OLAT 2020

The applicant filed a request for reconsideration of a Licence Appeal Tribunal decision that denied entitlement to a chronic pain assessment.

The respondent objected that the request was filed beyond the 21-day time limit under Rule 18.1 and failed to include supporting submissions.

The Tribunal found the request was untimely, lacked sufficient submissions explaining the alleged errors of law or fact, and no extension of time was requested.

The request for reconsideration was dismissed.

The applicant was injured in a motor vehicle accident and sought funding for a physiotherapy treatment plan in the amount of $3,078.72.

The respondent denied the treatment plan.

The Licence Appeal Tribunal found that the treatment plan was not reasonable and necessary, noting significant gaps in the applicant's treatment history and a lack of improvement despite previous facility-based treatment.

The Tribunal accepted the respondent's medical examination evidence that the applicant had reached maximum medical improvement and could manage her symptoms with a home-based exercise program.

The claims for an award and interest were also dismissed.

The respondent insurer requested a reconsideration of a Tribunal decision that found the applicant entitled to $877.93 for the cost of a psychological assessment.

The insurer argued the Tribunal erred in law and fact by not requiring the cost to be justified by the hourly rates of the service providers and by relying on the cost of the insurer's own examination.

The Vice Chair dismissed the request, finding no errors of law or fact in the original decision that would have likely led to a different result.

The applicant sought a catastrophic impairment assessment following a motor vehicle accident, which the respondent insurer denied.

A written hearing was scheduled, but the applicant failed to file any submissions or evidence.

The respondent requested the application be dismissed as abandoned.

The Tribunal discovered that the applicant's counsel of record had passed away and their practice was in trusteeship with the Law Society of Ontario.

Given the unique circumstances and the lack of clarity regarding the applicant's knowledge of the proceedings, the Tribunal declined to dismiss the application immediately.

Instead, the Tribunal ordered a resumption hearing and required the applicant to provide written submissions on why the matter should not be dismissed as abandoned.

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

The respondent denied several treatment plans for physiotherapy, psychological services, and physiatry assessments on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered soft tissue injuries and did not establish that pre-existing conditions, chronic pain with functional impairment, or psychological impairments warranted removal from the MIG.

As the $3,500 MIG limit was exhausted, the disputed treatment plans were not payable.

The application was dismissed.

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

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

The Tribunal found that the applicant suffered predominantly soft tissue injuries and failed to provide compelling medical evidence of pre-existing conditions, psychological impairment, or chronic pain that would remove her from the MIG.

As the funding limit was already reached, the disputed physiotherapy treatment plan was not payable.

The claim for medication costs was dismissed as already paid.

The applicant sought a special award under s. 10 of O. Reg. 664, alleging the respondent unreasonably delayed paying a settlement amount of $5,786.83 to two medical clinics.

The respondent argued the Tribunal lacked jurisdiction because the payment obligation arose from a private settlement agreement, not an entitlement under the Statutory Accident Benefits Schedule.

The Tribunal agreed it lacked jurisdiction, finding the dispute was contractual.

In the alternative, the Tribunal found the respondent's conduct did not meet the high threshold for a special award, as the delay resulted from a miscommunication regarding the submission of invoices through HCAI, rather than excessive or stubborn behaviour.

The motion was dismissed.

The applicant, who suffered catastrophic injuries as a pedestrian in a motor vehicle accident, sought a medical benefit for a physiotherapy treatment plan.

The respondent insurer denied the plan, relying on its expert assessors who opined that home-directed exercises were sufficient and that the applicant's neurological impairment was fixed.

The Tribunal preferred the evidence of the applicant's treating multidisciplinary team, finding the professionally directed physiotherapy reasonable and necessary to manage and prevent regression of the applicant's conditions.

The treatment plan was approved with interest.

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

The respondent denied the benefits on the basis of the Minor Injury Guideline and requested the applicant attend a psychological insurer's examination to determine if the Guideline applied.

The applicant attended but did not complete the examination, and subsequently failed to attend two functional capacity assessments.

The Tribunal found that the applicant failed to comply with section 44 of the Schedule and declined to exercise its discretion to allow the application to proceed under section 55(2).

The application was dismissed.

The applicant sought income replacement benefits (IRBs), attendant care benefits, and medical benefits following a motor vehicle accident.

The Tribunal found that the applicant met both the Pre-104 and Post-104 IRB tests due to chronic pain and depression preventing her from returning to her pre-accident employment as a cook, despite her part-time accommodated work at an assisted living residence.

The Tribunal dismissed the claims for attendant care and medical benefits, finding the applicant independent in personal care and no longer in need of the requested assistive devices or occupational therapy.

