a special award under s. 10 of Regulation 664 was also dismissed.

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

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

The Tribunal found that the applicant's injuries warranted removal from the MIG due to chronic pain syndrome and resulting functional limitations, relying on the family doctor's records and an independent chronic pain assessment.

However, the applicant's claims for income replacement benefits and specific treatment plans were dismissed due to a failure to produce required financial documentation and a lack of objective, contemporaneous medical evidence supporting the treatment plans.

The self-represented applicant sought various statutory accident benefits, including income replacement benefits, attendant care benefits, and several treatment and assessment plans following a motor vehicle accident.

The respondent raised a preliminary issue that the applicant should be barred from proceeding due to a failure to attend insurer's examinations.

The adjudicator found the respondent failed to prove proper notice of the examinations was given, allowing the hearing to proceed.

However, the applicant provided no documentary evidence or substantive testimony to support his claims, arguing only that he paid his insurance premiums and should therefore be entitled to benefits.

The adjudicator dismissed all claims, finding the applicant failed to meet his burden of proving entitlement on a balance of probabilities.

The appellant was denied income replacement benefits after her insurer discovered she misrepresented her address to obtain a lower premium.

The insurer subsequently charged her a retroactive premium increase.

The Licence Appeal Tribunal upheld the denial and refused to apply section 131 of the Insurance Act, which excuses non-compliance based on an insurer's conduct, finding it lacked equitable jurisdiction.

On appeal, the Divisional Court held the LAT erred in law by conflating equitable remedies with statutory relief under section 131, which the LAT has jurisdiction to apply.

The appeal was allowed and the matter remitted for a new hearing.

The applicant sought statutory accident benefits after spilling hot coffee on his lap while in his vehicle at a drive-thru.

The respondent denied the claim, arguing the incident did not meet the definition of an 'accident' under section 3(1) of the Schedule and that the application was submitted late.

The Tribunal found that while the purpose test was met, the causation test failed because the improperly secured coffee cup lid was an intervening act that directly caused the injuries, breaking the chain of causation from the use of the vehicle.

Furthermore, the Tribunal held that the applicant was barred from proceeding because he failed to notify the respondent within the prescribed timelines and did not provide a reasonable explanation for the delay.

The application was dismissed.

The applicant sought entitlement to numerous treatment plans for physical and psychological therapy, assistive devices, and assessments following a motor vehicle accident.

The Licence Appeal Tribunal denied the majority of the treatment plans, finding the applicant failed to prove they were reasonable and necessary, largely due to a lack of corroborating medical evidence and inconsistencies in the expert reports provided.

However, the Tribunal granted entitlement to translation services, a chronic pain assessment, and an attendant care assessment.

The Tribunal also ordered the respondent to pay a $250 special award under s. 10 of O. Reg. 664 for unreasonably withholding funding for the applicant's attendant care assessment while funding its own.

The applicant sought statutory accident benefits following a motor vehicle accident, which were denied by the respondent insurer.

The Licence Appeal Tribunal reviewed multiple treatment plans for physical and psychological therapies, attendant care assessments, and assistive devices.

The Tribunal found the applicant was entitled to partial payment for several treatment plans, including massage, acupuncture, physiotherapy, and psychological treatment, as well as attendant care assessments.

The Tribunal also awarded a $450 special award under s. 10 of O. Reg. 664, finding the insurer unreasonably denied the psychological components of a treatment plan without addressing them in its denial or submissions.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's denial of several treatment plans and medical expenses.

The Licence Appeal Tribunal found that the insurer's denial complied with s. 38(8) of the Schedule by adequately relying on an Insurer's Examination report.

The Tribunal partially allowed the claim for an aqua therapy program, limiting recovery to pool sessions incurred after the treatment plan was submitted and at the rate for an unregulated provider.

Claims for chiropractic laser therapy and orthotics were dismissed for lack of evidence, while a prescription expense for migraine medication was allowed.

The applicant's request for a special award under Ontario Regulation 664 was dismissed as the insurer's reliance on the medical assessment was not unreasonable.

The applicant insurer sought repayment of $9,673.38 in income replacement benefits (IRBs) paid to the respondent, alleging the respondent made untrue statements about his employment.

The insurer also sought recovery of $2,353.93 in accountant fees and costs of the proceeding.

The respondent did not participate in the hearing.

The Tribunal found that the respondent's claims were untrue and ordered repayment of the IRBs plus interest under section 52 of the Statutory Accident Benefits Schedule.

However, the Tribunal held it lacked jurisdiction to order repayment of the insurer's adjustment costs, including accountant fees.

The insurer's request for costs was denied as the respondent's non-participation did not impose additional costs on the insurer.

The applicant insurer sought repayment of benefits and claim adjustment costs from the respondent, alleging he wilfully misrepresented being a passenger in an insured vehicle during an accident.

The respondent did not participate in the hearing.

The Tribunal found that the respondent was not an occupant of the vehicle and that his claim was based on a wilful misrepresentation.

The Tribunal ordered the respondent to repay $200.00 in benefits plus interest.

However, the Tribunal held it lacked jurisdiction to order repayment of the insurer's claim adjustment costs, such as insurer's examination fees, and denied the insurer's request for costs of the proceeding.

The applicant insurer applied to the Licence Appeal Tribunal for repayment of statutory accident benefits paid to the respondent, alleging he was not a passenger in the insured vehicle at the time of the accident.

The Tribunal found that the respondent made a wilful misrepresentation, as evidence showed he was not an occupant of the vehicle.

The respondent was ordered to repay $2,400.00 in benefits plus interest.

However, the Tribunal dismissed the insurer's claim for reimbursement of adjusting and examination costs, finding no authority in the Schedule to order repayment of such expenses.

The insurer's request for costs of the proceeding was also dismissed.

The applicant sought accident benefits following a motor vehicle accident.

The insurer terminated income replacement benefits and sought repayment, alleging the applicant misrepresented her employment status.

The applicant failed to produce ordered employment records and did not attend the hearing.

Her counsel was permitted to withdraw due to a breakdown in the solicitor-client relationship.

The arbitrator dismissed the applicant's claims and ordered her to repay $18,914.29 in income replacement benefits, finding she wilfully misled the insurer about her work history.

The insurer was also awarded $3,500 in costs.

The applicant was injured in a motor vehicle accident and sought various medical, rehabilitation, and attendant care benefits from her insurer.

The insurer initially denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG), but later conceded her injuries were outside the MIG following an insurer's examination.

The Tribunal found that the applicant was entitled to the disputed physiotherapy and chiropractic treatment plans, as well as the cost of an attendant care assessment, because her injuries, which included chronic pain syndrome, warranted treatment outside the MIG.

However, the Tribunal dismissed the applicant's claims for replacement eyeglasses and out-of-pocket physiotherapy and acupuncture expenses due to a lack of supporting evidence connecting them to the accident or complying with the requirement to submit a treatment plan.

The applicant's request for costs was also dismissed.