OLAT 2018

The applicant sought statutory accident benefits 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 were subject to the $3,500 cap.

The applicant argued his injuries were not predominantly minor, citing a pre-existing condition and psychological impairment.

The Tribunal found no compelling evidence of a pre-existing condition that would prevent maximal recovery under the MIG, nor sufficient evidence of a psychological injury.

The Tribunal concluded the applicant's injuries fell within the MIG and dismissed the application.

The applicant brought a motion to vary a Case Conference Order to permit the use of affidavit evidence in a written hearing for statutory accident benefits.

The adjudicator dismissed the motion, finding that a request to vary an explicit order made by a case conference adjudicator must be brought by way of a reconsideration under Rule 18 of the Tribunal's Common Rules of Practice and Procedure.

The adjudicator also noted that introducing affidavit evidence into a written hearing format could distort the process by opening the door to cross-examinations or competing affidavits.

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

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

The applicant argued that a flap tear in his knee and a pre-existing condition removed him from the MIG.

The Tribunal found that a flap tear is a partial tear and falls within the definition of a minor injury.

The Tribunal also found no compelling evidence that the applicant's pre-existing condition was worsened by the accident or impeded his recovery.

The Tribunal concluded that the applicant sustained predominantly minor injuries, and since the $3,500 MIG limit was exhausted, the application for further benefits was dismissed.

The applicant's son brought a motion seeking to be appointed by the Licence Appeal Tribunal as the Administrator of the Estate of the late applicant, who died intestate, in order to continue a statutory accident benefits claim.

The Tribunal held that it lacks jurisdiction to appoint an estate administrator and declined to incorporate the Rules of Civil Procedure.

However, to prevent unfairness, the Tribunal adopted an approach similar to the Workplace Safety and Insurance Appeals Tribunal, allowing the son to proceed with the application if he provides the names and consents of all potential beneficiaries.

The applicant sought payment for an activities of daily living assessment and an orthopaedic assessment following a motor vehicle accident.

The respondent argued the claims were statute-barred as they were disputed more than two years after being denied.

The Tribunal found the applicant was statute-barred from claiming the activities of daily living assessment because a clear and unequivocal denial had been issued more than two years prior.

However, the denial for the orthopaedic assessment was not clear and unequivocal.

The Tribunal ordered the respondent to pay for the orthopaedic assessment, finding the applicant had incurred the cost before receiving a valid denial and was compliant with section 44 of the Schedule.

The applicant was injured in a rear-end motor vehicle collision and sought income replacement benefits (IRBs) from the respondent insurer.

The respondent terminated IRBs based on insurer's examinations.

The Tribunal found that the applicant's essential tasks of employment were sedentary and that the medical evidence did not support a substantial inability to perform those tasks.

The applicant's claims of physical and psychological impairments preventing work were contradicted by medical records and her ability to complete a post-secondary program.

The application for IRBs and interest was dismissed.

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

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

The applicant argued he should be removed from the MIG due to a pre-existing condition, psychological impairments, and chronic pain.

The adjudicator found insufficient evidence of a pre-existing condition that would prevent maximal recovery.

The adjudicator also rejected the psychological and chronic pain claims, noting they were based on a chiropractor's report that relied entirely on self-reporting without objective assessment or appropriate expertise.

The application was dismissed as the applicant's injuries remained within the MIG.

The respondent insurer brought a motion for third party productions of the applicant's employment, placement, and education records from various hospitals and colleges, and for a stay of proceedings pending receipt of these documents.

The applicant did not respond.

The Tribunal ordered summonses to issue for the requested documents, finding them relevant to the issues in dispute, including non-earner and attendant care benefits.

However, the Tribunal dismissed the motion for a stay, emphasizing the need for an efficient and timely resolution of the matter.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, neurobiofeedback, and physiotherapy.

The Tribunal found the applicant did not meet the threshold for a non-earner benefit, as his psychological impairments did not continuously prevent him from engaging in substantially all of his pre-accident activities.

The Tribunal granted the claim for neurobiofeedback, finding it reasonable and necessary to address the applicant's psychological distress and vehicular anxiety.

The claims for physiotherapy were dismissed, as the applicant had reached maximal medical recovery from a physical standpoint.

The applicant sought $2,909.47 for physiotherapy services following a motor vehicle accident.

The respondent denied the claim on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit under s. 18(1) of the Schedule had been reached.

The Tribunal found that the applicant failed to provide sufficient medical evidence to demonstrate that her injuries were not predominantly minor in nature.

The application was dismissed.

The applicant sought non-earner benefits following a motor vehicle accident.

The respondent insurer denied the claim.

