OLAT 2019

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

The insurer denied income replacement benefits and medical benefits for chiropractic services, arguing the applicant missed the two-year limitation period.

The Tribunal held that the limitation period for income replacement benefits starts when the applicant receives or is deemed to receive the denial letter, and the insurer failed to prove when this occurred, allowing the claim to proceed.

However, the applicant conceded missing the limitation period for the medical benefits.

The Tribunal found it lacked jurisdiction under s. 7 of the Licence Appeal Tribunal Act to extend the limitation period, as it is fixed under a regulation rather than an Act, barring the medical benefits claims.

The applicant was injured in a motor vehicle accident and sought medical benefits for physiotherapy, massage therapy, and swim passes.

The respondent denied the treatment plan based on an insurer's examination report which opined that no further facility-based treatment was required.

The Tribunal found the treatment plan was reasonable and necessary to address the applicant's ongoing pain and functional limitations, preferring the clinical notes and records over the insurer's examination prognosis.

The Tribunal ordered the respondent to pay the treatment plan with interest, but declined to grant an award under section 10 of Regulation 664, finding the respondent did not act unreasonably in relying on the assessment report.

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

The Licence Appeal Tribunal found that the applicant's right wrist impairment pre-dated the accident and was not caused by it.

The Tribunal granted the applicant's claims for a knee brace, chiropractic and physiotherapy treatment, a psychological assessment, and a chronic pain assessment, finding them reasonable and necessary.

However, the Tribunal dismissed the claims for income replacement benefits, finding the applicant did not suffer a substantial inability to perform his sedentary pre-accident employment as a debt collector.

The claim for attendant care benefits was also dismissed as the expenses were not incurred and the applicant was found to be independent with personal care tasks.

The applicant sought interest on income replacement benefits (IRBs) and an award for unreasonable delay following a motor vehicle accident.

The Tribunal found that the issue of interest for the period of April to December 2017 was not properly before it, as it was not raised in the application or case conference order.

The Tribunal also denied interest on IRBs from January 22, 2018, because the applicant failed to provide requested information in a timely manner, justifying the insurer's suspension of benefits under section 33 of the Schedule.

The claim for an award under O. Reg. 664 was dismissed as the applicant made no submissions on the issue.

The applicant was involved in a motor vehicle accident and sought a medical benefit of $1,977.05 for chiropractic services under the Statutory Accident Benefits Schedule.

The insurer denied the treatment plan.

The Adjudicator found that the applicant failed to prove the treatment was reasonable and necessary, noting that her treating physician did not recommend physical treatment for accident-related symptoms and relying on the insurer's assessment that further passive modalities would not be beneficial.

The claims for the medical benefit, interest, and a special award were dismissed.

The applicant sought income replacement benefits following a motor vehicle accident.

The respondent insurer denied the benefits and requested a preliminary issue hearing to dismiss the application because the applicant failed to submit a completed Disability Certificate (OCF-3) as required by section 36 of the Statutory Accident Benefits Schedule.

The applicant argued that the insurer should have taken a holistic approach and obtained the necessary information from his treating practitioners using signed authorizations.

The Tribunal held that section 36 places the onus on the applicant to submit a completed OCF-3 filled out by a health practitioner before entitlement to the benefit begins.

As the applicant had not submitted a completed OCF-3, the application was dismissed.

The appellant sought an extension of time to appeal a 45-day motor vehicle impoundment under the Highway Traffic Act.

The vehicle was impounded after the appellant's roommate, a suspended driver, operated it.

The appellant missed the 15-day appeal deadline by over two months and did not attend the teleconference motion hearing.

Applying the four-factor test for extending time, the Tribunal found no bona fide intention to appeal within the time limit, significant delay, prejudice to the respondent, and no reasonable chance of success on the merits, as the appellant had an alternative vehicle and the vehicle was not stolen.

The motion was denied.

The appellant company appealed the 45-day impoundment of its vehicle after an employee was caught driving it with a suspended licence.

The appellant argued it exercised due diligence by checking the employee's temporary licence upon hiring and claimed the impoundment caused exceptional hardship.

The Licence Appeal Tribunal dismissed the appeal, finding the appellant failed to exercise due diligence by not verifying the employee's driving record before assigning her to drive.

The Tribunal also found no exceptional hardship, as alternative transportation was available and the company remained operational.

The respondent insurer requested a reconsideration of a Tribunal decision that removed the applicant from the Minor Injury Guideline (MIG) and awarded six treatment plans.

The insurer argued the adjudicator violated procedural fairness and made significant errors of fact and law by relying on unsupported submissions, making medical conclusions not in the records, and misinterpreting various medical assessment reports.

The Vice-Chair found that while the adjudicator made two minor errors of fact, they were not significant enough to alter the outcome, as there was ample other evidence supporting the chronic pain diagnosis and the reasonableness of the treatment plans.

The request for reconsideration was dismissed.

