OLAT 2017

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.

The applicant was injured in a motor vehicle accident and sought medical benefits for psychological services under two treatment plans.

The respondent denied the claims, arguing the treatments were either duplicative of previously approved plans or not reasonable and necessary.

The Tribunal found that the applicant failed to prove the disputed treatment plans were reasonable and necessary, noting that the applicant had not fully consumed previously approved treatments and had ceased engaging in the proposed treatment.

The application for benefits was dismissed.

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

The respondent initially denied catastrophic designation, income replacement benefits, and attendant care benefits, but conceded the catastrophic designation and income replacement benefits shortly before the hearing.

The Tribunal found that the applicant's attendant care benefits were incurred because the service provider was working as a personal support worker at the time the services were rendered.

The Tribunal also awarded the applicant 30% of the income replacement benefits owed due to the respondent's unreasonable delay and excessive documentation requests.

The applicant brought a motion seeking production of all documentation relating to the stoppage, acceptance, payment, and subsequent denial of attendant care, housekeeping, and home maintenance benefits, and an order that the preliminary issue hearing be conducted orally rather than in writing.

The adjudicator dismissed the motion, finding that an oral hearing was not required as the evidence was documentary and the legal arguments were best presented in writing.

The adjudicator also declined to reconsider a previous order denying the broad production request, noting that equitable remedies like estoppel and waiver are beyond the Tribunal's jurisdiction and discoverability does not apply to statutory accident benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a non-earner benefit, chiropractic services, and a psychological assessment.

The respondent denied the medical and assessment benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's injuries were predominantly soft tissue injuries falling within the MIG, and that he failed to prove pre-existing conditions or chronic pain that would warrant an exception.

The Tribunal also dismissed the claim for a non-earner benefit, finding insufficient evidence that the applicant suffered a complete inability to carry on a normal life.

The claims for chiropractic services and a psychological assessment were dismissed as not reasonable and necessary.

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

The insurer denied the claims on the basis that the injuries fell within the Minor Injury Guideline and requested the applicant attend several insurer examinations.

The applicant failed to attend the examinations, arguing the notices did not provide sufficient medical reasons.

The Tribunal found the notices were sufficient and that the applicant failed to comply with section 44 of the Statutory Accident Benefits Schedule.

Consequently, the application was dismissed pursuant to section 55.

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

The respondent insurer scheduled a section 44 psychological assessment, which the applicant refused to attend.

The respondent argued the applicant was precluded from proceeding with the application due to this refusal.

The Tribunal found that the respondent's notice for the section 44 assessment failed to include medical or other reasons for the examination, rendering it non-compliant with the Schedule.

Consequently, the applicant was not precluded from proceeding with the application.

The applicant sought reconsideration of a previous decision regarding entitlement to a $1,950 chronic pain assessment following a motor vehicle accident.

The adjudicator found that the assessment was reasonable and necessary based on medical evidence showing the applicant suffered from spinal sprains and strains.

The applicant was awarded $1,950 for the assessment plus interest.

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

The insurer argued the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered a concussion and post-concussion syndrome, removing the claims from the MIG.

However, the Tribunal dismissed the applicant's claims for a chronic pain assessment and an in-home assessment, finding the applicant failed to prove they were reasonable and necessary.

Claims for interest and a special award were also dismissed.

The applicant sought ongoing income replacement benefits following a motor vehicle accident.

The respondent had paid benefits until November 2014 but denied further entitlement.

The Tribunal found that the applicant's ongoing back pain was related to pre-existing mild degenerative changes and obesity, not the accident.

Medical evidence also suggested symptom embellishment.

The Tribunal concluded the applicant failed to prove a substantial inability to perform his pre-accident employment or a complete inability to engage in any suitable employment.

The application for ongoing benefits was dismissed.

The respondent's request for repayment of an overpayment was also dismissed as it was not properly raised at the case conference.

The applicant's husband died of a fatal arrhythmia shortly after being involved in a motor vehicle accident.

The respondent insurer denied death and funeral benefits, arguing that the deceased's pre-existing coronary artery disease would have inevitably caused a fatal cardiac event independent of the accident.

The Tribunal applied the purpose and causation tests, finding that the stress of the accident triggered myocardial ischemia and a fatal arrhythmia.

The Tribunal preferred the evidence of the applicant's expert cardiologist over the respondent's expert, concluding that the accident was the direct cause of the death.

The applicant and her children were awarded death benefits, funeral benefits, and interest on overdue amounts.

No costs were awarded.

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

The insurer denied claims for occupational and physiotherapy services and required the applicant to attend insurer's examinations (IEs).

