OLAT 2018

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

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

The Licence Appeal Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, as surveillance and medical evidence showed she retained significant functional abilities.

Furthermore, the Tribunal concluded the applicant's injuries were predominantly minor and she failed to prove a pre-existing medical condition that would exempt her from the MIG cap.

As the $3,500 cap was exhausted, the claims for additional medical benefits and examination costs were dismissed.

The applicant sought a non-earner benefit and payment for two physiotherapy treatment plans following a motor vehicle accident.

The Tribunal found that the claim for the non-earner benefit was statute-barred, as the application was filed more than two years after the clear and unequivocal denial by the respondent.

The Tribunal also dismissed the claims for the medical benefits, finding that the applicant failed to provide sufficient contemporaneous medical evidence to prove the treatment plans were reasonable and necessary.

The respondent's request for costs was denied.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a non-earner benefit, medical cannabis, and osteopathy treatments (including a treadmill and vaporizer).

The Licence Appeal Tribunal denied the non-earner benefit, finding the applicant was still able to perform many self-care and daily living activities.

However, the Tribunal granted the medical benefits for medical cannabis and osteopathy, finding them reasonable and necessary given the applicant's ongoing pain and the recommendations of his treating practitioners.

Interest on overdue payments was also awarded.

The applicant was injured in a motorcycle accident and sought a medical benefit for physiotherapy services under the Statutory Accident Benefits Schedule.

The respondent insurer denied the treatment plan, arguing that the applicant had improved and could perform exercises independently.

The Tribunal found that the treatment plan's goals of pain reduction and improved function were reasonable and necessary given the applicant's injuries, which included post-concussion syndrome.

The Tribunal ordered the respondent to pay the $3,003.85 treatment plan and interest on any incurred expenses.

The applicant, who was a minor at the time of the motor vehicle accident, sought a non-earner benefit and medical benefits beyond the Minor Injury Guideline (MIG) limit.

The respondent argued the claim for the non-earner benefit was statute-barred under the two-year limitation period.

The Tribunal held that the limitation period was suspended under s. 6 of the Limitations Act because the applicant was a minor and her mother's assistance in applying for benefits did not make her a litigation guardian.

However, on the merits, the Tribunal found the applicant failed to prove a complete inability to carry on a normal life, noting inconsistencies in her self-reporting and preferring the respondent's insurer examinations.

The Tribunal also concluded the applicant's injuries fell within the MIG, as there was insufficient evidence of psychological impairment or chronic pain to warrant removal.

All claims for benefits and costs were dismissed.

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

The insurer denied a treatment plan and requested an insurer's examination under s. 44 of the Schedule.

The applicant refused to attend, arguing the Notice of Examination did not provide sufficient medical reasons.

The Tribunal found that the insurer's notice complied with s. 44 by referencing medical reports and questioning the nature of the impairment and appropriate treatment.

Consequently, under s. 55(1)(2) of the Schedule, the applicant is precluded from proceeding with her application to the Tribunal until she attends the requested assessments.

Both parties' requests for costs were denied.

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 statutory accident benefits for a driver anxiety assessment and a hydrotherapy program following a motor vehicle accident.

The Tribunal found that while the insurer's initial denial of the driver anxiety assessment was defective for failing to provide medical reasons, the defect was cured by a subsequent letter.

Because the applicant had not incurred the expense during the defective notice period, the insurer was not obligated to pay.

The Tribunal further held that neither the driver anxiety assessment nor the hydrotherapy program were reasonable and necessary, as the medical evidence did not support their effectiveness.

The application was dismissed.

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

The insurer denied payment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant suffers from Chronic Post Traumatic Pain Syndrome, removing her from the MIG.

The Tribunal ordered the insurer to pay for the disputed physiotherapy treatments, psychological assessment, and chronic pain assessment, finding them reasonable and necessary.

The applicant's claims for a special award and costs were dismissed, but interest on overdue payments was granted.

The applicant sought non-earner benefits following a 2013 motor vehicle accident.

The respondent denied the claim and later raised a preliminary issue, arguing the applicant's appeal to the Licence Appeal Tribunal was statute-barred under s. 56 of the Statutory Accident Benefits Schedule because it was filed more than two years after the denial.

The Tribunal found that the applicant had filed for mediation within the two-year period and commenced her appeal within the 90-day extension period following the mediator's report, as permitted by the transition rules.

The Tribunal dismissed the preliminary issue, holding the appeal was not statute-barred, and noted that even if it were, the applicant met the criteria for an extension under s. 7 of the Licence Appeal Tribunal Act.

The applicant sought payment of $2,200 for an attendant care assessment and Form 1 following a motor vehicle accident.

