OLAT 2020

The applicant sought statutory accident benefits after slipping and falling on ice while disembarking from his vehicle.

The respondent insurer denied the claim, arguing the incident did not meet the definition of an 'accident' under the Schedule because the applicant had already exited the vehicle.

The Tribunal found that the applicant was still holding the interior door handle when he fell, meaning he was in the process of disembarking, which is an ordinary use of a vehicle.

The Tribunal further held that slipping on ice while exiting a vehicle is a reasonably foreseeable risk and not an intervening act that breaks the chain of causation.

The incident was deemed an accident.

The applicant was injured in a motor vehicle accident and initially received a non-earner benefit (NEB) before it was terminated by the insurer in 2016.

The applicant's condition later deteriorated, leading to a catastrophic impairment designation and a new application for NEB in 2018.

The insurer argued the claim was statute-barred under s. 56 of the Statutory Accident Benefits Schedule as the two-year limitation period from the 2016 denial had expired.

The Tribunal applied the discoverability doctrine from Tomec, finding the applicant's cause of action for the new NEB claim only accrued when her psychological condition deteriorated in 2018.

The Tribunal held the claim was not statute-barred and, alternatively, would have granted an extension under s. 7 of the Licence Appeal Tribunal Act.

The applicant was injured in a rear-end motor vehicle accident and sought various medical and rehabilitation benefits, including psychological, chiropractic, physiotherapy services, and a neurological assessment.

The insurer denied the benefits.

The Licence Appeal Tribunal dismissed the application in its entirety, finding that the applicant had reached maximum medical recovery for his soft tissue injuries and that the proposed psychological services could be provided at a lower hourly rate by a subordinate practitioner.

The Tribunal also found the neurological assessment was not reasonable and necessary as the applicant's headaches were not directly caused by the accident.

The applicant was injured in a motor vehicle accident and sought $12,763.00 in lost educational expenses under the Statutory Accident Benefits Schedule, arguing that OSAP grants converted to loans due to his inability to attend college.

The Licence Appeal Tribunal dismissed the application, finding that the claimed expenses, specifically for room and board, were incurred after the accident rather than before it, failing to meet the criteria under section 21(5) of the Schedule.

Claims for a special award and interest were also dismissed.

The applicant sought reconsideration of a Licence Appeal Tribunal decision denying her claims for medical benefits, expenses, and an award under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The adjudicator found no error of fact or procedural unfairness regarding the denial of several OCF-18 treatment plans, noting the applicant's ongoing pain complaints indicated the treatment goals were not being met.

However, the adjudicator found an error was made regarding an October 2018 OCF-23, ruling that the outstanding amount was payable because the applicant had changed clinics while under the Minor Injury Guideline.

The request for reconsideration was partially granted.

The insurer requested a reconsideration of a decision finding that the applicant was insured under a newly acquired automobile provision when he crashed his motorcycle 11 days after purchase.

The insurer argued the Tribunal erred in law by misapplying case law regarding the 14-day automatic coverage extension and the applicant's subjective knowledge of coverage.

The Tribunal found no significant error of law or fact in the original decision, confirming that the 14-day extension applied automatically and the applicant's subjective belief was irrelevant to the coverage analysis.

The request for reconsideration was denied.

The applicant sought $2,260.00 for a chronic pain assessment following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the claim, finding that the treatment plan was technically deficient under s. 38(3) of the Statutory Accident Benefits Schedule because it lacked the required signatures and a statement from a health practitioner approving the plan.

Furthermore, the Tribunal found the assessment was not reasonable and necessary, as the medical evidence did not meet the criteria for chronic pain set out in the American Medical Association Guides.

Claims for a s. 10 award and interest were consequently dismissed.

The applicant sought to set aside a full and final settlement of his statutory accident benefits claim, arguing he lacked the mental capacity to enter into the agreement due to a traumatic brain injury sustained in a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to rebut the statutory presumption of capacity.

The Tribunal preferred contemporaneous medical and vocational evidence showing the applicant had average cognitive abilities over a capacity assessment conducted three months after the settlement.

The settlement was deemed valid as it was not rescinded within the two-day cooling-off period.

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

The Tribunal found that the applicant failed to meet her burden of proving that the proposed treatment plans were reasonable and necessary.

The medical evidence provided either did not support the specific treatments requested or pre-dated the treatment plans significantly.

The application was dismissed.

The applicant sought reconsideration of a decision denying her income replacement benefits beyond 104 weeks post-accident, relying on four new multidisciplinary reports as new evidence under Rule 18.2(d).

