OLAT 2020

The applicant sought statutory accident benefits after slipping and falling on snow while attempting to enter his vehicle.

The respondent denied benefits, arguing the incident was a slip and fall, not an automobile accident.

The Tribunal applied the two-part purpose and causation test from Greenhalgh.

It found the purpose test was met because the applicant was in the process of entering his vehicle, having unlocked it with a FOB and reached for the door handle.

The causation test was also met, as the slip and fall was part of a continuous chain of events with no intervening act, making the use of the vehicle a direct cause of the injuries.

The Tribunal concluded the incident was an 'accident' under the Schedule.

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

The adjudicator found that the applicant's injuries fell outside the Minor Injury Guideline (MIG) due to pre-existing physical conditions and an exacerbation of psychological injuries, relying on the respondent's own Insurer's Examination reports.

However, the adjudicator dismissed the claims for various treatment plans, finding them not reasonable and necessary because they proposed block fees without specifying the provider or duration of modalities, contrary to the Professional Services Guideline.

Claims for the costs of disability certificates, interest, and costs of the proceeding were also dismissed.

The applicant and respondent both requested a reconsideration of a previous Licence Appeal Tribunal decision that awarded the applicant a special award of $550.00 related to a denied physiatry assessment.

The respondent argued the adjudicator erred in law by considering extraneous factors and incorrectly quantifying the award.

The applicant argued the adjudicator erred in calculating the award amount by not including other denied treatment plans.

The adjudicator dismissed both requests, finding that the respondent failed to establish any error of law regarding the special award, and that the applicant's request involved issues not properly raised at the original hearing.

The applicant sought entitlement to seven treatment plans for chiropractic services following a motor vehicle accident.

The respondent requested the claim be dismissed due to the applicant's late filing of evidence and submissions.

The Tribunal allowed the late filing to avoid prejudice but awarded $300 in costs to the respondent for the applicant's unreasonable behaviour.

On the merits, the Tribunal dismissed the claim for chiropractic benefits, finding the applicant failed to prove they were reasonable and necessary, noting his increased post-accident activities and lack of supportive medical evidence.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to non-earner benefits (NEB) and a medical benefit for a physiotherapy treatment plan.

The Licence Appeal Tribunal found that the applicant failed to establish a complete inability to carry on a normal life, as she was still able to partially perform her pre-accident activities, and thus dismissed the NEB claim.

The Tribunal partially approved the physiotherapy treatment plan, finding it reasonable and necessary for pain reduction, but deducted costs incurred prior to the submission of the plan pursuant to s. 38(2) of the Schedule.

The claim for a special award under Ontario Regulation 664 was dismissed as the insurer's denials were not unreasonable.

The applicant sought statutory accident benefits following a rear-end motor vehicle accident.

The respondent denied certain physiotherapy and psychological treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant sustained predominantly minor injuries, noting the absence of any documented pre-existing condition that would prevent maximal recovery.

The Tribunal accepted the insurer's expert evidence over the applicant's psychological assessment, concluding that the disputed treatment plans and assessments were not reasonable and necessary.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits for a psychological assessment and chiropractic treatments, arguing his injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain.

The Licence Appeal Tribunal found that the applicant failed to prove his injuries were outside the MIG, as there was no evidence of a pre-existing condition or that he met the criteria for chronic pain syndrome.

Relying on insurer's examinations, the Tribunal concluded the requested treatments were not reasonable and necessary.

The application was dismissed, and claims for interest and an award were denied.

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

The respondent denied treatment plans for medical cannabis and chiropractic treatment, and requested insurer examinations under s. 44 of the Schedule.

The applicant failed to attend the examinations.

The Tribunal held that the insurer's requests were reasonably necessary and compliant with notice requirements.

Consequently, under s. 55(1), the applicant was barred from proceeding with the dispute regarding those treatment plans.

A separate claim for chiropractic treatment was dismissed as the applicant failed to prove it was reasonable and necessary.

The applicant sought medical benefits for physiotherapy, chiropractic treatment, massage, acupuncture, recreation therapy, and aromatherapy following a motor vehicle accident.

The respondent insurer denied the treatment plans, arguing the applicant's soft tissue injuries had resolved and the ongoing symptoms were related to a prior accident.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, as the medical evidence indicated the accident-related injuries were mild soft tissue strains that had resolved, and there was no exacerbation of pre-existing conditions.

The application was dismissed.

The applicant requested a reconsideration of a preliminary issue decision that found her statute-barred from proceeding with her LAT application for failing to attend Insurer's Examinations.

The applicant alleged errors of fact and law, procedural unfairness, and adjudicator bias.

