OLAT 2019

The applicant was injured in a snowmobile accident in 2012 but did not apply for statutory accident benefits until 2017, a delay of over five years.

The respondent insurer denied the claim based on the delay.

The Tribunal found that while the applicant's explanations regarding an abusive relationship and other hardships were credible, they did not reasonably explain the entire five-year and eight-month delay, particularly the two and a half years following her separation from her ex-husband.

The Tribunal held that the applicant failed to provide a reasonable explanation for the delay and is therefore statute-barred from proceeding with her application.

The applicants claimed to have been injured in a motor vehicle accident and applied for statutory accident benefits.

The respondent insurer denied the claims, alleging the accident was staged and the applicants wilfully misrepresented material facts.

Following a preliminary issue hearing, the adjudicator found that the applicants failed to prove on a balance of probabilities that an accident occurred within the meaning of s. 3(1) of the Schedule.

The adjudicator drew an adverse inference from the failure of key witnesses to testify and noted numerous inconsistencies in the evidence.

Concluding that the accident was staged, the adjudicator ordered the applicants to repay the medical and non-earner benefits they had received, but declined to order repayment of the insurer's adjusting costs.

The appellant appealed the Minister of Transportation's decision to downgrade his commercial DZ-class driver's licence to a class G licence due to a medical condition of seizures.

The Licence Appeal Tribunal panel was deadlocked on whether the seizures were likely to significantly interfere with his ability to drive a commercial vehicle safely.

Pursuant to the Licence Appeal Tribunal Act, the panel chair's decision resolved the deadlock.

The chair found that the appellant's seizures, which were generalized and unpredictable, posed an unacceptable risk for commercial driving, confirming the Minister's decision to downgrade the licence.

The dissenting member would have reinstated the commercial licence, finding the seizures were provoked by an anxiety disorder that was now stabilized.

The Registrar of Motor Vehicles sought a reconsideration of a Tribunal decision that ordered the release of an impounded vehicle on the basis that it was stolen.

The vehicle had been taken by an employee of the owner whose licence was suspended.

The Registrar argued that the Tribunal erred in its interpretation of 'stolen' under section 50.2(3)(a) of the Highway Traffic Act, asserting that the employee had tacit consent or lacked the requisite intent to steal.

The Tribunal dismissed the reconsideration request, finding no error of law or fact in its original determination that the vehicle was taken without permission from the workplace with the intent to deprive the owner of it, thereby meeting the definition of a stolen vehicle.

The appellant sought an extension of time to file an appeal of a Notice of Proposal to suspend its liquor licence.

The Registrar had granted multiple extensions over several months, but the appellant repeatedly failed to meet the deadlines.

Applying the Manuel factors, the Tribunal found no bona fide intention to appeal, an excessive delay of 5.5 months, prejudice to the Registrar, and a lack of demonstrated merit to the appeal.

The motion for an extension of time was dismissed.

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

The suspension was based on reports from treating specialists indicating the appellant suffered from cognitive impairment.

The Tribunal found that the appellant suffered from cognitive impairment and that it was likely to significantly interfere with his ability to drive safely, relying on two failed functional driving assessments and the inability of drivers with cognitive impairment to compensate for their functional impairment.

The Registrar's decision to suspend the licence was confirmed.

Both the applicant and respondent sought reconsideration of a Tribunal decision regarding statutory accident benefits.

The Vice-Chair found the Tribunal erred in awarding attendant care benefits at the Form 1 amount of $2,894.99 per month for a period when the applicant's wife provided care, reducing it to her actual economic loss of $935.00 per month.

The Vice-Chair also found the Tribunal erred in its formula for calculating the special award under s. 10 of O. Reg. 664 and directed the parties to recalculate it.

The Tribunal did not err in fixing an end date for benefits at the 104-week mark or in finding the respondent unreasonably withheld benefits.

The applicant requested a reconsideration of a decision dismissing his application for medical benefits, arguing the adjudicator failed to consider evidence and applied an incorrect test.

The Tribunal found that the applicant was attempting to re-litigate failed arguments and re-weigh the evidence, which is not the purpose of a reconsideration.

The Tribunal concluded there was no significant error of law or fact.

The respondent's request for costs was also dismissed, as the reconsideration request was not found to be frivolous or vexatious.

The applicant sought statutory accident benefits, including non-earner benefits and medical benefits for psychological services, following a minor rear-end motor vehicle accident.

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

The Tribunal preferred the respondent's independent medical examination reports over the applicant's expert reports, noting that the applicant's experts relied heavily on self-reporting which was contradicted by the applicant's own prior testimony and employment records indicating he was laid off due to a shortage of work rather than disability.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found his injuries fell within the Minor Injury Guidelines (MIG) and denied additional medical benefits.

The applicant argued the Tribunal erred in fact by not accepting his chronic pain syndrome diagnosis as taking him outside the MIG.

