OLAT 2019

The respondent insurer requested a reconsideration of a Tribunal decision that permitted the applicant's appeal for income replacement benefits to proceed despite being filed six days after the two-year limitation period.

The Tribunal had applied section 7 of the Licence Appeal Tribunal Act to extend the time.

On reconsideration, the Vice-Chair found no error of law or fact in the original decision, confirming that section 7 of the LAT Act prevails over the mandatory limitation period in section 56 of the SABS, and that the Tribunal properly applied the four-factor test for extending time.

The request for reconsideration was denied.

The applicant requested a reconsideration of a Tribunal decision finding that she was not entitled to case management services under s. 17(1)(b) of the Statutory Accident Benefits Schedule.

The applicant argued that purchasing the optional catastrophic impairment benefit under s. 28(1)5 was sufficient to trigger entitlement, even without a catastrophic impairment designation.

The Associate Chair confirmed the Tribunal's decision, applying principles of statutory interpretation to conclude that the optional benefit is only 'available' if the insured person actually sustains a catastrophic impairment.

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

The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued her injuries fell outside the MIG due to a pre-existing condition, chronic pain syndrome, and psychological impairments.

The Tribunal found insufficient compelling medical evidence to establish a pre-existing condition or chronic pain syndrome.

Applying the "but for" test for causation, the Tribunal concluded the applicant's psychological impairments were related to social, work, and family stressors rather than the accident.

The application was dismissed.

The applicant requested a reconsideration of a case conference order requiring him to produce a list of relevant, non-privileged documents from his accident benefits file.

The applicant argued this breached procedural fairness and was overly burdensome given the 13-year-old file.

The Vice Chair dismissed the request, finding the applicant misunderstood the order, which did not require producing the entire file or privileged documents, and that the order was within the adjudicator's discretion to ensure procedural fairness for both parties.

The applicant was injured in a motor vehicle accident and sought medical benefits for three chiropractic treatment plans under the Statutory Accident Benefits Schedule.

The respondent insurer denied the plans based on section 44 assessments.

The Licence Appeal Tribunal found the treatment plans reasonable and necessary, noting the applicant's pre-existing osteoarthritis and ongoing pain.

The Tribunal rejected the insurer's medical assessments because they failed to account for key medical evidence, including a diagnostic imaging report.

The applicant was awarded the disputed benefits and interest.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to three treatment plans for chiropractic services and a chronic pain assessment.

The respondent denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline and that he had recovered through a home-based exercise program.

The Licence Appeal Tribunal dismissed the application, finding that the chiropractic treatments were not reasonable and necessary as they provided minimal improvement compared to the home exercise program.

The Tribunal also denied the chronic pain assessment, preferring the respondent's expert evidence that the applicant lacked objective markers of chronic pain syndrome over the applicant's expert, whose opinion relied on subjective reports contradicted by contemporaneous medical records.

The applicant was injured in a motor vehicle accident and sought payment for an orthopaedic assessment under the Statutory Accident Benefits Schedule.

The insurer denied the claim.

The Licence Appeal Tribunal found that the orthopaedic assessment was not reasonable and necessary, as the referral came from the applicant's legal counsel rather than a medical professional, and there was no objective medical evidence of an orthopaedic injury.

The applicant's claims for interest and an award for unreasonable delay were dismissed.

The insurer's request for costs was also dismissed.

The applicant was injured in a motor vehicle accident and sought payment for the cost of examinations to determine catastrophic impairment.

The respondent denied the request, arguing that its own catastrophic examinations had already been completed and that the applicant's request was not for the purpose of preparing an application under section 45 of the Schedule.

The Tribunal found that the applicant was not precluded from seeking funding for her own examinations after submitting an OCF-19 application, as this ensures procedural fairness.

The Tribunal partially approved the treatment plan, finding that certain psychological and cognitive assessments, as well as a WPI rating assessment, were reasonable and necessary, while others were duplicative or unnecessary.

The applicant was also awarded interest on the overdue payments.

The applicant was injured in a motor vehicle accident and sought a medical benefit for chiropractic treatment and massage therapy.

The insurer denied the benefit on the basis that it was not reasonable and necessary.

The adjudicator found that the applicant had pre-existing chronic pain and failed to provide objective evidence that the requested treatment was reasonable and necessary for accident-related injuries.

The applicant's own treating practitioners recommended different modalities, and the applicant had previously reported that similar treatment was not helpful.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physical and psychological injuries.

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

The Licence Appeal Tribunal found that the applicant failed to meet the burden of proving that his physical or psychological injuries fell outside the MIG.

The Tribunal noted that the applicant's own treating physicians did not recommend chiropractic treatment and that his psychological complaints did not warrant treatment outside the MIG.

As the $3,500 limit for minor injuries had been exhausted, the disputed treatment plans were not payable.