The adjudicator dismissed the reconsideration request, finding no errors or bias, and strongly criticized the applicant's counsel for toxic and baseless submissions.

The respondent's request for costs was declined to avoid penalizing the applicant for her counsel's behaviour.

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

After failing to comply with multiple Tribunal orders to properly file and format her document brief, the Tribunal issued a notice of intention to dismiss the application.

The applicant did not respond or comply within the provided timeframe.

Consequently, the Tribunal dismissed the application without a hearing, finding that the applicant had abandoned her appeal.

The applicant requested a reconsideration of a decision finding her statute-barred from proceeding with an application for a non-earner benefit.

The applicant filed the request two days late and sought an extension of time, citing the COVID-19 pandemic emergency order.

The Tribunal denied the extension, finding no evidence that the pandemic caused the delay.

On the merits, the Tribunal found no significant error of law or fact in the original decision, confirming that the insurer's denial was clear and unequivocal and that the applicant qualified for income replacement benefits, precluding her from receiving a non-earner benefit.

The request for reconsideration and the insurer's request for costs were both denied.

The applicant, a 69-year-old retiree, was involved in a motor vehicle accident and sought a non-earner benefit from the respondent insurer.

The respondent denied the benefit, arguing the applicant did not suffer a complete inability to carry on a normal life and had a pre-existing shoulder injury.

The Tribunal found that the applicant failed to establish that his impairment continuously prevented him from engaging in substantially all of his pre-accident activities.

Medical evidence and the applicant's own self-reporting indicated he had returned to most of his activities of daily living.

The application for a non-earner benefit was dismissed, and the respondent's request for costs was also dismissed.

The applicant was injured in a rear-end motor vehicle collision and sought medical and rehabilitation benefits beyond the $3,500 limit of the Minor Injury Guideline (MIG).

The applicant argued that he suffered from chronic pain syndrome and psychological impairments that warranted removal from the MIG.

The Tribunal found that the applicant's physical injuries were soft tissue in nature and that his pain complaints did not meet the criteria for chronic pain syndrome under the AMA Guides.

Furthermore, the Tribunal concluded that the applicant's psychological complaints were clinically associated sequelae of his minor physical injuries.

As the applicant failed to prove his injuries were not predominantly minor, and the MIG funding limit was already exhausted, the claims for a psychological assessment, chiropractic treatment, and interest were dismissed.

The applicants, who both required leg amputations following a motorcycle accident, sought funding for home modifications under the Statutory Accident Benefits Schedule.

The parties presented competing modification plans, with the applicants proposing a one-storey expansion and the respondent proposing a two-storey build.

The adjudicator found the applicants' plan to be reasonable and necessary, as it accommodated their wheelchair needs while preserving their pre-accident lifestyle and avoiding the safety risks of a two-storey design.

The adjudicator also awarded the applicants 25% of the value of a back-up generator under section 10 of Regulation 664, finding that the respondent unreasonably delayed its approval.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits from the respondent insurer.

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

The applicant applied to the Licence Appeal Tribunal, arguing she should be excluded from the MIG due to pre-existing conditions, psychological impairment, and chronic pain.

The Tribunal found insufficient evidence of a pre-existing condition or a psychological impairment resulting from the accident.

The Tribunal concluded the applicant's injuries were predominantly minor and dismissed the application for benefits and interest.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing that chronic pain, psychological impairments, and pre-existing conditions warranted removal from the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor and that there was insufficient medical evidence of chronic pain, psychological diagnosis, or functional impairment to justify removal from the MIG.

As the applicant had not exhausted the MIG limits, the disputed treatment plans were deemed not reasonable and necessary.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits for massage and chiropractic services across three treatment plans.

The respondent denied the treatment plans following section 44 assessments.

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

The medical evidence submitted by the applicant, including reports from treating practitioners, was outdated, lacked specific recommendations for the disputed treatments, or failed to demonstrate how the treatments would achieve their stated goals.

The application was dismissed, and no interest was payable.

The applicant requested a reconsideration of a Tribunal decision that found her psychological impairments fell within the Minor Injury Guideline (MIG).

The adjudicator determined that an error of law was made in the previous decision, as the applicant's psychological impairment was rooted in previously documented anxiety and was not a clinically associated sequelae of her minor injuries from the accident.

The reconsideration was granted, and the previous decision was varied to remove the applicant from the MIG.

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

The Licence Appeal Tribunal considered whether treatment plans for chiropractic care and a chronic pain assessment were reasonable and necessary.

The Tribunal found the chiropractic treatment plan was not reasonable and necessary due to minimal improvement and unchanging symptoms.

However, the Tribunal approved the chronic pain assessment, finding it reasonable and necessary given the applicant's persistent pain and the lack of success with traditional therapy.