OLAT 2019

The appellant requested a reconsideration of a Tribunal decision confirming the revocation of his registration as a class 2 gaming assistant.

The revocation followed an incident where the appellant found and took home approximately $2,000 from a casino floor.

The appellant argued the Tribunal violated procedural fairness and made an error of law by imposing a sanction disproportionate to his conduct, citing employment law principles.

The Tribunal dismissed the request, finding that proportionality of sanction is not a procedural fairness issue and that employment law principles do not apply to regulatory proceedings focused on protecting the public interest.

The appellant's rental vehicle was impounded after it was driven by an individual with a suspended licence.

The appellant appealed the impoundment to the Licence Appeal Tribunal, arguing that his staff exercised due diligence in checking the driver's licence and that the impoundment would cause exceptional hardship.

The Tribunal found that the appellant had alternatives to the impounded vehicle and would not suffer significant and lasting economic loss.

Furthermore, the Tribunal found that the appellant's staff failed to check the driver's licence, demonstrating a lack of due diligence.

The appeal was dismissed and the impoundment was confirmed.

The respondent requested a reconsideration of an adjudicator's decision denying a request to adjourn a hearing.

The Associate Chair dismissed the request, noting that under the amended Rule 18.1 of the Common Rules of Practice and Procedure, requests for reconsideration are only accepted for decisions that finally dispose of an appeal.

Because the proceeding was ongoing, the request was dismissed.

The applicant was injured in a motor vehicle accident and sought payment for four physiotherapy treatment plans under the Statutory Accident Benefits Schedule.

Although the applicant had been removed from the Minor Injury Guideline for psychological reasons, the adjudicator found that the physical injuries were minor sprains and strains.

The applicant failed to provide objective medical evidence to prove the physical treatments were reasonable and necessary, relying only on a clinic letter and OHIP summary.

The adjudicator accepted the respondent's section 44 medical examination report, which concluded the applicant had reached maximum medical recovery physically.

The application was dismissed.

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

The respondent later denied post-104-week IRBs based on several Insurer's Examinations.

The applicant applied to the Tribunal but withdrew the claim pending a catastrophic assessment, and the parties agreed to toll the limitation period.

The applicant failed to recommence the application before the tolling period expired.

The applicant argued the initial denial was invalid because the respondent failed to provide all examination reports to her treating practitioner under section 37(5) of the Schedule.

The Tribunal found the denial was clear and unequivocal, triggering the limitation period.

The Tribunal declined to extend the limitation period under section 7 of the LAT Act, finding the applicant was statute-barred from proceeding.

The applicant sought income replacement benefits, medical and rehabilitation benefits for chiropractic treatment, and the cost of a psychological assessment following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and she did not suffer a substantial or complete inability to work.

The adjudicator dismissed the application, finding no medical evidence supported the applicant's inability to work.

Insurer examination reports consistently showed no physical or psychological impairments preventing a return to employment.

The adjudicator also found the applicant failed to prove the proposed chiropractic treatments and psychological assessment were reasonable and necessary.

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

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

The Licence Appeal Tribunal found that the applicant sustained a psychological injury and chronic pain syndrome, removing her from the MIG.

The Tribunal awarded medical benefits for a chronic pain program and one chiropractic/massage treatment plan, as well as the costs of psychological and orthopaedic assessments.

The applicant was also awarded pre-104 week income replacement benefits (IRBs) due to her inability to perform her heavy pre-accident work as a machine operator, but her claim for post-104 week IRBs was dismissed for lack of evidence regarding alternative suitable employment.

A claim for a special award for unreasonable delay was dismissed.

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

The insurer raised a preliminary issue that the applicant was barred from proceeding due to non-attendance at insurer examinations; the Tribunal found the notice of examination was deficient and allowed the claim to proceed.

On the merits, the Tribunal held that the applicant's psychological impairments removed him from the Minor Injury Guideline (MIG).

The Tribunal approved the psychological assessment and treatment plans as reasonable and necessary, but denied the claims for attendant care benefits, physiotherapy, and chiropractic treatment.

The claim for a special award was also dismissed.

The applicant was involved in a motor vehicle accident and received $3,700 in medical and rehabilitation benefits from the respondent insurer.

The insurer subsequently alleged that the applicant was not a passenger in the vehicle, that the accident was staged, and sought repayment of the benefits under s. 52 of the Statutory Accident Benefits Schedule due to wilful misrepresentation.

The Tribunal found the applicant to be a credible witness, noting that her vague recollection of the accident was explained by documented cognitive dysfunction related to multiple sclerosis.

The Tribunal concluded that the applicant was indeed in the accident and did not make a wilful misrepresentation.

The insurer's claim for repayment was dismissed.

The respondent insurer brought a motion to stay the applicant's LAT application pending her attendance at an occupational therapy catastrophic impairment insurer's examination (OT CAT IE).

The applicant argued she was not required to attend because the insurer's notices denying catastrophic impairment and requesting the IE did not comply with the medical reasons and timeline requirements of section 45(3)(b) of the Schedule.