The applicant, who was catastrophically impaired in a motor vehicle accident, sought attendant care benefits of $6,000 per month.

The respondent conceded entitlement but disputed the quantum and whether past services provided by the applicant's sister were 'incurred' under the Schedule.

The Tribunal found the applicant required 24-hour basic supervisory care due to unpredictable cognitive and visual episodes, entitling her to $6,000 per month for most of the claimed period.

The Tribunal also found the sister provided services in a professional capacity, satisfying the incurred test.

The claim for a special award was dismissed as the insurer's delay was reasonable given accounting and documentation issues.

The appellant appealed the 45-day impoundment of his vehicle for driving while suspended.

He argued that he did not know his licence was suspended following a DUI conviction in New York, that he exercised due diligence by checking his record once, and that the impoundment caused exceptional hardship to his real estate business.

The Tribunal dismissed the appeal, finding that his licence was indeed suspended, he failed to exercise due diligence by not checking his status regularly or opening registered mail from the Ministry, and he failed to establish exceptional hardship because he had not explored all alternatives, such as renting a vehicle.

The applicant insurer sought repayment of $2,400 in income replacement benefits paid to the respondent following an automobile accident, alleging the respondent wilfully misrepresented his home address when renewing his policy.

The Licence Appeal Tribunal found that the insurer failed to establish on a balance of probabilities that the respondent wilfully misrepresented his address.

The evidence, including the motor vehicle accident report and adjustor's log notes, did not support the insurer's claim.

The application for repayment was dismissed.

The applicant sought an income replacement benefit following a motor vehicle accident.

The matter was scheduled for a four-day hearing, but the applicant failed to appear.

As the applicant bore the onus to prove entitlement and called no evidence, the application was dismissed.

The respondent's request for costs was also denied, as the unrepresented applicant's failure to appear did not meet the high standard of unreasonable, frivolous, vexatious, or bad faith conduct under Rule 19.

The applicant filed a request for reconsideration of a case conference order that allowed an adjuster to represent themselves and warned that failure to attend the resumed case conference would result in the application being dismissed.

The Associate Chair dismissed the request for reconsideration, 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.

Because the proceeding was ongoing, the request was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, which the respondent insurer denied.

The applicant applied to the Licence Appeal Tribunal for dispute resolution.

After failing to comply with submission deadlines, failing to communicate with the Tribunal or his counsel, and failing to respond to the respondent's motion to dismiss, the Tribunal found the applicant had abandoned his application.

The application was dismissed pursuant to Rule 3.4(d) of the Tribunal's Common Rules of Practice and Procedure.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically a treatment plan for physiotherapy services in the amount of $1,797.00.

The insurer denied the benefit.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plan was reasonable and necessary, noting that the applicant had tried physiotherapy pre-accident without significant benefit and that insurer examinations did not recommend it.

The application was dismissed and no interest was awarded.

The applicant sought various statutory accident benefits following a motor vehicle accident, including ongoing income replacement benefits (IRBs), the cost of an accountant's report, and medical benefits for assistive devices and psychological treatment.

The Tribunal found that the applicant was not entitled to ongoing IRBs because she had returned to full-time work and was paid her normal salary.

The cost of the accountant's report was deemed unreasonable due to the applicant's failure to provide accurate information regarding collateral benefits.

The claims for assistive devices and further psychological treatment were also dismissed, as the Tribunal preferred the evidence of the insurer's examiners, who concluded the items and treatments were not reasonable and necessary given the applicant's functional recovery.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's denial of two chiropractic treatment plans, interest, and an award for unreasonable withholding.

The Tribunal found the October 2017 treatment plan reasonable and necessary based on timely medical records and psychological assessments, but dismissed the May 2018 plan due to a lack of persuasive evidence and an uncontested insurer examination finding symptom magnification.

The applicant was awarded interest on the approved plan but denied a special award, as the insurer had responded to the plans within the required timelines and provided valid medical reasons.

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

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

The applicant argued her pre-existing knee osteoarthritis, psychological impairments, and chronic pain removed her from the MIG.

The Tribunal found the pre-existing condition was not exacerbated by the accident and did not prevent maximal recovery.

The Tribunal also found insufficient medical evidence to support a psychological impairment or chronic pain diagnosis that would remove the applicant from the MIG.

The application was dismissed.

The applicant was injured in three separate motor vehicle accidents and sought a non-earner benefit and medical benefits.

The respondent denied the benefits on the basis that the applicant failed to attend section 44 insurer examinations.

The respondent raised a preliminary issue that the applicant was barred from proceeding with the Tribunal application due to this non-attendance.

The Tribunal found that the respondent made reasonable attempts to accommodate the applicant's scheduling requests and that the applicant failed to provide a reasonable explanation for his non-attendance.

The Tribunal held that the applicant is barred under section 55(2) of the Schedule from proceeding with his application until he attends the required insurer examinations.