OLAT 2019

The 72-year-old appellant appealed the suspension of his driver's licence by the Registrar of Motor Vehicles.

The suspension was initiated after a psychiatrist submitted a medical report indicating the appellant suffered from cognitive impairment likely to interfere with safe driving.

Although a recent cognitive assessment showed improvement, the appellant had previously failed a functional driving evaluation and refused to take another one due to cost.

The Licence Appeal Tribunal found that the appellant continues to suffer from a medical condition likely to significantly impact his ability to drive safely and confirmed the suspension until he provides a satisfactory driving evaluation.

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

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

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

The Tribunal found that the applicant did not provide compelling evidence that her pre-existing condition prevented her from achieving maximum medical recovery within the MIG.

Furthermore, the Tribunal found insufficient evidence of psychological impairment or chronic pain caused by the accident.

The application for a $2,200 psychological assessment and interest was dismissed, as the injuries were deemed predominantly minor.

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

The Licence Appeal Tribunal applied the Heath test to compare the applicant's pre- and post-accident activities.

The Tribunal found that the applicant's post-accident activities, including caring for his daughters, cleaning, and watching movies, were not so significantly restricted as to constitute a complete inability to carry on a normal life.

The application for non-earner benefits, interest, and costs was dismissed.

The applicant sought non-earner benefits following a motor vehicle accident, which the respondent insurer denied.

The respondent raised a preliminary issue that the applicant's appeal was statute-barred because it was not commenced within the two-year limitation period under section 56 of the Statutory Accident Benefits Schedule.

The Tribunal found that the respondent's Explanation of Benefits did not comply with the notice requirements of section 37(4) of the Schedule, as it failed to provide adequate medical and other reasons for the denial in plain language.

Consequently, the limitation period was never triggered, and the applicant's claim was not out of time.

The applicants, two brothers, suffered serious burn injuries from an explosion and fire while replacing the fuel pump of an inoperable vehicle in a residential garage.

They applied for statutory accident benefits, which their insurers denied on the basis that the incident was not an 'accident' under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal held a preliminary issue hearing to determine if the incident met the definition of an accident.

Applying the purpose and causation tests, the Tribunal found that repairing an inoperable vehicle hoisted on jacks is not an ordinary and well-known activity to which automobiles are put by motorists.

The Tribunal concluded the applicants were not using the vehicle for a motoring purpose, and therefore the incident was not an accident within the meaning of the Schedule.

The applications for benefits were dismissed.

The applicant, a pedestrian who sustained catastrophic injuries in a motor vehicle accident and subsequently passed away, sought various medical and rehabilitation benefits.

The Licence Appeal Tribunal dismissed the claims, finding that several treatment plans were either already paid, not proven to be reasonable and necessary, or barred because the applicant failed to attend required insurer's examinations under section 44 of the Schedule.

The respondent's request for costs was also dismissed.

The applicant was injured in a motor vehicle accident in Michigan and sought statutory accident benefits from her Ontario insurer.

In a preliminary issues hearing, the Tribunal determined that the Ontario Schedule, not the Michigan Code, applied to the claim because the insurer had not filed a certificate in Michigan.

The Tribunal also held that an OCF-19 must be submitted for a catastrophic impairment determination, rejecting the argument that an insured could be 'deemed' catastrophically impaired.

Finally, the Tribunal found several of the applicant's claims for benefits were statute-barred by the two-year limitation period or precluded because valid applications (OCF forms) were never submitted to the insurer, though it exercised its discretion to extend the limitation period for a few specific claims.

The appellant appealed the Director's decisions to amend the terms and conditions of its licence to operate a youth residence and to subsequently suspend the licence.

The Tribunal found that the standard of review for the Director's decisions under the CYFSA is correctness, with no deference owed.

The Tribunal upheld the amended conditions, finding them appropriate given the serious concerns regarding staffing shortages, medication errors, and the inability of staff to manage high-risk youth.

The Tribunal also confirmed the suspension of the licence, concluding that the cumulative circumstances, culminating in an incident where two youths required hospitalization after absconding and consuming alcohol, constituted an immediate threat to the health, safety, and welfare of the residents.

The applicant sought a death benefit under the Statutory Accident Benefits Schedule following the death of his father, who was involved in a minor rear-end motor vehicle accident and died eight days later.

The insurer denied the benefit on the basis that the death was not caused by the accident.

The Tribunal applied the 'but for' test for causation and found that the deceased's death was the result of pre-existing medical issues, including hypertension and a subsequent fall, rather than the accident.

The application was dismissed.