The applicant was awarded IRBs with deductions for her part-time income, plus interest, but no special award was granted.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that granted the applicant entitlement to two treatment plans.

The respondent argued that the Tribunal breached procedural fairness by relying on the applicant's affidavit evidence after the respondent had waived cross-examination under the mistaken belief that the affidavit was being withdrawn.

The Adjudicator agreed that a significant error of fact and breach of procedural fairness occurred, as the Tribunal had relied heavily on the untested affidavit in its original decision.

The reconsideration was granted, the original decision was cancelled, and a rehearing on written submissions without the affidavit was ordered.

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

The respondent insurer stopped paying the benefits and issued a clear and unequivocal denial letter.

The applicant filed an application with the Licence Appeal Tribunal more than two years after the denial.

The Tribunal found the application was statute-barred under s. 56 of the Statutory Accident Benefits Schedule and declined to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act, 1999, noting the applicant's failure to file evidence or establish reasonable grounds for an extension.

The applicant insurer sought repayment of $9,197.65 in income replacement benefits paid to the respondent following a motor vehicle accident.

The insurer alleged the respondent wilfully misrepresented his employment status, as Records of Employment confirmed he was terminated prior to the accident.

The respondent did not participate in the hearing.

The Tribunal found the insurer proved wilful misrepresentation and ordered the respondent to repay the benefits with interest.

The applicant sought non-earner benefits after slipping on black ice and fracturing her ankle while exiting her parked vehicle.

The respondent denied the benefits on the basis that the incident was not an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal applied the two-part purpose and causation test and found that while the purpose test was met, the causation test was not.

The Tribunal concluded that the ice was an independent intervening event that directly caused the injuries, breaking the chain of causation from the use or operation of the automobile.

The application was dismissed.

The applicant requested a reconsideration of a preliminary issue decision that barred her application for statutory accident benefits because it was filed beyond the two-year limitation period.

The applicant argued the Tribunal acted outside its jurisdiction and made errors of law by not properly weighing evidence and misconstruing her arguments.

The Tribunal dismissed the request, finding that the applicant was attempting to re-litigate the issues and failed to establish any of the criteria required for granting a reconsideration under Rule 18.2.

The applicant sought statutory accident benefits for psychological services, chiropractic services, and a driver anxiety assessment following a motor vehicle accident.

The insurer denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to establish on a balance of probabilities that the requested treatments and assessment were reasonable and necessary as a result of the accident.

The Tribunal noted the applicant's pre-existing psychological conditions and found insufficient evidence linking her current symptoms to the accident.

Claims for interest and an award under Regulation 664 were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits and medical benefits for psychological services.

The respondent denied the benefits, arguing that the applicant's injuries fell within the Minor Injury Guideline (MIG) and that a prior Tribunal decision had already determined this issue.

The Tribunal found that the MIG issue was res judicata, as it had been fully adjudicated in a previous hearing between the same parties.

Regarding the non-earner benefits, the Tribunal concluded that the applicant failed to prove a complete inability to carry on a normal life, preferring the respondent's medical evidence over the applicant's self-reporting and expert opinions.

The application was dismissed.

The applicant sought various medical and rehabilitation benefits following a 2012 motor vehicle accident.

The Licence Appeal Tribunal denied claims for PRP injections, a neuropsychological assessment, an in-home assessment balance, and assistive devices, finding them either not reasonable and necessary or statute-barred for failure to attend an insurer's examination.

The Tribunal partially approved a treatment plan for psychological counselling, awarding $3,118.77 plus interest, after finding the proposed costs for transportation, brokerage, and documentation to be gratuitous and inflated.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming he sustained a catastrophic impairment.

The respondent denied the catastrophic designation, alleging the applicant was malingering, and denied treatment plans for chiropractic care and assessments.

The Tribunal found the applicant sustained a catastrophic impairment, preferring the evidence of the applicant's experts over the respondent's neuropsychologist, who used outdated tests and viewed her role as a 'detective'.

The Tribunal denied the chiropractic treatment plan as it was largely outside the scope of chiropractic practice.

The cost of a neuropsychological assessment was approved as reasonable and necessary, while a triage assessment was denied.

The appellant appealed a Notice of Proposed Order by the Registrar to refuse its registration as a gaming supplier.

The Registrar based its refusal on the past conduct of the appellant's principal, which included multiple infractions of the OLG Lottery Retailer Manual, convictions under the Smoke Free Ontario Act, and a failure to disclose these infractions and past criminal charges on the application.

The Licence Appeal Tribunal found that the principal's repeated failure to comply with industry-specific rules and his lack of candour demonstrated a pattern of non-compliance.

The Tribunal concluded there were reasonable grounds to believe the appellant would not act with honesty, integrity, or in accordance with the law, and directed the Registrar to refuse the registration.