OLAT 2020

The appellant appealed the Registrar of Motor Vehicles' decision to suspend his commercial driver's licence for medical reasons following a seizure and intercranial hemorrhage.

The appellant argued that he had no history of seizures and that a five-year seizure-free requirement was excessive.

The Tribunal found that the appellant's medical condition, including the risk of future seizures and the high dose of antiseizure medication, was likely to significantly interfere with his ability to drive a commercial motor vehicle safely.

The Registrar's decision to downgrade the licence was confirmed.

The appellant appealed the 45-day impoundment of her motor vehicle under the Highway Traffic Act, arguing that the impoundment resulted in exceptional hardship.

The vehicle was impounded after the appellant's fiancé was caught driving it while his license was suspended.

The Licence Appeal Tribunal dismissed the appeal, finding that the appellant had alternatives to the impounded vehicle, such as relying on relatives and friends for transportation, and that the inconvenience and financial impact did not meet the threshold for exceptional hardship.

The appellant appealed the 45-day impoundment of his motor vehicle on the ground of exceptional hardship after it was driven by his son whose licence was suspended.

The appellant failed to dial into the teleconference hearing.

The respondent's agent presented evidence of the impoundment and the driver's suspended licence.

The Tribunal dismissed the appeal and confirmed the impoundment, as the appellant adduced no evidence to establish exceptional hardship.

The appellant corporation appealed the 45-day impoundment of its service vehicle, which was driven by an employee whose driver's licence was suspended.

The appellant argued the vehicle was stolen because the employee took it without authorization, and alternatively, that it exercised due diligence by collecting the employee's licence information upon hiring.

The Licence Appeal Tribunal dismissed the appeal, finding the vehicle was not stolen as the employee used it for company business without intent to deprive the owner.

Furthermore, the appellant failed to establish due diligence because it did not verify the validity of the employee's licence.

The applicant requested a reconsideration of a decision finding her statute-barred from disputing entitlement to non-earner benefits due to failing to apply within the two-year limitation period.

The applicant argued the adjudicator erred in fact and law by not finding a bona fide intention to appeal and by failing to consider the respondent's delay in providing her accident benefit file.

The adjudicator dismissed the request, finding no error of law or fact, as the applicant failed to demonstrate a bona fide intention to appeal within the limitation period and the respondent's delay did not relieve the applicant of her obligation to file on time.

The applicant sought reconsideration of a Licence Appeal Tribunal decision that denied her claim for a TMJ assessment and interest.

She argued the Tribunal erred in law by misapplying the doctrine of res judicata and violated procedural fairness by failing to consider a new dental assessment report.

The adjudicator dismissed the request, finding that res judicata was correctly applied because a previous decision had already determined the TMJ impairment was pre-existing and not caused by the accident.

Furthermore, the new dental report was considered but did not alter the conclusion regarding causation.

The applicant requested a reconsideration of a decision denying funding for a catastrophic impairment (CAT) assessment.

The applicant argued the adjudicator erred in law by requiring proof that the assessment was reasonable and necessary, rather than just that the fees were reasonable, and by analyzing the medical evidence to determine necessity.

The adjudicator dismissed the request, finding no error in law.

Sections 25(1)(5) and 38(8) of the Statutory Accident Benefits Schedule, read together, place the burden on the applicant to prove the assessment itself is reasonable and necessary.

The adjudicator also found no error in weighing the medical evidence to conclude the assessment was not necessary.

The respondent's request for costs was dismissed as the applicant's conduct was not unreasonable, frivolous, vexatious, or in bad faith.

The applicant requested a reconsideration of a preliminary issue decision that found his claims for attendant care and housekeeping benefits were statute-barred.

The Tribunal originally held that the two-year limitation period began when the insurer pre-emptively denied the benefits in 2005, long before the applicant was determined to be catastrophically impaired in 2015.

Applying the recent Court of Appeal decision in Tomec, the adjudicator found that the doctrine of discoverability applies.

The applicant did not discover his eligibility for the benefits until he was deemed catastrophically impaired.

Therefore, the limitation period did not begin in 2005, and the applicant's claim is not statute-barred.

The reconsideration was granted.

The respondent insurer requested a reconsideration of a Tribunal decision that found the applicant's injuries fell outside the Minor Injury Guideline (MIG) and awarded various medical benefits and assessments.

The insurer argued the Tribunal failed to provide adequate reasons, ignored its independent medical examiners, and erred in law by relying on a chiropractor for a chronic pain diagnosis.

The adjudicator denied the request, finding the Tribunal provided adequate reasons, properly weighed the competing medical evidence, and did not require a formal chronic pain diagnosis to determine the injuries were not predominantly minor.

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

The insurer determined the injuries fell within the Minor Injury Guideline (MIG) and denied treatment plans for physiotherapy and a psychological assessment.

The Tribunal found the applicant failed to provide compelling evidence of psychological injuries, chronic pain, or pre-existing conditions that would warrant removal from the MIG.

The Tribunal concluded the applicant sustained predominantly minor injuries, is subject to the $3,500 funding limit, and is not entitled to the disputed treatment plans, interest, or an award.

