OLAT 2019

The applicant sought statutory accident benefits following a motor vehicle accident, including an in-home assessment and three neuropsychological assessments.

The respondent insurer raised preliminary issues arguing the claims were statute-barred.

The adjudicator found the claim for the in-home assessment was barred under s. 38(2) of the Schedule because the expense was incurred before the treatment plan was submitted.

The adjudicator also found the claim for the neuropsychological assessments was barred under s. 56 of the Schedule because the application was filed outside the two-year limitation period.

The adjudicator declined to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act, 1999, noting the applicant had previously withdrawn a timely application without explanation.

The application was dismissed.

The appellant appealed the 45-day impoundment of his vehicle after he lent it to a friend whose driver's licence was suspended.

The appellant argued he exercised due diligence by inspecting the friend's licence, which appeared valid and unexpired, and that the impoundment caused exceptional hardship.

The Tribunal found that the appellant exercised due diligence, as it was not reasonably required for him to check a government website after physically inspecting the licence.

The Tribunal also found that the appellant established exceptional hardship, as he lived in a remote community, had no reasonable alternative transportation, and suffered an immediate, significant, and lasting loss of employment as a longshoreman and construction worker.

The Tribunal ordered the Registrar to release the vehicle.

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

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

The applicant contended he suffered psychological injuries, relying on a psychological assessment diagnosing him with PTSD and depression.

The Tribunal found the applicant's self-reported normal daily routine and lack of psychological complaints to his family doctor contradicted the psychological diagnosis.

The Tribunal concluded the applicant's injuries fell within the MIG and dismissed the application for the cost of a psychological assessment.

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

Prior to the hearing, the applicant filed a motion to exclude the evidence of an independent medical examiner.

The respondent failed to file its written submissions responding to the exclusion motion by the deadline due to an administrative error, although it did file its affidavit and brief on time.

The respondent brought a motion to extend the time to file its written submissions.

The Tribunal granted the extension, finding that the error was inadvertent, the respondent moved quickly to rectify it, and denying the extension would unfairly limit the respondent's participation and deny it the opportunity to present its case fully.

The applicant sought statutory accident benefits following a 2010 motor vehicle accident.

The respondent insurer raised preliminary issues regarding the applicant's failure to submit treatment plans prior to incurring expenses and failure to attend a required insurer's examination.

The Tribunal held that the applicant was barred from proceeding with most of the disputed expenses because they were incurred without a treatment plan, except for a foot orthotics expense under $250 which fell within a statutory exception.

The Tribunal also held that the applicant was barred from proceeding with claims for treatment plans because he failed to attend a properly scheduled section 44 insurer's examination.

The applicant was injured in a motor vehicle accident and sought approval for psychological and physiatry assessments.

The insurer denied the treatment plans on the basis that they were not reasonable and necessary, noting that it had already approved nine other assessments related to a catastrophic impairment determination.

The Tribunal found that the requested assessments were duplicative and not reasonable and necessary given the comprehensive slate of assessments already approved.

The claims for the costs of examination and interest were dismissed.

The insurer's request for costs was also dismissed.

The applicant sought post-104-week income replacement benefits following a motor vehicle accident.

The insurer denied the benefits based on insurer's examinations concluding the applicant did not suffer a complete inability to engage in suitable employment.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to provide sufficient recent medical evidence to rebut the insurer's expert reports and prove a complete inability to work.

Claims for interest and a special award were also dismissed.

The applicant was struck by a minivan while crossing the street and sought statutory accident benefits, including non-earner benefits, attendant care, housekeeping, and medical benefits for assistive devices.

The Tribunal dismissed the claims for non-earner and attendant care benefits, finding the applicant failed to provide sufficient evidence of her pre- and post-accident activities or that attendant care expenses were incurred.

The claim for a mattress topper was statute-barred as it was purchased before a treatment plan was submitted.

However, the Tribunal found the anti-fatigue mat was reasonable and necessary, and ordered the respondent to pay for it.

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

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

The applicant argued that pre-existing physical and psychological conditions from prior accidents should remove him from the MIG.

The Licence Appeal Tribunal found that the applicant sustained predominantly minor soft tissue injuries.

The Tribunal further held that the applicant failed to provide compelling evidence that any pre-existing conditions would prevent his maximal recovery within the $3,500 MIG limit.

The application for a psychological assessment and interest was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic treatment and a chronic pain assessment.

The insurer denied the treatment plans.

The Tribunal found that the applicant proved the reasonableness and necessity of the chiropractic treatment plans and the chronic pain assessment, relying on the applicant's ongoing pain complaints and the recommendations of her treating practitioners and an orthopaedic surgeon.

The Tribunal also addressed procedural issues, excluding a late-filed clinical note but allowing the applicant to file missing treatment plans to ensure a fair adjudication.

The applicant was awarded the disputed benefits with interest, but her claims for a special award and costs were dismissed.

