OLAT 2019

The applicant was injured in a motor vehicle accident and sought medical benefits for physiotherapy and costs of examination for orthopaedic, attendant care, and psychological assessments.

The insurer denied the benefits, arguing the applicant's injuries had resolved or were related to a subsequent accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the treatments and assessments were reasonable and necessary.

The Tribunal gave significant weight to the insurer's examination reports and noted the applicant's lack of candor regarding a second motor vehicle accident.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that found the applicant was outside the Minor Injury Guideline (MIG).

The insurer argued the adjudicator misapplied the test for the pre-existing condition exception and improperly shifted the burden of proof.

The Associate Chair granted the reconsideration, finding that the adjudicator made a significant error by exempting the applicant from the MIG despite explicitly noting there was no compelling evidence, such as clinical notes and records, documenting a pre-existing condition that would prevent maximal recovery.

The original decision was set aside, and the applicant was found to be subject to the MIG.

The applicant sought income replacement benefits following a motor vehicle accident, claiming chronic pain prevented him from returning to his pre-accident work as a supervisor and interior finisher.

The respondent insurer terminated benefits after 104 weeks.

The Tribunal found that the applicant did not suffer a substantial inability to perform his pre-accident employment, relying on surveillance evidence showing him performing physical work and medical reports indicating normal functioning.

The Tribunal dismissed the application for income replacement benefits, an award for unreasonable withholding, and interest.

The applicants requested a reconsideration of a motion decision that denied their request to exclude certain insurer's reports from evidence.

The applicants argued the adjudicator mischaracterized their position, asserting the reports should have been excluded because they were not served within the 10-day timeframe prescribed by s. 38(13) of the Statutory Accident Benefits Schedule.

The Associate Chair dismissed the reconsideration request, finding that even if the adjudicator misunderstood the specific date referenced, the alleged error was immaterial because the reports were directly relevant to the issues in dispute.

The respondent insurer sought reconsideration of a decision awarding the applicant $1,000 in costs.

The costs were originally awarded because the respondent conceded the applicant's entitlement to an income replacement benefit at the start of the hearing, which the adjudicator found to be unreasonable and vexatious conduct that caused unnecessary preparation expense.

The respondent argued the adjudicator made errors of law and fact by failing to follow prior decisions, misunderstanding its position, and lacking justification for the quantum.

The Vice-Chair denied the reconsideration request, finding no significant error of law or fact, and held that the adjudicator properly exercised discretion in assessing the parties' conduct and awarding costs.

The applicant sought entitlement to a $2,486 chronic pain assessment following a motor vehicle accident.

The insurer denied the treatment plan, arguing the applicant's chronic pain was a pre-existing condition and that he only suffered a minor strain in the accident.

The Tribunal agreed with the insurer, finding that video surveillance contradicted the applicant's claims of impairment and the conclusions of his assessing physician.

The Tribunal concluded the accident did not cause the chronic pain and the treatment plan was not reasonable and necessary.

The applicant, who was deemed catastrophically impaired following a motor vehicle accident, sought payment for four physiotherapy treatment plans.

The insurer denied the claims on the basis that the applicant had reached maximal medical recovery for his musculoskeletal injuries.

The adjudicator preferred the evidence of the insurer's medical examiners, finding that the applicant's pain complaints had a strong non-organic component and that further physiotherapy would not be beneficial.

The adjudicator also found that the insurer's notices of denial were sufficient.

The application was dismissed.

The applicant sought reconsideration of a decision denying her claim for accident benefits after she slipped and fell at a gas station.

The adjudicator had previously found that the incident did not meet the definition of an 'accident' under the Statutory Accident Benefits Schedule.

On reconsideration, the applicant argued that the adjudicator erred in applying the two-part test for an accident.

The adjudicator dismissed the request, finding no error of law or fact in the application of the purpose and causation tests, as the applicant had completed refuelling and was walking away from her vehicle when she fell.

The applicant sought reconsideration of an interlocutory decision that denied an adjournment of a preliminary issue hearing.

The applicant had requested the adjournment pending the outcome of an application for leave to appeal to the Court of Appeal in a similar case regarding limitation periods.

The Tribunal dismissed the reconsideration request, finding no error of law or breach of procedural fairness in the original decision.

The Tribunal emphasized the need for fair, efficient, and timely conduct of proceedings, noting that delaying hearings to await potential outcomes in unrelated civil actions is impractical and unfair.

The insurer requested a reconsideration of a Licence Appeal Tribunal decision that denied its request for repayment of $6,059.23 in Income Replacement Benefits (IRBs) paid to the insured.

The insurer argued that the Tribunal erred by failing to deduct corporate losses from the insured's pre-accident self-employment income when calculating the quantum of IRBs payable.

The Vice-Chair agreed, finding that under section 7(2) of the Statutory Accident Benefits Schedule, losses from self-employment must be used to reduce pre-accident employment income.

After deducting the corporate losses and post-accident income, the insured's IRB entitlement was zero.

The reconsideration was granted, and the insured was ordered to repay the $6,059.23 overpayment.