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

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove a complete inability to carry on a normal life.

Evidence showed the applicant continued to play hockey and work as a sheet metal worker post-accident.

The claims for medical benefits were also dismissed for lacking evidence that they were reasonable and necessary.

The applicant sought reconsideration of a case conference report that closed her file on consent, purportedly due to a lack of jurisdiction because she had not filed a completed Disability Certificate and the insurer had not explicitly denied her claim for a non-earner benefit.

The Vice-Chair granted the reconsideration, finding that the applicant did not consent to the closure and that the Tribunal either erred in determining jurisdiction or violated the rules of natural justice by failing to provide sufficient notice.

A new case conference was ordered to properly address the jurisdictional issue.

The respondent insurer filed a request for reconsideration of an adjudicator's decision granting the applicant's claim for income replacement benefits and psychological treatment.

The Associate Chair dismissed the request, finding that the respondent failed to meet the criteria for reconsideration under Rule 18.2.

The request was vague, provided no particulars of the alleged error of law, and lacked supporting analysis or evidence.

The respondent insurer filed a request for reconsideration of an adjudicator's interlocutory decision denying its request for the production of the applicant's pre-accident medical and income records.

The Associate Chair dismissed the request for reconsideration.

Under the amended Rule 18.1 of the Common Rules of Practice and Procedure, which applies to orders issued on or after February 7, 2019, requests for reconsideration are only accepted for decisions that finally dispose of an appeal.

Because the proceeding was ongoing and the motion decision did not finally dispose of the appeal, the request was dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for a treatment plan proposing physiotherapy and massage therapy.

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

The adjudicator found that the applicant failed to prove the treatment plan was reasonable and necessary, noting that the applicant had reached maximum medical improvement, the treatment goals were unattainable, and previous treatment had not resulted in pain reduction.

The application for benefits, interest, and costs was dismissed.

The applicant sought a medical benefit of $3,483.14 for chiropractic services following a motor vehicle accident.

The respondent denied the treatment plan, relying on an insurer's examination which concluded the applicant's soft tissue injuries were treatable within the Minor Injury Guideline and that maximum medical recovery had been reached.

The Tribunal found the applicant's expert reports did not specifically address the disputed treatment plan or were outside the assessor's area of expertise.

The Tribunal concluded the treatment plan was not reasonable and necessary, and dismissed the claims for the medical benefit, an award for unreasonable delay, and interest.

The respondent insurer filed a request for reconsideration of an adjudicator's preliminary decision which found that an attendant care benefit claim was not statute-barred.

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

The applicant sought an interim order for payment of statutory accident benefits due to delays in the hearing process.

The respondent argued the Licence Appeal Tribunal lacks jurisdiction to award interim benefits.

The Tribunal held that it does not have jurisdiction to award interim benefits, as the Insurance Act requires such powers to be explicitly granted by regulation, which the legislature has not done.

The preliminary issue was dismissed.

The applicant sought non-earner benefits following a 2014 motor vehicle accident.

The insurer denied the benefits in September 2014.

The applicant initially pursued arbitration at FSCO but later filed an application with the Licence Appeal Tribunal in June 2018, beyond the two-year limitation period.

The Tribunal found it had jurisdiction to hear the matter because the FSCO proceeding did not result in a finalized settlement or arbitration.

However, the Tribunal held the applicant was statute-barred from proceeding.

Applying section 7 of the LAT Act, the adjudicator declined to extend the limitation period, noting significant unexplained delays, failure to comply with production orders, and resulting prejudice to the respondent.

The applicant sought death benefits following the death of his father, who was involved in a minor rear-end motor vehicle accident and died eight days later.

The deceased had a pre-existing history of diabetes, hypertension, and heart issues, and suffered a fall at home days after the accident, leading to a brain bleed.

Applying the 'but for' test for causation, the adjudicator found that the accident did not cause the death.

The medical evidence, including a Coroner's report and a medical opinion, established that the death resulted from pre-existing medical issues and the subsequent fall, not the motor vehicle accident.

The application was dismissed.

The respondent insurer requested a reconsideration of a Tribunal decision that awarded the applicant a chronic pain assessment.

The insurer argued the Tribunal erred by not considering the assessor's qualifications, by finding the assessment reasonable for wrist pain, and by failing to address the lack of a signature on the treatment plan under s. 38(3) of the Schedule.

The adjudicator dismissed the request, finding no significant errors of law or fact.

The adjudicator also held that the insurer had implicitly waived the signature requirement by processing the electronic treatment plan and denying it on substantive medical grounds without raising the procedural defect until the hearing.