OLAT 2020

The applicant was injured in a motor vehicle accident and sought medical benefits for physiotherapy beyond the $3,500 Minor Injury Guideline (MIG) limit.

The applicant argued that chronic neck pain and pre-existing degenerative disc disease warranted removal from the MIG.

The Tribunal found insufficient medical evidence to support a diagnosis of chronic pain causing functional impairment or to show that pre-existing conditions prevented maximal medical recovery within the MIG.

The application for the physiotherapy treatment plan, interest, and a bad faith award was dismissed.

The applicant sought payment of $11,533.24 for the unapproved balance of a treatment plan (OCF-18) for multi-disciplinary catastrophic impairment assessments.

The insurer had partially approved the plan for $12,000.

The Tribunal found that the unapproved assessment items were needless bifurcations or duplications of assessments already conducted by the insurer, and the applicant failed to prove they were reasonable and necessary.

The Tribunal awarded $400 for the cost of completing the OCF-18 and OCF-19 forms, but denied the remainder of the claim.

The appellant appealed a proposal to refuse to issue him a licence as an owner and trainer of Standardbred horses.

The Registrar refused the licence based on the appellant's failure to disclose his extensive disciplinary history on his application and his participation in a hidden ownership scheme while unlicenced.

The appellant argued his past conduct was caused by cognitive impairments and schizophrenia, which were now being managed.

The Tribunal found reasonable grounds to believe the appellant would not act with integrity or honesty, noting a lack of independent evidence showing sufficient improvement in his cognitive abilities to adhere to the strict regulations of the horse racing industry.

The Tribunal directed the Registrar to carry out the proposal to refuse the licence.

The applicant sought various statutory accident benefits following a 2007 motor vehicle accident.

The insurer denied the benefits between 2008 and 2010.

The applicant applied to the Licence Appeal Tribunal in 2019 and 2020, well beyond the two-year limitation period.

The Tribunal found that the insurer's denials were clear, unequivocal, and compliant with the legal requirements to trigger the limitation period.

The Tribunal also held that it lacked jurisdiction under section 7 of the Licence Appeal Tribunal Act to extend the limitation period for a regulation like the Schedule.

The applicant was therefore barred from proceeding with her claims.

The appellant appealed the 45-day impoundment of her vehicle, which was seized after being driven by an individual with a suspended licence.

The appellant argued she exercised due diligence and that the impoundment caused exceptional hardship.

The Licence Appeal Tribunal found the appellant failed to exercise due diligence, as she did not closely inspect the driver's licence or verify its status despite red flags.

The Tribunal also found no exceptional hardship, as the appellant had alternative transportation options available.

The appeal was denied and the impoundment order confirmed.

The applicant sought funding for a chronic pain assessment following a motor vehicle accident.

The insurer denied the treatment plan, but the applicant argued the denial notices were defective under s. 38(8) of the Schedule.

The Tribunal found that the insurer's denial letters failed to provide specific medical reasons or details about the applicant's condition, rendering them non-compliant.

Consequently, under s. 38(11), the treatment plan became payable without an analysis of reasonableness and necessity.

The Tribunal awarded the cost of the assessment plus interest, but declined to order an award under O. Reg. 664, finding the insurer's conduct was not excessive or imprudent.

The applicant sought a special award under section 10 of Ontario Regulation 664, alleging that the respondent insurer unreasonably withheld or delayed payment of a physiotherapy treatment plan.

The applicant claimed that the respondent's communications were confusing and led her to believe the plan was denied.

The Tribunal found that the respondent's communications, including an Explanation of Benefits, clearly stated that the treatment plan was approved because an insurer's examination report was not provided within 10 business days, despite the medical assessor concluding the treatment was not reasonable and necessary.

The Tribunal held that the delay was caused by the applicant's misinterpretation of clear communications and her subsequent delay in filing the application, not by any unreasonable conduct of the respondent.

The claim for a special award was dismissed.

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

The applicant argued the Tribunal made significant errors of law and fact, specifically regarding the mandatory payment provisions under s. 38(11) of the Statutory Accident Benefits Schedule and the consideration of a psychological assessment.

The adjudicator found no significant errors of law or fact that would have changed the outcome, noting that the proposed treatment plans were not reasonable and necessary.

The request for reconsideration was dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for chiropractic treatment.

The respondent insurer denied the treatment plans on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant failed to provide compelling contemporaneous medical evidence, such as clinical notes and records, to support the need for the disputed chiropractic treatment.

The Tribunal preferred the evidence of the respondent's independent medical examiner, who concluded the applicant suffered uncomplicated soft-tissue injuries that had resolved.

The application was dismissed, and no interest was awarded.

The applicant was injured in a motor vehicle accident and sought payment for two chiropractic treatment plans totaling approximately $7,100.

The respondent insurer denied the plans, arguing the applicant had reached maximum recovery and further facility-based treatment was not medically indicated.