The applicant was struck by a public transit bus and sought attendant care and non-earner benefits.

The insurer denied the claims and raised preliminary issues regarding the applicant's failure to comply with requests for medical information under s. 33 of the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant completely failed to provide the requested medical documentation for over three years without a reasonable explanation.

The applicant's reliance on a law firm policy not to produce records older than one year pre-accident was rejected as an unreasonable excuse.

Consequently, the insurer was found not liable to pay the disputed benefits, and the appeal was dismissed.

The respondent insurer requested a reconsideration of a Tribunal decision that awarded the applicant $200 for the remaining cost of a psychological assessment.

The insurer argued the Tribunal erred in law by basing its finding on whether the $200 difference between the assessor's recommended amount and the approved amount was "significant," and that the applicant failed to prove the fee was reasonable under section 25 of the Schedule.

The Vice-Chair dismissed the request, finding that the Tribunal carefully weighed the evidence, including the insurer's own assessor's opinion, and made no significant error of law that would have led to a different outcome.

The insurer requested a reconsideration of a Licence Appeal Tribunal decision that found the claimant's psychological injuries fell outside the Minor Injury Guideline and approved a $2,200 psychological assessment.

The insurer argued the adjudicator erred in law and breached procedural fairness by relying on the claimant's psychologist, who had only been licensed for three months and did not comply with the Tribunal's expert witness rules.

The Vice-Chair denied the reconsideration, applying the Westerhof framework to find that the claimant's psychologist was a participant expert, not a litigation expert, and thus exempt from the strict expert rules.

The Vice-Chair concluded the adjudicator made no material errors of law or fact and reasonably exercised her discretion in weighing the competing psychological evidence.

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

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

The Tribunal found that the applicant's physical injuries, including ongoing pain, did not warrant removal from the MIG, as range of motion was normal and the applicant had returned to pre-accident activities.

The Tribunal also preferred the respondent's psychological assessment, finding no psychological injury.

As the applicant had exhausted the $3,500 MIG limit, the claims for further medical benefits and examinations were dismissed, along with claims for an award and interest.

The appellant's driver's licence was suspended by the Registrar of Motor Vehicles following a medical condition report indicating substance use disorder and a psychiatric illness.

The appellant appealed the suspension.

The Licence Appeal Tribunal found that the appellant did not suffer from a psychiatric disorder, but did suffer from moderate alcohol use disorder.

However, the Tribunal concluded that the Registrar failed to establish that the appellant's alcohol use disorder was likely to significantly interfere with his ability to drive safely, nor was there evidence that he was addicted to alcohol.

The Tribunal set aside the Registrar's decision to suspend the licence.

The appellant travel agency appealed a Notice of Proposal to revoke its registration under the Travel Industry Act, 2002.

The Registrar alleged a deteriorating pattern of non-compliance, including failures to meet financial reporting deadlines, maintain working capital, and comply with trust accounting regulations.

Despite multiple inspections and warnings, the appellant failed to rectify its trust accounting deficiencies and provide required reconciliations.

The Tribunal found that the appellant repeatedly contravened the Act, the Regulation, and its conditions of licensing.

The Tribunal ordered the Registrar to carry out the proposal to revoke the appellant's licence.

The appellant appealed the 45-day impoundment of her vehicle after it was driven by her son, who had a suspended licence.

The appellant argued that the driver was not under suspension and that the impoundment would cause exceptional hardship.

The Tribunal found that the son was driving the vehicle while his licence was suspended.

The Tribunal also found that the appellant did not meet the test for exceptional hardship because she had access to alternative transportation, including public transit and assistance from her daughter.

The appeal was dismissed and the impoundment was confirmed.

The appellant's driver's licence was suspended indefinitely in 2008 due to impaired driving convictions.

In 2018, his licence was reinstated subject to a permanent ignition interlock condition.

The appellant appealed to the Licence Appeal Tribunal to remove the condition.

The Tribunal dismissed the appeal, finding it lacked jurisdiction because the condition was imposed automatically by operation of law under the Highway Traffic Act, not by a discretionary decision of the Minister or Registrar that could be appealed.

The applicant requested a reconsideration of a Tribunal decision that reduced the hourly rate for a psychological assessment from $149.61 to $58.19.

The Tribunal had found that the assessment was performed by a social worker acting as a psychometrist, not a psychologist.

The Vice-Chair dismissed the request for reconsideration, finding no denial of natural justice, no error of law in applying the psychometrist rate from the Professional Services Guideline, and no error of fact.

The appellant appealed the Registrar of Motor Vehicles' decision to suspend his driver's licence following a hypoglycemic episode while driving.

The appellant, an 85-year-old with Type II diabetes, pulled over when he felt light-headed and was treated at a hospital.

The Licence Appeal Tribunal found that the appellant's diabetes was well-controlled, he was diligent with his treatment, and the incident was a one-time lapse in judgment due to skipping lunch.

The Tribunal concluded that the appellant's condition was not likely to significantly interfere with his ability to drive safely and set aside the licence suspension.