The Licence Appeal Tribunal found that the applicant failed to prove she suffered a complete inability to carry on a normal life.

The adjudicator preferred the respondent's multidisciplinary assessment reports, which found no objective physical or psychological impairment preventing the applicant from engaging in her pre-accident activities, and noted evidence of symptom exaggeration.

The applicant's failure to produce pre-accident disability records further undermined her claim.

The application was dismissed.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) from the respondent insurer.

The insurer terminated the IRBs, and the applicant appealed to the Licence Appeal Tribunal seeking IRBs for a disputed period of approximately three weeks before she returned to work.

The Tribunal found that the applicant failed to provide contemporaneous medical evidence demonstrating a substantial inability to perform the essential tasks of her pre-accident employment as a hairdresser.

Relying on the respondent's multidisciplinary independent medical examination, the Tribunal dismissed the claim for IRBs, interest, and costs.

The applicant was struck by a vehicle in a parking lot and sought income replacement benefits and medical benefits for chiropractic services.

The adjudicator found that the applicant did not suffer a complete inability to engage in employment after the first 104 weeks, relying on independent medical examinations which concluded she could perform the essential tasks of her employment.

The adjudicator also found that the proposed chiropractic treatments were not reasonable and necessary.

All claims, including those for interest and a special award, were dismissed.

The applicant sought a non-earner benefit and the cost of an in-home assessment following a motor vehicle accident.

The adjudicator found the applicant was not a reliable witness and had failed to disclose significant post-accident activities, such as travelling, working, and doing housework, to her medical assessors.

Consequently, the adjudicator placed little weight on the applicant's medical reports and concluded she did not meet the stringent test for a non-earner benefit.

However, the adjudicator ordered the respondent to pay for the incurred in-home assessment and applicable interest.

The applicant's request for costs was denied.

The respondent brought a motion to dismiss the application for statutory accident benefits as abandoned.

The applicant failed to attend multiple scheduled case conferences, including the most recent one on March 26, 2018.

The Tribunal provided the applicant with written notice that the application could be dismissed and an opportunity to provide written submissions, but the applicant failed to respond.

The Tribunal found that reasonable efforts were made to contact the applicant and dismissed the application as abandoned.

The applicant was injured while driving a dirt bike at a closed course competition and sought statutory accident benefits.

The respondent denied the claim on the basis that the dirt bike was not an 'automobile' under the Schedule.

The Tribunal held that the dirt bike was exempt from the requirement to be insured under section 2(1)(e) of O. Reg. 863 under the Off-Road Vehicles Act, as it was driven at a closed course competition.

Consequently, the dirt bike did not meet the definition of an automobile, and the applicant was not involved in an 'accident' entitling him to benefits.

The application was dismissed.

The applicant brought a motion seeking production of unredacted adjuster log notes and an order declaring third-party property damage and bodily injury files inadmissible.

The respondent had denied benefits on the basis that no accident occurred and the applicant made material misrepresentations.

The Tribunal dismissed the motion for unredacted notes but ordered the respondent to produce redacted log notes, including those of the third parties, with detailed explanations for each redaction.

The Tribunal found the notes were presumptively relevant to understanding the basis for the denial of benefits, and the respondent could not use privilege as a shield to prevent disclosing the reasons for denial.

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

The respondent denied certain medical expenses, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant contended that her post-April 2016 impairments, including lower back issues requiring surgery, were caused by the accident and thus her injuries were not predominantly minor.

The Tribunal found that the applicant's later impairments were the result of pre-existing degenerative conditions, not the accident, relying on the uncontroverted opinion of the respondent's orthopedic assessor.

The Tribunal concluded the applicant's injuries were subject to the MIG and dismissed her claims for medical expenses, interest, and a special award.

The applicant brought a motion for a resumption of a case conference to seek further orders, including adding a claim for an award, further productions, and changing the hearing format from written to in-person.

The respondent opposed the motion, arguing that the doctrines of issue estoppel and res judicata applied because the issues were allegedly disposed of at the initial case conference.

The Tribunal found that the prior decision was not final, as a claim for an award can be added at any time, making the production requests a live issue.

The Tribunal ordered a resumption of the case conference and changed the hearing format to in-person, noting that the complex issues in dispute would not be adequately addressed in a written hearing.

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

The adjudicator found that the applicant failed to prove he was employed at the time of the accident or that he suffered a substantial inability to perform the essential tasks of his employment, noting his continued participation in physical sports and lack of business documentation.

The adjudicator also dismissed the claims for medical benefits, relying on an insurer's examination report indicating that maximum medical recovery had been achieved and finding insufficient evidence that further chiropractic treatments were reasonable and necessary.

The application was dismissed.