The Tribunal found the treatment plans were reasonable and necessary, preferring the clinical records of the applicant's treating family physician over the respondent's independent medical assessors.

The Tribunal noted the applicant experienced ongoing pain that improved with physical therapy.

The applicant was awarded entitlement to both treatment plans with interest.

The appellant appealed a decision denying his claim for compensation from the Motor Vehicle Dealers Compensation Fund following a dealership's receivership.

The Fund provides compensation only to consumers, not for business transactions.

The appellant argued he purchased the vehicle for personal use, despite having purchased 14 other vehicles for export to Ecuador.

The Tribunal found the evidence, including the involvement of a global shipping company and the timing of the purchases, indicated the vehicle was purchased as part of a business venture.

The appeal was dismissed.

The appellant appealed a Notice of Proposal to refuse his registration as a salesperson under the Motor Vehicle Dealers Act, 2002.

At the start of the hearing, the appellant requested an adjournment, citing insufficient time to review the respondent's materials and work commitments.

The respondent objected, arguing the appellant had received the materials electronically months prior and that an adjournment would prejudice its civilian witnesses.

The adjudicator granted the adjournment in part, ordering the hearing to commence so the respondent could call its case, but allowing flexibility for the appellant's work schedule and adjourning the hearing to new dates for the appellant to present his case.

The appellant appealed the 45-day impoundment of her vehicle after she allowed a stranger to test drive it, who was subsequently stopped by police and found to have a suspended licence.

The appellant argued the impoundment caused exceptional hardship.

The Tribunal dismissed the appeal, finding that the appellant had alternatives to the vehicle, such as walking to appointments and relying on friends for groceries, and therefore did not meet the criteria for exceptional hardship.

The applicant sought income replacement benefits and various medical and rehabilitation benefits following a motor vehicle accident.

The adjudicator found that the applicant failed to prove a substantial inability to perform her pre-accident employment tasks, noting evidence that she had returned to work at multiple jobs with no loss of income.

The adjudicator also dismissed the claims for medical benefits, finding that the proposed treatments and assessments were not reasonable and necessary, relying in part on the respondent's medical examinations which concluded the applicant had reached maximum medical improvement.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained predominantly minor soft tissue injuries and rejected her claims of chronic pain and psychological impairments, preferring the insurer's psychiatric assessment over the applicant's expert reports.

However, the Tribunal ordered the insurer to pay $1,090.00 for one physiotherapy treatment plan because the insurer failed to provide notice of its refusal within the 10-day period required by section 38(8) of the Schedule.

The remaining claims for medical benefits and assessments were denied as the $3,500 MIG limit had been reached.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal found that while the applicant's pre-existing chronic pain and degenerative disc disease removed her from the Minor Injury Guideline, she had reached maximum medical improvement from her accident-related injuries.

Relying on the respondent's medical assessments, the Tribunal concluded that further facility-based treatment was not reasonable and necessary.

The application for benefits, interest, and a special award was dismissed.

The applicant sought non-earner benefits following a 2016 motor vehicle accident.

The respondent insurer denied the benefits in August 2017.

The applicant filed an application with the Licence Appeal Tribunal in November 2019, beyond the two-year limitation period under section 56 of the Statutory Accident Benefits Schedule.

The Tribunal considered whether to extend the limitation period under section 7 of the Licence Appeal Tribunal Act, 1999.

The Tribunal found the applicant failed to establish a bona fide intention to appeal within the limitation period, the delay of four months was excessive, the respondent would be prejudiced, and the application lacked merit.

The application was dismissed as statute-barred.

The applicant, a family-run restaurant, applied to the Licence Appeal Tribunal to remove a condition on its liquor licence that restricted the sale and service of alcohol past midnight.

The applicant argued that the restriction put it at a competitive disadvantage and that the economic impact of the Covid-19 pandemic constituted a change in circumstances.

The Tribunal found that the change in the competitive landscape and the pandemic's impact satisfied the requirement for a change in circumstances.

Relying on strong support from immediate neighbours, the Tribunal concluded that removing the condition was in the public interest and ordered its removal.

The applicant sought a special award under section 10 of Ontario Regulation 664, alleging the respondent insurer unreasonably delayed payment of income replacement benefits.

The insurer argued the delay was justified because the applicant was late in submitting the required application forms and medical records.

The Tribunal found that the insurer unreasonably delayed payment from January 4, 2019, to April 5, 2019, as it was aware the applicant was self-represented and had already provided a statement to its Special Investigations Unit.

The Tribunal awarded the applicant a 15% special award on the benefits paid during that period, plus interest.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits.

The respondent denied medical benefits, attendant care, and the cost of a psychological assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG due to psychological impairments, chronic pain, and a pre-existing shoulder injury.

The Tribunal found that the applicant failed to provide compelling medical evidence to support her removal from the MIG.

Furthermore, the Tribunal concluded that the disputed treatment plans and assessment were not reasonable and necessary, and dismissed the claim for attendant care benefits due to a lack of evidence.