OLAT 2017

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits, attendant care benefits, and various medical and rehabilitation benefits.

The adjudicator found that the applicant failed to provide compelling evidence to demonstrate a complete inability to carry on a normal life or that her injuries fell outside the Minor Injury Guideline.

Relying on the insurer's medical examinations, the adjudicator concluded the applicant's injuries were minor and dismissed all claims for benefits.

The respondent's request for costs was also denied.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, which the respondent insurer denied.

The applicant filed for mediation at FSCO, but the mediation did not take place and the file was closed.

The applicant subsequently applied to the Licence Appeal Tribunal.

The respondent argued the application was statute-barred as it was filed beyond the two-year limitation period and the 90-day extension following a failed mediation.

The Tribunal found that while the 90-day extension applied, the applicant filed his application approximately a week after the extension expired.

As the applicant failed to provide authority to extend the limitation period further, the application was dismissed as statute-barred.

The applicant, who was injured in a motor vehicle accident while riding his bicycle, sought an increased quantum for attendant care benefits provided by his mother.

The applicant argued the rate should reflect the wage his mother would have earned had she not stopped looking for employment to care for him.

The Tribunal found that the applicant failed to prove his mother suffered an economic loss within the meaning of section 3(7)(e)(iii)(b) of the Schedule, as there was insufficient evidence that she would have found employment or been able to work given her own psychological impairments.

The claim for an increased quantum was dismissed.

The applicant was struck by a vehicle while crossing an intersection as a pedestrian.

She applied for accident benefits, but the respondent insurer denied treatment plans for psychological and physiotherapy services, arguing her injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's severe major depressive disorder and situational phobia, as diagnosed by her psychologist, removed her from the MIG.

The Tribunal ordered payment for the psychological services as reasonable and necessary, but denied the physiotherapy services due to insufficient evidence supporting their necessity.

The applicant sought non-earner benefits, medical and rehabilitation benefits, and attendant care benefits following a motor vehicle accident.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and she did not meet the test for non-earner benefits.

The Tribunal found that the applicant failed to provide compelling evidence to prove she suffered a complete inability to carry on a normal life.

Furthermore, the Tribunal concluded that the applicant's injuries were minor and she had exhausted the MIG limit, disentitling her to the claimed medical and attendant care benefits.

The application was dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for an attendant care assessment and chiropractic treatment.

The respondent insurer denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the proposed treatment would exceed the $3,500 cap.

The Tribunal found that while the applicant sustained an impairment, he failed to meet the burden of proving his injuries warranted treatment outside the MIG.

The Tribunal rejected the applicant's claims of chronic pain and psychological impairment due to insufficient medical evidence and credibility issues.

Consequently, the disputed treatment plans and claim for interest were dismissed.

The applicant sought an income replacement benefit and interest following a motor vehicle accident.

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

As the applicant bore the burden of proof and presented no evidence, the Tribunal dismissed the claim.

The respondent's request for costs was deferred to a separate written hearing.

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

After 104 weeks, the respondent scheduled insurer's examinations to determine ongoing entitlement.

The applicant failed to attend the examinations due to a scheduling conflict with her school attendance, insisting on weekend appointments.

The respondent suspended benefits and raised a preliminary issue that the applicant was precluded from proceeding before the Tribunal under section 55 of the Schedule.

The Tribunal found that while the failure to attend was due to a miscommunication, the applicant must still attend the examinations before proceeding with her claim, and ordered her to make herself available during the week.

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

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

The applicant argued that his pre-existing conditions of spondylolysis and spina bifida oculta, along with chronic pain and psychological impairments, removed him from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence that his pre-existing conditions prevented him from achieving maximum medical recovery under the MIG.

Furthermore, there was insufficient evidence to support a diagnosis of chronic pain or psychological impairment.

Consequently, the applicant's injuries were deemed predominantly minor, and he was not entitled to the disputed benefits.

The applicant appealed the insurer's denial of statutory accident benefits but withdrew the appeal during a case conference after the insurer alleged he had concealed a prior workplace injury.

The insurer subsequently brought a motion for costs under Rule 19, arguing the applicant's conduct amounted to bad faith.

The adjudicator dismissed the motion, finding the evidence did not establish that the applicant had sustained a significant workplace injury or that he had intentionally lied or acted in bad faith during the proceeding.

The respondent insurer requested a reconsideration of a Tribunal decision which found that the applicant's injuries fell outside the Minor Injury Guideline (MIG) due to psychological impairments.

The insurer argued the Tribunal made significant errors of fact and law in assessing the medical evidence and failing to determine the predominant injury.

The Executive Chair denied the request, finding that the hearing adjudicator carefully weighed the evidence and made determinations of fact within their jurisdiction, and did not make any significant error of law or fact that would have led to a different decision.

