OLAT 2019

The applicant was injured in a motor vehicle accident and sought medical, rehabilitation, and non-earner benefits from the respondent insurer.

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

The applicant contended that psychological impairments and chronic pain removed him from the MIG.

The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from psychological impairments or chronic pain caused by the accident.

The Tribunal concluded the injuries were predominantly minor and treatable within the MIG.

Furthermore, the applicant was not entitled to a non-earner benefit as he did not suffer a complete inability to carry on a normal life, nor was the proposed chiropractic treatment reasonable and necessary.

The applicant applied to the Licence Appeal Tribunal for income replacement benefits (IRBs) more than two years after the insurer issued an Explanation of Benefits denying the claim.

The insurer raised a preliminary issue that the claim was statute-barred.

The Tribunal found that the insurer's denial was clear and unequivocal, triggering the two-year limitation period.

The Tribunal declined to extend the limitation period under section 7 of the Licence Appeal Tribunal Act, finding no bona fide intention to appeal within the time limit and significant prejudice to the insurer.

The application for IRBs was dismissed as statute-barred.

The applicant was injured in a motor vehicle accident and sought payment for psychological and chiropractic treatment plans, as well as an award for unreasonable delay.

The insurer partially approved the psychological treatment but denied the remaining balances for documentation and planning, and fully denied the chiropractic treatment.

The Licence Appeal Tribunal found that the applicant failed to prove the disputed treatment plans were reasonable and necessary, noting a lack of supporting medical evidence and contradictions with the applicant's self-reporting.

The application was dismissed in its entirety.

The appellant appealed a Notice of Proposed Order to refuse his registration as a Category Two gaming assistant.

The Registrar refused the application due to discrepancies between the appellant's disclosure and his actual criminal and driving records, which included multiple crimes of dishonesty and driving while suspended.

The appellant claimed memory loss from a 2013 stroke caused the omissions.

The Tribunal rejected this explanation, finding it lacked credibility and medical corroboration.

The Tribunal concluded there were reasonable grounds to believe the appellant would not act with honesty, integrity, or in accordance with the law, and ordered the Registrar to carry out the refusal.

The applicant filed a second request for reconsideration regarding an amended decision that confirmed the quantum of a weekly income replacement benefit.

The Licence Appeal Tribunal dismissed the second request, noting that the original request had already been considered and the decision amended, and advised the applicant to pursue judicial review or an appeal if they remained in disagreement.

The applicant sought income replacement benefits, medical benefits, and the cost of examinations following a motor vehicle accident.

The adjudicator found no evidence that the applicant missed work due to the accident, noting she was laid off for unrelated reasons.

Furthermore, the applicant was involved in a second, unrelated motor vehicle accident shortly after the first, and failed to prove that the injuries requiring treatment were caused by the first accident.

The application was dismissed in its entirety.

The respondent insurer requested a reconsideration of a Tribunal decision that found the applicant was entitled to the costs of a psychological assessment.

The insurer argued the Tribunal referred to evidence not before it, mischaracterized the dispute as one regarding hourly rates, improperly placed the onus on the respondent, and failed to adhere to case law.

The Adjudicator dismissed the request, finding that while the original decision used imprecise language regarding invoices, it did not constitute an error of fact.

The Adjudicator also found no error in the weighing of evidence regarding the time required to complete the assessment and report, and distinguished the case law relied upon by the insurer.

The request for reconsideration was denied.

The applicant sought reconsideration of a Tribunal order denying his motion to reinstate a previously withdrawn application.

The underlying dispute concerned the billing rate for a psychotherapist under a treatment plan that had been approved for psychologist services.

The Vice-Chair dismissed the reconsideration request, finding no error in the original decision because the treatment plan as submitted had been fully settled, and the new dispute regarding psychotherapist rates was not ripe for adjudication as it had never been submitted to the insurer for processing.

The appellants appealed a decision by Tarion Warranty Corporation disallowing their claim for alleged structural defects in their new home.

At the hearing, the self-represented appellant brought a motion for the adjudicator to recuse herself, alleging bias, which was dismissed for lack of evidence.

On the merits, the appellants failed to provide any evidence to support their claims of structural defects.

The Tribunal accepted the expert evidence of a structural engineer retained by Tarion, who confirmed the home was built in accordance with the Ontario Building Code and that all issues had been remediated.

The appeal was dismissed.

The appellants appealed the Registrar's decision denying their claims for warranty coverage under the Ontario New Home Warranties Plan Act for their new home.

The claims included a basement leak, a creaking shower base, uneven heating and cooling, an uncentered patio door, and main floor vibration.

The Licence Appeal Tribunal dismissed the appeal, finding that the basement leak had been resolved, the shower base and floor vibration were not abnormal or deficient, the temperature measurements were inaccurate, and the patio door placement was agreed to in the purchase agreement.

The appellants failed to prove any of the items were warrantable deficiencies under the Act.

The appellant appealed the Registrar of Motor Vehicles' decision to suspend her driver's licence for medical reasons under s. 47(1) of the Highway Traffic Act.