The Tribunal dismissed the request, finding that the reports could have been obtained prior to the release of the original decision and that the applicant made a tactical decision not to seek an adjournment.

Furthermore, the Tribunal held that the new evidence would not have affected the result, as the reports relied on self-reporting that was contradicted by surveillance evidence showing the applicant engaging in various activities.

The respondent's request for costs was also dismissed.

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

The insurer denied the claims for chiropractic treatment and out-of-pocket expenses on preliminary grounds of non-compliance with the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant incurred the chiropractic treatment before submitting the treatment plans, contrary to s. 38(2).

Furthermore, the applicant and his unlicensed service provider failed to follow the mandatory procedural steps for submitting invoices under s. 49.1 and s. 64(7).

The application for benefits was dismissed.

The applicant sought statutory accident benefits for chiropractic treatment following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that one treatment plan was statute-barred due to the applicant's failure to attend a section 44 insurer's examination.

The Tribunal found the applicant was statute-barred from claiming the $1,053.84 treatment plan because he failed to attend the properly scheduled examination without reasonable explanation.

Furthermore, the Tribunal held the applicant failed to prove he suffered from chronic pain warranting removal from the MIG.

As the MIG limits were exhausted, the claims for medical benefits and interest were dismissed.

The applicant was injured in a motorcycle accident and sought a determination of catastrophic impairment (CAT) under the Statutory Accident Benefits Schedule, along with entitlement to three treatment plans.

The Tribunal found that the applicant's combined physical and psychological impairments resulted in a 48% whole person impairment, falling short of the 55% threshold required for a CAT designation under Criterion 7.

However, the Tribunal found the disputed treatment plans for physiotherapy and psychotherapy to be reasonable and necessary, ordering the respondent to pay them up to the medical and rehabilitation policy limit, plus interest.

The applicant sought a medical benefit for physiotherapy treatment following a motor vehicle accident, along with interest and an award for unreasonable delay.

The adjudicator found that the applicant failed to demonstrate that the proposed treatment was reasonable and necessary, relying on the respondent's section 44 assessment which concluded the physical impairments were soft-tissue in nature and had reached maximal medical improvement.

As no benefits were payable, the claims for interest and an award were also dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and medical benefits.

The insurer initially placed the applicant in the Minor Injury Guideline (MIG) and denied post-104 IRBs.

The Tribunal found the applicant suffered a complete inability to engage in any employment for which she was reasonably suited due to severe depression and psychological issues arising from the accident, entitling her to post-104 IRBs.

The Tribunal also awarded a 30% special award under s. 10 of O. Reg. 664 on the medical treatment plans, finding the insurer unreasonably delayed approval and improperly relied on an assessor's legal conclusion regarding the MIG, but denied an award on the IRBs.

The applicant sought statutory accident benefits following a motor vehicle accident, including treatment plans for physiotherapy, a psychological pre-screening, and a chronic pain assessment.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to meet her burden of proving the disputed treatment plans were reasonable and necessary, noting a lack of persuasive medical evidence and reliance on reports that did not support the requested treatments.

The claims for the disputed treatment plans and interest were dismissed.

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

After the respondent eventually agreed to fund the disputed benefits, the sole remaining issue was whether the applicant was entitled to a special award under section 10 of O. Reg. 664 for unreasonable delay.

The Tribunal found that the respondent unreasonably delayed payment by improperly claiming that section 25 assessments were duplications of section 44 assessments and by failing to reconsider earlier denials after removing the applicant from the Minor Injury Guideline.

A nominal special award of $400 was ordered.

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

The insurer requested the applicant elect between an income replacement benefit and a non-earner benefit.

The applicant filed an application with the Licence Appeal Tribunal before making an election or receiving a denial from the insurer.

The Tribunal held it lacked jurisdiction to adjudicate the claim because, under section 280 of the Insurance Act, there can be no dispute until a claim is denied by the insurer.

The application was dismissed.

The applicant, a minor, was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and occupational therapy treatment plans.

The respondent insurer denied the plans.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, as medical evidence indicated his accident-related injuries had resolved and he had returned to his activities of daily living.

The application was dismissed.

The appellant appealed a decision of the Registrar of Motor Vehicles to cancel its Commercial Vehicle Operator's Registration (CVOR) certificate and seize its plates.

The appellant had a history of safety problems, including a high violation rate resulting from at-fault collisions, out-of-service safety defects, and highway traffic violations.

Despite previous interventions, including a suspension and specific performance conditions, the appellant's violation rate continued to increase.

The Tribunal found that the appellant's safety record provided reason to believe it would not operate a commercial motor vehicle safely and confirmed the Registrar's cancellation order.