The applicant was injured in a motor vehicle accident and sought payment for an orthopaedic assessment.

The insurer denied the claim, arguing the assessment should be funded through OHIP and that the applicant fell within the Minor Injury Guideline.

The Tribunal found that the insurer failed to provide valid medical reasons for the denial within the required timeframe under s. 38(8) of the Schedule, triggering automatic payment under s. 38(11).

The Tribunal also rejected the insurer's broad interpretation of s. 47(2) regarding OHIP coverage.

The applicant was awarded the cost of the assessment and interest, but denied costs.

The applicant sought statutory accident benefits, including physiotherapy, attendant care, and the cost of an assessment, following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the claims.

The claim for physiotherapy was denied because the applicant failed to provide the relevant treatment and assessment plan in evidence.

The claims for attendant care benefits and the assessment cost were dismissed because the applicant failed to comply with the procedural requirements of the Statutory Accident Benefits Schedule, specifically by incurring the expenses before submitting the required Form 1 and treatment plans to the insurer.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and medical benefits for physiotherapy and chiropractic treatment.

The insurer denied the claims.

The Tribunal found that the applicant was not entitled to IRBs for the initial period due to her failure to provide requested financial information on time.

However, the Tribunal concluded that the applicant suffered a substantial inability to perform the essential tasks of her pre-accident employment as a kitchen helper due to her physical and deteriorating psychological impairments, entitling her to IRBs for the subsequent periods claimed.

The Tribunal denied the medical benefits, finding that the applicant's physical injuries had largely resolved and the disputed treatment plans were not reasonable and necessary.

The applicant claimed statutory accident benefits and subsequently withdrew his application after failing to meet production timelines set in a case conference order.

The respondent brought a motion for costs, arguing the applicant's conduct was unreasonable, frivolous, vexatious, or in bad faith.

The Licence Appeal Tribunal dismissed the motion, finding that the applicant made substantial efforts to comply with the orders and that the respondent could have consented to an adjournment request instead of opposing the withdrawal.

The Tribunal held that a withdrawal alone is rarely sufficient for a costs award.

The applicant sought a determination that her impairments from a motor vehicle accident met the 55% whole person impairment (WPI) threshold for catastrophic impairment under the Statutory Accident Benefits Schedule.

The adjudicator evaluated conflicting medical evidence regarding the applicant's neurological and psychological impairments, including sleep disorders, mental status, and somatic disorders.

While the adjudicator preferred much of the applicant's medical evidence and found the insurer's assessors had underestimated the impairments, the final combined WPI was determined to be 51%.

As this fell short of the 55% threshold, the application was dismissed.

The applicant sought reconsideration of a decision denying a consent request to adjourn a hearing pending a global mediation.

The Executive Chair granted the reconsideration and the adjournment, finding that the subsequent unavailability of the applicant's expert witness constituted new information that would have affected the original decision.

The Executive Chair also criticized the lack of transparency and reasons in the original denial.

The appellant travel agency appealed a Notice of Proposal by the Registrar to revoke its registration under the Travel Industry Act, 2002.

The Registrar proposed revocation based on the appellant's failure to file financial statements, improper trust account disbursements, failure to maintain and provide business records, and failure to issue proper agency invoices.

The Licence Appeal Tribunal found that the appellant's designated manager had abdicated responsibility for the business to an employee who failed to comply with regulatory requirements and concealed correspondence from the Registrar.

The Tribunal concluded that the past conduct of the appellant's officers and directors afforded reasonable grounds for belief that the business would not be carried on in accordance with the law and with integrity and honesty.

The Tribunal ordered the Registrar to carry out the proposal to revoke the registration.

The Registrar issued a Notice of Proposal to refuse the registration of AM Auto as a motor vehicle dealer and to revoke the registration of Abdul Majeed as a salesperson.

An OMVIC inspection revealed a pattern of material non-disclosure regarding the accident and repair history of used vehicles sold by the dealership.

The Licence Appeal Tribunal found that the appellants' failure to disclose material facts to consumers and other dealers, along with poor record-keeping, afforded reasonable grounds to believe they would not carry on business in accordance with the law and with integrity and honesty.

The Tribunal directed the Registrar to carry out the proposal.

The appellant appealed a proposal by the Registrar to refuse his registration as a real estate salesperson.

The Registrar's proposal was based on the appellant's past criminal convictions for tax evasion, unregistered trading in motor vehicles, bankruptcy, and a previous revocation of his motor vehicle salesperson registration.

The Licence Appeal Tribunal found that the appellant's financial position and past conduct afforded reasonable grounds for belief that he would not carry on business in accordance with the law and with integrity and honesty.

The Tribunal directed the Registrar to carry out the proposal to refuse registration.