The application was dismissed.

The applicant sought reconsideration of a Licence Appeal Tribunal decision confirming the quantum of her income replacement benefits.

The applicant argued that her fixed business expenses remained the same after the accident, despite her house cleaning business becoming inactive, and claimed an additional $2,758.01.

The Associate Chair denied the reconsideration request, finding no error in the Tribunal's conclusion that the applicant did not incur certain fixed business expenses while her business was inactive.

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

The insurer classified the injuries under the Minor Injury Guideline (MIG) and requested in-person insurer's examinations under section 44 of the Schedule to assess further treatment plans.

The applicant repeatedly refused to attend, arguing the insurer was not entitled to examinations for MIG claims.

The Tribunal found the applicant non-compliant with section 44, noting the insurer has the authority to require examinations to re-evaluate MIG applicability.

Due to the consistent refusal and resulting prejudice to the insurer, the application was dismissed pursuant to section 55.

The applicant, who was self-represented, requested an adjournment at the start of a catastrophic impairment hearing after his former counsel disengaged shortly before the hearing.

During the preliminary matters, the applicant suffered a medical emergency (seizure) in the hearing room.

The adjudicator granted the adjournment, finding that the applicant needed time to retain new counsel and that proceeding would not permit an adequate hearing and could negatively impact the applicant's health.

The applicant, injured in a motor vehicle accident, sought statutory accident benefits and filed a motion for the production of the respondent's adjuster log notes from the date of the OCF-1 to the date of the application to the Tribunal.

The respondent argued that notes created after the initial FSCO application were protected by litigation privilege.

The Tribunal granted the motion in part, ordering the production of the log notes subject to redactions for relevance, reserves, and privilege, noting that litigation privilege attached to the issue of catastrophic impairment only upon its denial on December 5, 2016.

The appellant appealed the 45-day impoundment of his vehicle under the Highway Traffic Act after his brother was caught driving it with a suspended licence.

The appellant argued that the impoundment caused financial strain and exceptional hardship.

The Tribunal dismissed the appeal, finding that the appellant had access to public transportation as an alternative to the impounded vehicle, which precluded a finding of exceptional hardship under the regulations.

The Registrar requested a reconsideration of a Tribunal decision that directed the Registrar not to carry out a proposal to refuse the appellant's registration as a motor vehicle salesperson.

The Registrar argued the Tribunal applied the wrong standard of proof, improperly relied on an email, and failed to follow the Divisional Court's directions regarding the appellant's past criminal charges and outstanding warrant.

The Associate Chair dismissed the reconsideration request, finding that even if the standard of proof was misstated, the Tribunal would not likely have reached a different decision, and that the Tribunal properly considered the evidence and the Divisional Court's directions.

The appellant appealed the 45-day impoundment of his vehicle, which was driven by his son whose licence was suspended.

The appellant argued due diligence and exceptional hardship.

The Tribunal found the appellant did not exercise due diligence as he failed to verify his son's licence status.

The Tribunal also found no exceptional hardship because the appellant had alternative transportation options and the vehicle was classified as unfit to drive.

The appeal was dismissed and the impoundment order confirmed.

The appellant's vehicle was impounded for 45 days after it was driven by an individual with a suspended licence.

The appellant appealed the impoundment under section 50.2 of the Highway Traffic Act, arguing she exercised due diligence because she did not know the individual would be driving, and claiming exceptional hardship.

The Licence Appeal Tribunal dismissed the appeal, finding the appellant failed to establish due diligence as she entrusted the vehicle to her daughter without ensuring it would not be driven by an unlicensed driver.

The Tribunal also found no exceptional hardship, as the appellant had access to an alternative vehicle and faced only minor inconvenience.

The appellant applied for a liquor sales licence for a proposed restaurant and programmable art space in Kensington Market.

The Registrar issued a notice of proposal to review the application after receiving objections from residents, the City of Toronto, and the Friends of Kensington Market.

The objectors argued the licence was not in the public interest due to concerns about noise, disturbance, and increased traffic.

The Tribunal found that the objectors failed to establish that granting the licence was contrary to the public interest, noting the appellant's business model was less likely to cause disturbances than existing problematic establishments.

The Tribunal directed the Registrar to issue the licence but attached conditions restricting hours of service and requiring signage, a contact number for residents, and exterior lighting to address community concerns.

The applicant applied under s. 14(2) of the Liquor Licence Act to remove four conditions from its liquor licence, citing a change in circumstances since the licence was granted in 2000.

The respondent agreed that three conditions were unenforceable and took no position on the application.

The Tribunal found a change in circumstances, noting that the local community council had extended operating hours without patio music restrictions, the streetscape had changed significantly, and no public objections were received after notice was posted.

The Tribunal ordered the removal of the conditions.