The Tribunal found that while the insurer's notices were indeed defective and non-compliant, the requested OT CAT IE was still reasonable and necessary to complete a deferred neuropsychological assessment.

The Tribunal granted a four-month stay of the application to allow the insurer to issue a compliant notice and for the applicant to attend the examination.

The minor applicant was struck by a garbage truck at age six and sought statutory accident benefits, claiming a catastrophic impairment.

The respondent insurer denied the catastrophic designation.

The Licence Appeal Tribunal considered competing neuropsychological evidence regarding the applicant's functioning and adaptation in the school setting.

The Tribunal preferred the evidence of the applicant's expert and found that the applicant sustained a class 4 marked impairment in adaptation due to mental and behavioural disorders caused by the accident.

The Tribunal concluded the applicant sustained a catastrophic impairment and is entitled to expanded benefits.

The appellant appealed the impoundment of her vehicle, which was detained after being driven by an acquaintance whose licence was suspended.

The appellant argued she exercised due diligence because the driver had previously told her the licence was reinstated, and alternatively, that the impoundment caused exceptional hardship due to her terminal lung disease.

The Tribunal found the appellant failed to establish due diligence, as she did not take the minimal step of asking to see the driver's licence.

However, the Tribunal found the impoundment resulted in exceptional hardship, as the appellant had no alternative transportation, could not obtain groceries, and missed medical appointments, posing a threat to her health.

The Tribunal ordered the release of the vehicle.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to non-earner benefits and medical benefits for physiotherapy and acupuncture.

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

The Tribunal found that the applicant suffered from pre-existing psychological impairments and chronic pain that were worsened by the accident, removing her from the MIG.

The Tribunal preferred the evidence of the applicant's experts and her own sworn affidavit over the insurer's assessor, who had not been provided with the applicant's complete medical history.

The Tribunal awarded the non-earner benefits and the physiotherapy treatment plans as reasonable and necessary, but denied the acupuncture claim because it was not properly submitted via an OCF-18.

The applicant sought medical benefits for physiotherapy, chiropractic, and massage therapy services following a motor vehicle accident.

The respondent denied the treatment plan based on an insurer's examination.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the treatment was reasonable and necessary.

The Tribunal preferred the evidence of the respondent's orthopedic surgeon, who concluded the applicant had reached maximum medical recovery and would not benefit from further facility-based treatment, over the applicant's medical records which showed limited improvement.

The Registrar of Motor Vehicles ordered the cancellation of the appellant's Commercial Vehicle Operator's Registration (CVOR) certificates due to a poor safety record, including a failed audit, vehicle inspection deficiencies, and an unpaid fine.

The appellant appealed the cancellation to the Licence Appeal Tribunal.

The Tribunal found that while the Registrar's concerns were justified, the appellant had implemented an action plan and taken concrete steps to improve its safety performance.

The Tribunal modified the Registrar's order, replacing the cancellation with a 20-day suspension of the CVOR certificates.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to an income replacement benefit (IRB) and a medical benefit for acupuncture.

The adjudicator dismissed the IRB claim, finding the applicant failed to prove a substantial inability to perform the essential tasks of his employment, noting he had returned to work and collected employment insurance during the claimed period.

However, the adjudicator found the applicant's injuries were not predominantly minor injuries under the Minor Injury Guideline due to continuous and severe pain symptoms.

Consequently, the applicant was awarded the outstanding balance for the acupuncture treatment plan and interest.

The applicant sought statutory accident benefits for physiotherapy and chiropractic treatment following a motor vehicle accident.

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

The Tribunal found that the applicant's physical and psychological injuries were minor and fell within the MIG, relying on the uncontradicted reports of the respondent's insurer examination assessors.

As the applicant had exhausted the $3,500 MIG limit, the claims for medical benefits were dismissed.

Claims for interest and costs were also dismissed.

The applicant appealed a Notice of Proposal to Refuse Registration as a Gaming Supplier (Seller) under the Gaming Control Act, 1992.

The Registrar proposed refusal based on the applicant's 2011 conviction for fraud over $5,000 against her former employer, which involved a sophisticated scheme and breach of trust.

The Tribunal found that the applicant's past conduct provided reasonable grounds to believe she would not act with integrity, honesty, or in the public interest as a lottery ticket seller.

The Tribunal ordered the Registrar to carry out the proposal to refuse the application.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for an adjustable mattress and a filing cabinet.

The respondent partially denied the treatment plan.

The Tribunal found that the adjustable mattress was reasonable and necessary to address the applicant's severe sleep disturbances and chronic pain, which were exacerbated by the accident.

However, the Tribunal found that the filing cabinet was not reasonable and necessary, as the applicant already possessed one and failed to demonstrate the necessity of an additional unit.

The applicant was awarded the cost of the mattress and interest on the overdue benefit.

The applicant requested that the adjudicator recuse himself and void his previous decision dismissing the applicant's motion to strike the respondent's preliminary issue, alleging a reasonable apprehension of bias.

The adjudicator applied the test for reasonable apprehension of bias and found that the applicant failed to meet the high threshold required to overcome the presumption of impartiality.

The request for recusal was refused and the previous decision was confirmed.