The insurer denied the treatment plan.

The Licence Appeal Tribunal found that while the insurer is liable to pay reasonable fees for such an assessment, the expense must first be incurred by the insured.

Because the applicant had not incurred the expense, and there was no evidence the insurer unreasonably withheld or delayed payment to justify deeming it incurred, the claim was dismissed.

Claims for interest and costs were also dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found his injuries fell within the Minor Injury Guideline (MIG) and upheld the insurer's denial of two treatment plans.

Prior to the reconsideration decision, the insurer revised its position, approved full payment for both treatment plans, and removed the applicant from the MIG.

The only remaining issue was whether the applicant was entitled to interest on the outstanding benefits.

The Executive Chair granted the reconsideration in part, ordering the insurer to pay interest on the overdue payments in accordance with the Statutory Accident Benefits Schedule.

The applicant was injured in a motor vehicle accident and sought medical benefits for chiropractic services.

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

The applicant argued that her injuries, including a pre-existing condition and psychological issues, warranted treatment beyond the MIG cap.

The Tribunal found that the applicant sustained predominantly minor soft tissue injuries and failed to provide compelling evidence of a pre-existing condition or psychological injury that would prevent maximal recovery under the MIG.

The application was dismissed.

The applicant sought reconsideration of a Tribunal decision dismissing her application for accident benefits.

The insurer had denied two Treatment and Assessment Plans and requested insurer examinations, providing only general statements that the medical documentation did not support the need for treatment.

The Executive Chair found that the insurer failed to satisfy the notice requirements under s. 38(8) of the Statutory Accident Benefits Schedule, as it did not provide specific medical reasons based on the applicant's file.

Consequently, under s. 38(11)2, the insurer was ordered to pay for the disputed benefits.

The request for a special award was denied.

Both parties requested reconsideration of several interlocutory procedural orders regarding the timing, content, length, and sequencing of supplementary written submissions following a hearing on whether the applicant suffered a catastrophic impairment.

The Associate Chair found that the previous orders violated the rules of natural justice and procedural fairness by requiring the respondent to file submissions before the applicant.

The reconsideration was granted in part, previous orders were cancelled, and a new schedule for submissions was ordered.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied his claim for statutory accident benefits.

He argued the Tribunal made a significant error of fact and violated procedural fairness by failing to explicitly refer to or consider certain medical evidence submitted prior to the hearing.

The Executive Chair dismissed the request, finding that the Tribunal is not required to explicitly refer to every piece of evidence in its reasons, and that the applicant failed to demonstrate how the omitted documents were relevant to the benefits at issue.

The insurer requested a reconsideration of a Licence Appeal Tribunal decision that denied its motion for costs.

The insurer argued that the applicant's conduct, including withdrawing the application the day before the hearing and failing to provide sufficient medical evidence, was frivolous and vexatious.

The Associate Chair found that the applicant had provided some rational foundation for his claim and was not acting without reasonable cause.

The request for reconsideration was denied, as the applicant's conduct did not meet the threshold for a cost award under Rule 19.

The respondent insurer brought a preliminary issue motion arguing that the Licence Appeal Tribunal lacks jurisdiction to determine whether an applicant is catastrophically impaired when there are no associated substantive benefits in dispute.

The adjudicator dismissed the motion, finding that the Insurance Act and the Statutory Accident Benefits Schedule do not require a claim for a specific substantive benefit to accompany an application for a catastrophic impairment determination.

The Tribunal has jurisdiction to determine catastrophic impairment on a stand-alone basis.

The applicant was injured in a motor vehicle accident and sought an Income Replacement Benefit (IRB).

The insurer sought to deduct post-accident business income earned by the applicant in 2016 from the IRB under section 7(3)(b) of the Statutory Accident Benefits Schedule.

The applicant argued he was not actively engaged in the business post-accident, having hired another chiropractor to run day-to-day operations.

The Tribunal found that the applicant remained actively engaged in major business decisions and that the Schedule does not distinguish between active and passive income for the purposes of deduction.

The Tribunal held that the insurer was entitled to deduct the post-accident business income, reducing the applicant's IRB entitlement to zero.

The applicant was injured in a motorcycle accident and sought payment for neurological, chronic pain, and orthopaedic assessments under the Statutory Accident Benefits Schedule.

The respondent denied the treatment plans.

The Licence Appeal Tribunal found that the chronic pain assessment was reasonable and necessary given the applicant's ongoing complaints of pain and stiffness.

However, the Tribunal dismissed the claims for neurological and orthopaedic assessments, finding insufficient medical evidence to support their necessity.

Claims for interest and costs were also dismissed.