The appellant had suffered a severe traumatic brain injury in a 2015 motorcycle accident.

Despite her belief that she had recovered, medical evidence and a functional driving assessment demonstrated ongoing cognitive, emotional, and behavioural impairments, as well as a lack of insight into her condition.

The Licence Appeal Tribunal found that the appellant's TBI-related cognitive and adjustment disorders were likely to significantly interfere with her ability to drive safely, and confirmed the licence suspension.

The applicant was injured in a rear-end motor vehicle accident and sought accident benefits.

The insurer determined the injuries fell within the Minor Injury Guideline (MIG) and denied a $1,553.76 chiropractic treatment plan because the $3,500 funding limit was exhausted.

The applicant argued that pre-existing conditions, chronic pain, and PTSD removed him from the MIG.

The Tribunal found no compelling evidence that pre-existing conditions prevented maximal recovery within the MIG, and no medical diagnosis of chronic pain or PTSD.

The Tribunal concluded the injuries were minor, the MIG limit applied, and the disputed treatment plan was not payable.

The appellant homeowner appealed a decision by Tarion Warranty Corporation denying warranty coverage for several alleged defects in his new home, including water puddling, grading issues, and interior defects.

The Licence Appeal Tribunal dismissed the appeal, finding that the items either fell outside the scope of the second-year warranty or were deemed withdrawn because the appellant failed to request a conciliation inspection within the strict statutory timelines prescribed by Regulation 892.

The applicant was struck by a streetcar as a pedestrian and sought a catastrophic impairment designation under the Statutory Accident Benefits Schedule due to psychological, emotional, and behavioural impairments.

The respondent denied the designation.

The Tribunal found that the applicant sustained a traumatic brain injury resulting in a Class 4 (Marked) impairment in the Adaptation domain under Chapter 14 of the AMA Guides.

The Tribunal preferred the evidence of the applicant's experts, noting the applicant's inability to cope with stressors, recurring need to escape uncontrolled situations, and suicidal ideations.

The Tribunal concluded the applicant sustained a catastrophic impairment and is entitled to extended medical and rehabilitative treatment limits.

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

The respondent insurer determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and refused to pay for certain physiotherapy treatment plans.

The applicant applied to the Licence Appeal Tribunal, arguing that chronic pain removed them from the MIG.

The adjudicator found that the applicant's pain was intermittent and did not meet the criteria for chronic pain syndrome, preferring the evidence of the respondent's independent medical examiner over the applicant's family physician.

The adjudicator concluded the injuries were predominantly minor and subject to the $3,500 funding limit.

One treatment plan was denied as it proposed treatment outside the MIG, while another was approved subject to the funding limit.

No interest was awarded.

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

The insurer denied treatment plans for chiropractic and psychological services, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that while the physical injuries were predominantly minor, the applicant demonstrated on a balance of probabilities that she sustained psychological impairments removing her from the MIG.

The Tribunal ordered payment for the psychological assessment and treatment plans, along with interest, but denied the chiropractic treatment plan as not reasonable and necessary.

The applicant sought a rehabilitation benefit of $2,464.00 for physiotherapy following a 2010 motor vehicle accident.

The respondent denied the treatment plan, arguing that collateral benefits were available and that the ongoing pain was not accident-related.

The Licence Appeal Tribunal found insufficient evidence to determine if collateral benefits were exhausted.

However, the Tribunal concluded the treatment plan was not reasonable and necessary, as medical evidence indicated the applicant's ongoing pain was caused by workplace repetitive strain rather than the accident.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, as well as the costs of several assessments, which the respondent insurer denied.

The Licence Appeal Tribunal found that the proposed chiropractic and psychological treatment plans, along with a chronic pain assessment, were reasonable and necessary given the applicant's ongoing pain and psychological symptoms.

However, the Tribunal concluded that a cognitive assessment and a driver's reintegration assessment were not reasonable and necessary, as the applicant did not exhibit cognitive impairment and the driving phobia could be addressed through the approved psychological treatment.

The applicant was awarded interest on overdue payments, and no costs were awarded to either party.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The adjudicator found that the applicant failed to prove she suffered a substantial inability to perform the essential tasks of her employment, noting she returned to work post-accident and was terminated for performance issues.

The adjudicator preferred the respondent's insurer's examination reports, which concluded the applicant had no functional impairments preventing her from working.

The claims for IRBs, treatment plans, and assessments were dismissed.

The appellant appealed the 90-day suspension of his driver's licence under section 48.3 of the Highway Traffic Act for failing to provide a breath sample.

He argued that he was unable to provide the sample due to asthma and panic attacks.

The Licence Appeal Tribunal found that the appellant failed to prove on a balance of probabilities that he was medically unable to provide the sample.

The Tribunal preferred the evidence of the arresting officer, who testified that the appellant made weak blows, failed to make a seal, and exhibited no signs of respiratory distress, over the evidence of the appellant and his family physician.

The appeal was dismissed and the suspension confirmed.