The applicant failed to attend the IEs, arguing the insurer's denial letters did not comply with the notice requirements under sections 38(8) and 44(5) of the Schedule.

The Tribunal found that the denial letters sufficiently provided medical reasons for the IEs.

Consequently, the applicant had no valid defence for her non-attendance and is barred under section 55 of the Schedule from proceeding before the Tribunal until she attends the required IEs.

The minor applicant was injured while riding a dirt bike on a privately owned track.

He sought statutory accident benefits, which the respondent denied.

At a preliminary issue hearing, the Tribunal had to determine whether the motorcycle was an 'automobile' and whether the incident was an 'accident' under the Schedule.

The Tribunal found that the motorcycle was not required to be insured under the Off-Road Vehicles Act because it fell under the exemption for vehicles driven at a 'closed course competition'.

Consequently, the motorcycle was not an 'automobile' and the incident was not an 'accident'.

The application for benefits was dismissed.

The applicant was injured in a motor vehicle accident and sought approval for a psychiatric assessment.

The respondent insurer denied the treatment plan and requested the applicant attend an independent psychiatric examination under s. 44 of the Statutory Accident Benefits Schedule.

The applicant refused to attend, arguing the insurer failed to provide adequate medical reasons.

On a preliminary issue, the Tribunal found the insurer's notice complied with s. 44.

While the applicant could be precluded from proceeding under s. 55 for non-attendance, the Tribunal exercised its discretion to adjourn the application for 60 days to allow the applicant to attend the examination, noting it would be unfair to bar the claim entirely when both parties agreed a psychiatric assessment was necessary.

The applicant, a pedestrian injured in a motor vehicle accident, applied for non-earner benefits after the respondent insurer terminated them.

The adjudicator applied the Heath test to determine whether the applicant suffered a complete inability to carry on a normal life.

Finding that the applicant's pain and physical limitations practically prevented her from engaging in substantially all of her pre-accident activities, including walking, housekeeping, and caring for her grandchildren, the adjudicator concluded she met the test.

The applicant was awarded ongoing non-earner benefits and interest on overdue payments.

The applicant sought reconsideration of a Tribunal decision that partially granted her motion regarding hearing procedure.

She challenged the admission of addendum reports from the insurer's assessors, the refusal to order production of adjuster log notes and draft reports, and the denial of costs.

The Executive Chair dismissed the request for reconsideration, finding no error in the Tribunal's balancing of the insurer's right to respond with the applicant's right to a fair hearing, and agreeing that the requested documents were not relevant to the issue of non-earner benefits.

The applicant sought medical benefits for chiropractic treatment following a motor vehicle accident.

The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 cap had been exhausted.

The applicant argued the respondent's denial notices were defective under s. 38(8) of the Schedule and that a pre-existing condition of chronic chest pain warranted treatment outside the MIG.

The Tribunal found the denial notices were compliant and that the applicant failed to provide compelling evidence of a pre-existing condition that would prevent maximal recovery under the MIG.

The claims for medical benefits, interest, a special award, and costs were dismissed.

The applicant was injured in a T-bone collision and received income replacement benefits (IRBs) for two years.

The insurer terminated IRBs at the 104-week mark, arguing the applicant could return to suitable employment.

The Tribunal found that the applicant's accident-related soft tissue injuries aggravated pre-existing arthritis in his hand, resulting in chronic pain and functional limitations.

Given his physical restrictions, limited education, and lack of transferable skills, the Tribunal concluded he suffered a complete inability to engage in suitable employment and was entitled to ongoing IRBs.

Claims for further chiropractic and massage treatments were dismissed as not reasonable or necessary.

The applicant sought statutory accident benefits after sustaining injuries when she fell off the rear bumper of a moving vehicle while 'car surfing'.

The respondent insurer denied benefits, arguing the incident did not meet the definition of an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal applied the two-part Amos test and found that the vehicle was being used for transportation, an ordinary and well-known activity, despite the applicant's dangerous and illegal use of it.

The Tribunal concluded that the applicant was involved in an accident and is entitled to proceed with her claim for benefits.

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

After the applicant failed to attend two case conferences, the respondent requested that the application be dismissed as abandoned.

The Tribunal initially found that the application had been withdrawn by the applicant's paralegal at the first case conference.

The respondent requested a reconsideration, arguing that the application should be dismissed as abandoned and that the Tribunal breached procedural fairness by accepting late submissions from the applicant that were not served on the respondent.

The Executive Chair denied the request for reconsideration, finding that while a breach of procedural fairness occurred, it was inconsequential and caused no prejudice.

The Executive Chair upheld the finding that the application was withdrawn rather than abandoned, and denied the respondent's request for costs.