OLAT 2017

The applicant tripped in a pothole and fell while walking towards her parked minivan in a parking lot.

She applied for statutory accident benefits, claiming the incident was an 'accident' under section 3(1) of the Schedule.

The Tribunal applied the two-part purpose and causation test and found that walking towards a parked car does not satisfy the purpose test.

Furthermore, the pothole was an intervening act that directly caused the injuries, breaking the chain of causation.

The application was dismissed.

The applicant brought a motion to adjourn a scheduled three-day hearing regarding non-earner and attendant care benefits.

The applicant had recently served an Application for Determination of Catastrophic Impairment (OCF-19) and argued that proceeding with the hearing before the catastrophic impairment issue was resolved could result in a multiplicity of proceedings.

The respondent opposed the adjournment, citing delay.

The adjudicator granted the adjournment, finding that the delay in serving the OCF-19 was justified by the need for medical testing, and that adjourning the hearing would avoid duplicative proceedings and allow for a full and fair hearing on the merits.

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

The Licence Appeal Tribunal found the applicant suffered a complete inability to engage in any employment for which he was reasonably suited, entitling him to a post-104 week income replacement benefit.

The Tribunal also determined the applicant sustained a catastrophic impairment, as his combined physical, neurocognitive, and mental/behavioural impairments met the 55% whole person impairment threshold under the AMA Guides.

However, the applicant's claims for specific medical and rehabilitation benefits were dismissed for lack of evidence proving they were reasonable and necessary.

The applicant sought non-earner benefits following a motor vehicle accident, claiming a complete inability to carry on a normal life.

The Tribunal reviewed the applicant's pre-accident life, noting significant pre-existing health conditions and mobility restrictions.

The Tribunal found that post-accident, the applicant continued to engage in substantially all of the activities she ordinarily engaged in before the accident, such as household chores, shopping, and family vacations, albeit with some modifications and assistance.

Consequently, the application for non-earner benefits was dismissed.

The applicant brought a motion to combine his appeal for the denial of ongoing income replacement and other benefits with the insurer's earlier appeal for the repayment of income replacement benefits based on material misrepresentation.

The insurer opposed the motion, arguing that consolidation would require adjourning an already scheduled hearing for which it had incurred costs.

The Tribunal dismissed the motion, finding no efficiency in consolidating the files because the issues were distinct and required separate evidentiary bases.

The Tribunal also noted that consolidation would prejudice the insurer's right to an expeditious determination of its repayment applications.

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

The respondent raised preliminary issues regarding the applicant's failure to attend a physiatry insurer examination (IE) and failure to provide information under section 33 of the Schedule.

The Tribunal held that the applicant is barred from proceeding with her IRB claim until she attends the physiatry IE, as the respondent's request was reasonably necessary.

However, the Tribunal found that the applicant had provided sufficient information and documentation to the respondent, meaning her claim was not barred under section 33.

Neither party was awarded costs.

The applicant filed a motion to combine his appeal for ongoing statutory accident benefits with the insurer's appeal for the repayment of income replacement benefits based on material misrepresentation.

The Tribunal dismissed the motion, finding that the issues were distinct and required separate evidentiary bases.

The Tribunal also noted that consolidating the files would prejudice the insurer by delaying its already scheduled hearing and causing the loss of expenditures incurred for that hearing.

The applicant sought medical benefits for occupational therapy assessments following a motor vehicle accident.

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

The applicant argued the insurer's denial letters failed to comply with the notice requirements under section 38(8) of the Schedule.

The Tribunal found the denial letters were compliant.

Furthermore, the Tribunal concluded the applicant failed to prove his injuries fell outside the MIG.

Consequently, the claim for an in-home assessment was barred by section 25(2) of the Schedule, and the claim for a work site assessment was dismissed for lack of evidence that it was reasonable and necessary.

The respondent brought a motion to dismiss the application without a hearing, arguing the applicant abandoned the proceeding by failing to attend a scheduled case conference.

The respondent also sought costs, alleging the applicant's conduct was unreasonable and vexatious.

The Tribunal dismissed the motion, finding the applicant's attendance at the motion hearing and his affidavit evidence of a mental breakdown demonstrated he had not abandoned his claim.

The Tribunal also declined to award costs, accepting the applicant's explanation for his absence and finding his conduct was not intended to harass or show disrespect.

The respondent brought a motion to exclude a medical report filed by the applicant after the deadline set in a case conference order.

The applicant argued the report was merely supplementary to an earlier report.

The Tribunal found that admitting the report without allowing the respondent to respond would be prejudicial.

To balance the applicant's right to present her case with the respondent's right to procedural fairness, the Tribunal granted the motion in part by adjourning the hearing to allow the respondent to have the applicant assessed and to respond to the late report.

