OLAT 2020

The appellant appealed the 90-day impoundment of his motor vehicle after it was driven by a suspended driver who lived with him.

The appellant argued he exercised due diligence by hiding the keys before leaving for work.

The Tribunal found that the statutory due diligence defence only applies to determining whether a driver's licence is suspended, not to preventing access to the vehicle.

Since the appellant knew the driver was suspended, and the vehicle was not stolen, none of the statutory grounds for release under section 50.2(3) of the Highway Traffic Act were met.

The appeal was dismissed.

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

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

The applicant argued the insurer failed to provide adequate medical reasons for the denial because it did not arrange an Insurer's Examination (IE).

The Tribunal held that the insurer provided sufficient medical reasons by pointing to the lack of corroborating medical evidence in the applicant's clinical records.

Finding the applicant's psychological evidence lacked credibility, the Tribunal concluded the injuries were predominantly minor and dismissed the application.

The applicant was injured in a motor vehicle accident and sought medical benefits for chiropractic treatment.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant contended her injuries, including disc bulges and chronic pain, warranted removal from the MIG.

The Tribunal found the applicant failed to provide sufficient evidence linking her degenerative changes to the accident or establishing a chronic pain diagnosis.

Furthermore, the applicant did not meet the criteria under s. 18(2) of the Schedule to prove a pre-existing condition that would prevent maximal recovery within the MIG.

As the MIG limits were exhausted, the treatment plan and interest claims were dismissed.

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

The respondent argued that the applicant's injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 limit.

The applicant contended that pre-existing conditions and psychological impairments removed her from the MIG.

The adjudicator found that the applicant failed to provide compelling medical evidence that her pre-existing back pain would prevent maximal recovery under the MIG.

Furthermore, there was insufficient evidence of psychological impairments outside the MIG.

The application was dismissed as the injuries were predominantly minor.

The applicant sought statutory accident benefits for physical and psychological injuries allegedly sustained in a motor vehicle accident.

The respondent denied the claims, arguing that the accident was not the cause of the applicant's impairments, pointing to extensive pre-existing medical and psychological issues, including trauma from Syria and family legal troubles.

The Tribunal applied the 'but for' test and found that the applicant failed to prove the accident was a necessary cause of her impairments.

Furthermore, the Tribunal found that the requested medical benefits and catastrophic impairment assessments were not reasonable and necessary, or were duplicative and contrary to the Schedule.

The application was dismissed.

The applicant sought statutory accident benefits for various treatment plans following a rear-end motor vehicle collision.

The respondent insurer denied the plans, arguing the applicant had reached maximum medical recovery.

The Licence Appeal Tribunal partially allowed the application, finding that the applicant continued to suffer from accident-related psychological impairments, including driving anxiety, and physical pain.

The Tribunal granted full funding for chiropractic treatment and partial funding for psychological therapy and a driver's reintegration program, reducing the amounts to comply with the Superintendent's Guideline.

Claims for physiotherapy, a chronic pain assessment, and the balance of the psychological treatment plans were dismissed.

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

The respondent denied the benefits 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 chronic pain and pre-existing conditions.

The Tribunal found that the applicant failed to provide compelling medical evidence of a chronic pain diagnosis or that her pre-existing conditions would prevent maximal recovery within the MIG limits.

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

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found her injuries fell within the Minor Injury Guideline.

The applicant argued the Tribunal erred in its weighing of the medical evidence, specifically regarding the reports of Dr. Nathanson, Dr. Oshidari, and Dr. Wilderman.

The adjudicator dismissed the request, finding that the Tribunal properly exercised its discretion in weighing the evidence, including giving limited weight to diagnoses of chronic pain and severe PTSD that lacked sufficient foundation or were outside the assessors' scope of expertise.

The reconsideration was dismissed.

The applicant sought statutory accident benefits after her adult son was killed in a motorcycle accident.

The respondent denied the claim on the basis that the applicant was not an 'insured person' under the policy.

The applicant was not the named insured, a designated driver, or a spouse, and argued she was a dependant of the named insured (her son's friend).

The Tribunal found no evidence that the applicant was principally dependent for financial support or care on the named insured.

The application was dismissed as the applicant failed to prove she was an insured person under the Schedule.

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

The respondent insurer denied a treatment plan for physiotherapy and massage services, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant sustained a concussion and chronic pain, which are not minor injuries under the Schedule.