The applicant filed a request for reconsideration of a preliminary motion decision that found they were precluded from proceeding with a claim for income replacement benefits due to a limitation period.

The Licence Appeal Tribunal 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.

The applicant sought reconsideration of a Tribunal decision denying entitlement to certain chiropractic services and a psychiatric assessment following a motor vehicle accident.

The Tribunal had denied the chiropractic services because the applicant failed to attend a reasonably requested insurer's examination, triggering a statutory bar to proceeding.

The psychiatric assessment was denied because the expense was incurred before the treatment plan was submitted, contrary to the Statutory Accident Benefits Schedule.

On reconsideration, the adjudicator found no significant errors of law or fact in the original decision that would have led to a different result.

The request for reconsideration was dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits for chiropractic treatment and the cost of a disability certificate under the Statutory Accident Benefits Schedule.

The respondent denied the claims, arguing the applicant's recovery had plateaued and further treatment was not reasonable and necessary.

The adjudicator found that the applicant failed to establish the treatment plan was reasonable and necessary, noting the absence of clinical records supporting improvement and the applicant's own reports of plateaued recovery.

The claim for the disability certificate cost was also dismissed as it was not requested by the insurer nor required under the Schedule.

The application was dismissed in its entirety.

The applicant sought medical and rehabilitation benefits and an income replacement benefit (IRB) following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that he was self-employed, requiring different documentation for the IRB.

The Tribunal found that while the applicant's physical injuries were predominantly minor, his pre-existing chronic back pain prevented maximal medical recovery within the MIG, thereby removing him from its limits.

However, the Tribunal agreed with the respondent that the applicant was a self-employed "controlling mind" of his salon business, and dismissed the IRB claim because the applicant failed to provide sufficient documentation to calculate the benefit.

The claim for an award for unreasonable withholding of benefits was also dismissed.

The applicant requested a reconsideration of a previous Tribunal decision that denied income replacement benefits, removal from the Minor Injury Guideline, and payment for treatment plans.

The applicant argued the adjudicator erred in law in interpreting section 38 of the Statutory Accident Benefits Schedule regarding the insurer's notice of denial, and that the adjudicator's failure to consider illegible clinical notes was grossly unfair.

The adjudicator dismissed the request, finding no error of law in the interpretation of section 38, as the treatment had not been incurred and the insurer eventually provided medical reasons.

Furthermore, the adjudicator held that the illegible notes did not constitute new evidence, as the applicant could have arranged for their transcription prior to the hearing.

The applicant was injured in a motor vehicle accident and sought medical benefits, cost of examinations, and a non-earner benefit.

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

The Tribunal found that the applicant failed to prove on a balance of probabilities that she suffered from chronic pain, a psychological impairment, or a pre-existing condition that would remove her from the MIG.

Furthermore, the applicant did not meet the Heath test to establish a complete inability to carry on a normal life.

The application for benefits was dismissed.

The applicant requested a reconsideration of a Tribunal decision that denied her claim for a non-earner benefit.

The applicant argued that the adjudicator made significant errors of law and fact by failing to properly interpret the evidence, including medical reports, clinical notes, and video surveillance, and by misapplying the Heath principles.

The adjudicator reviewing the reconsideration request found that the original decision provided a well-reasoned analysis of the evidence and submissions.

The adjudicator concluded that there was no significant error of law or fact that would have led to a different outcome, and dismissed the request for reconsideration.

The applicant was injured as a passenger in a single-vehicle accident.

The vehicle was owned by the applicant's father and driven by the applicant's friend, who was unlicensed and had been drinking.

The respondent insurer denied the applicant's claim for statutory accident benefits, arguing that the applicant knew or ought reasonably to have known that the driver was operating the vehicle without the owner's consent, triggering the exclusion under s. 31(1)(c) of the Schedule.

The Tribunal found that the owner had given the applicant broad, unrestricted permission to allow others to drive, establishing implied consent.

Furthermore, the Tribunal held that an ordinary person in the applicant's position would have reasonably believed the driver had consent.

The exclusion did not apply, and the respondent was ordered to pay the disputed benefits.

Claims for a special award and costs were dismissed.

The applicant requested a reconsideration of a Tribunal decision that dismissed her claim for statutory accident benefits.

The applicant had slipped and fallen on ice while opening her car door.

The adjudicator originally found that the incident was not an 'accident' under the Schedule because the ice was the intervening and dominant cause of the fall, breaking the chain of causation.

On reconsideration, the applicant argued this finding was an error of fact and law.

The adjudicator dismissed the request, finding no error in the application of the causation test, the intervening causes analysis, or the dominant feature analysis.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her entitlement to income replacement benefits and a chronic pain assessment following a motor vehicle accident.

The applicant argued the Tribunal made significant errors of fact and law by ignoring medical evidence and applying incorrect legal tests.

The adjudicator dismissed the request, finding that the Tribunal properly weighed the evidence, correctly applied the legal test for chronic pain assessments, and made no significant errors that would have led to a different outcome.