The applicant sought statutory accident benefits after tripping on an uneven curb shortly after disembarking from a vehicle.

The respondent denied the claim, arguing the incident did not meet the definition of an 'accident' under the Schedule.

The Tribunal found that the use or operation of the vehicle was not the direct cause of the injuries, as the chain of causation was broken by an intervening act—the uneven curb.

The application was dismissed, and the respondent's request for costs was denied.

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

After failing to attend an initial case conference, the applicant and his counsel failed to attend the reconvened case conference despite being warned that failure to appear could result in dismissal.

The respondent moved to dismiss the application.

The adjudicator granted the motion and dismissed the application for abandonment under Rule 3.4 of the Licence Appeal Tribunal Rules of Practice and Procedure.

The applicant sought a medical benefit of $2,000 for psychological services following a motor vehicle accident.

The Tribunal dismissed the claim, finding that the applicant's self-reporting to her own experts was inconsistent with her statements during the insurer's examination.

The Tribunal preferred the evidence of the insurer's expert, who concluded that the applicant did not suffer from a psychological impairment requiring formal services.

The applicant's request for costs was also denied as it was unsupported by evidence or argument.

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

The insurer paid benefits for a period before sending a notice of refusal on March 5, 2015.

The applicant filed an application with the Tribunal on March 6, 2017.

The insurer brought a preliminary motion arguing the application was statute-barred for missing the two-year limitation period by one day.

The Tribunal dismissed the motion, finding that the limitation period does not begin to run until the applicant receives the notice of refusal.

Under the Statutory Accident Benefits Schedule, notice sent by regular mail is deemed received on the fifth business day after it is sent, meaning the limitation period had not expired when the application was filed.

The applicant sought statutory accident benefits for psychological and physiotherapy services following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application.

The Tribunal found the applicant's evidence for psychological services unreliable due to unexplained contradictions in his self-reporting between his own expert and the insurer's examiner.

The claim for physiotherapy services was dismissed because the applicant failed to submit the disputed treatment plan.

The applicant's request for costs was also denied as it lacked supporting evidence or argument.

The respondent brought a motion to dismiss the application without a hearing, arguing the applicant abandoned the proceeding by failing to attend a scheduled case conference.

The respondent also sought costs, alleging the applicant's conduct was unreasonable and vexatious.

The self-represented applicant provided affidavit evidence that he missed the case conference due to a mental breakdown and had no intention of abandoning his claim.

The Tribunal found the applicant had not abandoned the appeal and accepted his explanation for his absence.

The motion to dismiss and the request for costs were both dismissed.

The applicants were injured in a motor vehicle accident while in the course of their employment.

They elected to opt out of the WSIA scheme and join a class action lawsuit against the Province of Newfoundland and Labrador, which allowed them to claim statutory accident benefits from the respondent.

When the class action was ultimately dismissed, the respondent terminated their accident benefits, arguing they were no longer eligible.

The Tribunal held that the applicants' election to sue was made in good faith based on legal advice and not primarily for the purpose of claiming accident benefits.

The Tribunal further held that the ultimate failure of the civil action did not retroactively invalidate their election or their entitlement to accident benefits.

The applicant sought a non-earner benefit following a 2014 motor vehicle accident, having previously been involved in three other accidents.

The Tribunal found that the applicant failed to meet her onus of proving a complete inability to carry on a normal life, noting a lack of evidence regarding her pre-accident activities and credibility issues with her self-reporting.

The Tribunal placed limited weight on the psychological assessments because the assessors lacked critical information about the applicant's prior accidents and academic history.

The application for benefits, interest, and costs was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident but failed to participate in the dispute resolution process or attend a scheduled case conference.

The applicant's counsel brought a motion to be removed from the record due to a breakdown in the solicitor-client relationship, and the respondent brought a motion to dismiss the application as abandoned.

The Licence Appeal Tribunal granted both motions, removing counsel from the record and dismissing the application as abandoned pursuant to Rule 3.4 of the Licence Appeal Tribunal Rules of Practice and Procedure.

The applicant sought statutory accident benefits for physiotherapy services and orthopaedic and psychiatric assessments following a motor vehicle accident.

The respondent insurer denied the claims based on insurer examinations.

The adjudicator found that the physiotherapy services were reasonable and necessary for managing the applicant's chronic pain, rejecting the insurer's argument that treatment must lead to full recovery.

The adjudicator also approved the assessments, noting the insurer's assessors conducted paper reviews without reviewing key medical reports.

Finding that the insurer unreasonably withheld payments, the adjudicator ordered a special award of 50% of the disputed amounts, plus interest.