The applicant sought statutory accident benefits for chiropractic and massage therapy following a motor vehicle accident.

The Tribunal found that the insurer failed to provide adequate medical reasons for denying two treatment plans, violating section 38(8) of the Schedule, and ordered them payable.

The Tribunal also found that the applicant suffered from chronic pain and that the remaining chiropractic treatment plans were reasonable and necessary, except for treatment incurred prior to the submission of the plans.

The claim for massage therapy was denied as no treatment plan had been submitted.

The applicant sought entitlement to an income replacement benefit and several treatment and assessment plans following a motor vehicle accident.

The respondent denied the income replacement benefit, arguing that the applicant's inability to work was due to congestive heart failure, a stroke, and cardiac arrhythmia that were not caused by the accident.

The adjudicator applied the 'but for' test and found that the applicant failed to establish a causal link between the accident and his subsequent cardiac and neurological conditions.

Consequently, the claim for an income replacement benefit was dismissed.

However, the adjudicator found that the applicant was entitled to medical benefits for chiropractic and psychological services, as well as the cost of an attendant care assessment, because these were reasonable and necessary to treat accident-related impairments.

A treatment plan for other goods and services was denied.

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

The respondent partially approved a psychological assessment plan, reducing the requested fee of $2,267.80 to $1,389.87 based on an insurer's examination.

The Tribunal found that the respondent's assessor failed to provide a rationale for the reduced fee breakdown and that the applicant's assessor was not required to provide an hourly breakdown under the Schedule.

The Tribunal ordered the respondent to pay the outstanding balance of $877.93 plus interest.

The applicant sought accident benefits following a motor vehicle collision.

The respondent denied a chiropractic treatment plan and a chronic pain assessment 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 applicant argued that pre-existing low back pain, psychological impairments, and chronic pain removed him from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence of a pre-existing condition that would prevent maximal recovery within the MIG limits.

Furthermore, the Tribunal gave little weight to the orthopaedic surgeon's recording of self-reported psychological symptoms and found insufficient evidence to establish chronic pain.

As the injuries were predominantly minor and the funding limit was exhausted, the application was dismissed.

The appellant's vehicle was impounded for 45 days after being driven by a driver violating an ignition interlock condition.

The appellant filed a notice of appeal 8 days after the 15-day deadline and brought a motion to extend the time to appeal.

Despite receiving notice, the appellant failed to attend the teleconference motion hearing and provided no evidence.

The Tribunal denied the motion, finding the appellant failed to meet the onus of establishing that the justice of the case required an extension.

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

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

The Tribunal found that the applicant suffered from meralgia paresthetica and chronic pain as a result of the accident, which removed him from the MIG.

However, the Tribunal concluded that the applicant did not suffer a psychological impairment.

Because the applicant failed to submit the disputed treatment plans (OCF-18s) into evidence, the Tribunal could not determine whether the claimed medical benefits and examination costs were reasonable and necessary, and allowed the applicant 30 days to submit them.

The applicant was struck by a vehicle as a pedestrian and sought statutory accident benefits for physical and psychological injuries.

The insurer limited her medical and rehabilitation benefits to $3,500, arguing her injuries fell within the Minor Injury Guideline.

The applicant claimed she suffered from chronic pain, a nerve impingement, and a psychological condition (PTSD) that removed her from the minor injury limit.

The Tribunal found that her physical soft tissue injuries had resolved and rejected her psychological expert's report because the expert had never actually met her.

The Tribunal concluded the applicant sustained predominantly minor injuries and dismissed her claims for further medical benefits and assessments.

The applicant sought statutory accident benefits for chiropractic treatment and a psychological assessment following a 2010 motor vehicle accident.

The insurer denied the claims on the basis that the treatment and assessments were not reasonable and necessary.

The Tribunal found that the applicant failed to establish causation on a balance of probabilities, noting that contemporaneous medical records did not link her knee, back, and chest pain to the accident, but rather to subsequent intervening incidents including a fall at home, a boating incident, and a trip and fall.

The application was dismissed.

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

The respondent denied a treatment plan and scheduled an insurer examination under section 44 of the Schedule.

The applicant failed to attend the examination, and the respondent argued she was barred from proceeding with her application under section 55.

The Tribunal found that the applicant provided a reasonable explanation for her non-attendance, as she did not receive notice of the examination and had been advised by her former counsel that they would handle all appointments.

The Tribunal exercised its discretion to allow the applicant to proceed with her application, subject to the condition that she attend a rescheduled insurer examination.

The respondent's request for costs was dismissed.

The insurer brought an application to the Licence Appeal Tribunal seeking a determination that the insured was not catastrophically impaired and was not entitled to income replacement benefits, as well as seeking repayment of overpaid benefits.

The insured raised a preliminary issue arguing the Tribunal lacked jurisdiction because the insured had not disputed the insurer's determinations.

The Tribunal held that an insurer cannot bring an application to determine entitlement to benefits or catastrophic impairment where the insured has not disputed the insurer's denial, as no 'dispute' exists under s. 280 of the Insurance Act.

However, the Tribunal allowed the insurer's application for repayment of overpaid income replacement benefits to proceed.