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

The Tribunal reasonably relied on medical reports diagnosing soft tissue injuries and the applicant's own admissions, and correctly noted that a chronic pain diagnosis does not automatically remove an insured from the MIG without proof it is separate and distinct from the minor injuries.

The applicant sought reconsideration of a decision denying three chiropractic treatment plans and a chronic pain assessment.

The applicant argued the Tribunal made a significant error of law by preferring the respondent's medical expert, who found no objective basis for chronic pain syndrome, over the applicant's expert.

The applicant also sought to introduce a 1995 academic paper as new evidence.

The Tribunal dismissed the reconsideration request, finding that the weighing of expert evidence is within the adjudicator's prerogative and did not constitute an error of law.

The Tribunal also refused to admit the academic paper, as it could have been obtained earlier and actually supported the respondent's expert's characterization of chronic pain syndrome.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued the Tribunal made errors of fact and law by giving little weight to her orthopaedic surgeon's report, failing to consider her family physician's records, and failing to conclude she suffered from chronic pain syndrome due to a partial shoulder tear.

The adjudicator dismissed the request, finding no error in affording the orthopaedic report little weight as it lacked diagnostic criteria and credentials regarding chronic pain.

Furthermore, the family physician's records did not establish the AMA criteria for chronic pain syndrome, and the applicant failed to prove the Tribunal would have reached a different decision based on the shoulder tear.

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

The respondent partially approved the plan but denied funding for massage therapy.

The Tribunal found that massage therapy was not reasonable and necessary, as the applicant's family physician and the insurer's examination physician both recommended only active therapy such as physiotherapy and home exercises.

A late-filed chiropractic report recommending massage therapy was admitted but given less weight due to its timing.

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

The applicant sought reconsideration of a Tribunal decision that found it lacked jurisdiction to hear an appeal of a Notice of Proposal to deny a liquor licence transfer.

The Tribunal had previously determined that because the underlying licence was revoked and the proposal withdrawn, there was no proposal to appeal.

On reconsideration, the adjudicator found no violation of procedural fairness, no error of law, and no false evidence, concluding that the Tribunal's jurisdiction is strictly limited by statute.

The request for reconsideration was denied.

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

The respondent insurer denied the treatment plans based on insurer's examinations indicating the applicant had recovered from her injuries and no longer suffered from PTSD or musculoskeletal impairments.

The Licence Appeal Tribunal found that the applicant failed to establish the treatment plans were reasonable and necessary, noting her return to work, surveillance evidence, and lack of supporting medical documentation.

The application was dismissed, along with claims for interest and an award under Ontario Regulation 664.

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 shoulder injuries and headaches should remove him from the MIG.

The Tribunal found that the applicant failed to provide sufficient medical documentation to establish a pre-existing condition that would prevent him from achieving maximal medical recovery within the MIG.

As the applicant had already exhausted the $3,500 MIG limit, the claims for further physiotherapy and interest were dismissed.

The applicant sought accident benefits for psychological injuries following a motor vehicle accident, arguing they fell outside the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found the applicant's injuries were predominantly minor and subject to the $3,500 MIG limit, preferring the respondent's neuropsychological assessment which found evidence of malingering over the applicant's psychological report.

The Tribunal dismissed the claims for a psychological assessment and treatment plan, finding the assessment costs were incurred prematurely and the treatment was not reasonable and necessary.

Claims for an award and interest were also dismissed.

The applicant insurer sought repayment of $7,600 in income replacement benefits (IRBs) paid to the respondent, alleging she wilfully misrepresented her employment status at the time of the accident.

The respondent claimed she was employed as a cleaner, but her testimony was contradicted by the alleged employer's Human Resources Director and documentary evidence, including bank statements and tax records.

The Tribunal found the respondent was not a credible witness and concluded she was unemployed at the time of the accident.

The Tribunal ordered the respondent to repay the $7,600 in IRBs plus interest due to wilful misrepresentation.

The applicant was injured in an ATV accident and deemed catastrophically impaired.

After initially returning to work and reporting no need for housekeeping assistance, his condition deteriorated and he sought post-104-week income replacement and housekeeping benefits.

The insurer requested section 44 insurer's examinations to assess entitlement, which the applicant refused to attend.

The Tribunal found the requested examinations were reasonably necessary given the change in the applicant's condition and the lack of prior examinations for these specific benefits.

The applicant was held to be statute-barred under section 55 of the Schedule from proceeding with his application until he attends the scheduled examinations.

The respondent insurer brought a preliminary issue motion seeking to restrict the applicant from disputing the denial of income replacement benefits, arguing the applicant failed to attend ten scheduled insurer examinations.

The Tribunal found that the insurer failed to comply with its obligation under s. 44(9)2.i. of the Statutory Accident Benefits Schedule to schedule the examinations at a convenient day, time, and location for the applicant, who was working modified duties.

As the insurer, not the applicant, failed to comply with the Schedule, the motion was dismissed and the applicant was permitted to proceed with the claim.