The Tribunal concluded the injuries fell outside the MIG and ordered the respondent to pay the $1,328.10 treatment plan, finding it reasonable and necessary, along with interest on overdue payments.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming a substantial inability to perform the essential tasks of his pre-accident employment as a gas station cashier.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal found that the medical evidence, including reports from the applicant's physicians and occupational therapists, did not support a finding of substantial inability to work.

The applicant's claim for IRBs, interest, and a special award was dismissed.

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

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

The applicant argued that psychological impairments, insomnia, and chronic pain removed him from the MIG.

The Tribunal found that the applicant's physical injuries were soft tissue injuries falling within the MIG definition.

The Tribunal concluded the applicant failed to provide sufficient evidence that his insomnia or chronic pain were caused by the accident.

As the injuries were predominantly minor, the disputed treatment plans and examination costs were not payable.

The application was dismissed.

The applicant requested a reconsideration of a motion decision that denied their request to change the in-person hearing venue from Toronto to Brampton.

The Associate Chair dismissed the request, 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 venue decision was interlocutory, the reconsideration request was dismissed.

The applicant sought Non-Earner Benefits (NEBs) and medical benefits following a motor vehicle accident.

The Tribunal found the applicant was not entitled to NEBs because he failed to demonstrate a complete inability to carry on a normal life, as medical evidence showed he continued to participate in substantially all pre-accident activities.

The Tribunal approved a treatment plan for relaxation CDs but denied plans for chiropractic services, finding the latter were not reasonable and necessary given the minimal and short-lasting relief reported.

The claim for an award for unreasonably withheld payments was dismissed.

The applicant, a pedestrian struck by a taxi, sought various statutory accident benefits from the Motor Vehicle Accident Claims Fund.

The Tribunal found the applicant was removed from the Minor Injury Guideline due to a psychological impairment.

Claims for two psychological treatment plans were denied because the applicant failed to sign them as required by s. 38(3)(a) of the Schedule.

The Tribunal approved the balance of a third psychological treatment plan and two chiropractic treatment plans, finding them reasonable and necessary.

A claim for the balance of a neuropsychological assessment was denied as it exceeded the $2,000 cap under s. 25(1)(5).

Claims for prescription medications were partially approved.

The respondent's request for costs was dismissed.

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

The respondent insurer denied certain medical benefits and assessments on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's injuries, including a cervical strain and a left shoulder calcific tendinosis, were predominantly minor injuries or unrelated to the accident.

The Tribunal concluded that the applicant did not suffer from chronic pain caused by the accident and that the disputed treatment plans were not reasonable and necessary.

The application was dismissed.

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

The insurer denied the claim for non-earner benefits and income replacement benefits in a clear and unequivocal explanation of benefits.

The applicant filed an application with the Licence Appeal Tribunal regarding income replacement benefits only, but later sought to change the issue to non-earner benefits after the two-year limitation period had expired.

The Tribunal found the application for non-earner benefits was statute-barred under s. 56 of the Statutory Accident Benefits Schedule.

The Tribunal declined to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act, finding no bona fide intention to appeal within the time limit, excessive delay, prejudice to the insurer, and lack of merit to the claim.

The application was dismissed.

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

The applicant claimed exceptions to the MIG based on a pre-existing condition, psychological conditions, and chronic pain, and sought $2,230.64 for a chiropractic treatment plan.

The adjudicator found that the applicant's injuries were minor and that his ongoing pain was likely aggravated by his work as a driver rather than caused by the accident.

The applicant failed to provide objective medical evidence to support any of the claimed exceptions.

The application was dismissed, including claims for the treatment plan, interest, and a special award under Regulation 664.

The applicant, who was catastrophically impaired following a motor vehicle accident, sought payment for a psychovocational assessment, winter tires, and a wellness retreat in British Columbia.

The Licence Appeal Tribunal found that the psychovocational assessment was not payable as it was incurred prior to the submission of the treatment plan and was not reasonable and necessary given the volume of existing medical opinions.

The Tribunal also held that winter tires do not constitute a vehicle modification under the Schedule and that the wellness retreat was not reasonable and necessary.

The application was dismissed.

The applicant sought death and funeral benefits from the respondent insurer after her spouse died from smoke inhalation in his motor vehicle.

The fire investigation report concluded the fire was intentionally set by the deceased using a cigarette lighter, a dishtowel, and gasoline.

The Tribunal applied the two-part test for an 'accident' under section 3 of the Statutory Accident Benefits Schedule.

The Tribunal found that the incident did not meet the purpose test, as the vehicle was used as a venue and mechanism for suicide, which is an aberrant use.

Furthermore, the incident did not meet the causation test, as the intentional setting of the fire was an independent intervening act that broke the chain of causation.

The application was dismissed.