OLAT 2020

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

The insurer partially approved a treatment plan for a home accessibility assessment, capping it at $2,000 pursuant to s. 25(5)(a) of the Schedule.

The applicant argued the cap only applied to medical assessments.

The Tribunal held that the $2,000 limit applies to any assessment, including home accessibility assessments, as the report involved an appraisal of the applicant's health status.

The Tribunal also awarded the applicant $200 under s. 10 of Regulation 664 due to the insurer's unreasonable delay in paying for occupational therapy cognitive training sessions.

The applicant requested a reconsideration of a decision finding that her motor vehicle accident injuries fell within the Minor Injury Guideline (MIG).

The applicant argued the Tribunal applied an incorrect test and failed to properly consider her pre-existing injuries and medical evidence.

The adjudicator dismissed the request, finding no error of law or fact.

The adjudicator held that the applicant failed to provide compelling evidence that her pre-existing injuries prevented maximal medical recovery within the MIG, and noted that the applicant had successfully returned to her pre-accident employment.

The applicant requested a reconsideration of a decision denying entitlement to disputed treatment plans on the basis that they were not reasonable and necessary.

The applicant argued that the adjudicator erred in law by applying an incorrect test and that the treatment plans should be deemed incurred under s. 3(8) of the Statutory Accident Benefits Schedule.

The Vice Chair dismissed the request, finding no error of law or fact in the original analysis.

The Vice Chair held that s. 3(8) did not apply because the treatment plans were not payable under the Schedule, and therefore payment was not unreasonably withheld or delayed.

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

The Tribunal found that the applicant's claim for a dental assessment was statute-barred as it was filed beyond the two-year limitation period, and the Tribunal lacked jurisdiction under s. 7 of the Licence Appeal Tribunal Act to extend it.

The Tribunal determined that the applicant's left knee and right shoulder issues were pre-existing and not caused by the accident.

However, the applicant was entitled to a treatment plan for assistive devices (excluding a knee brace) because the insurer failed to provide proper medical reasons for its denial under s. 38(8) of the Schedule.

Claims for an in-home assessment and an ENT assessment were dismissed as the applicant failed to prove they were reasonable and necessary.

The request for an award for unreasonable delay was also dismissed.

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

The respondent denied the treatment plans and an expense claim form.

The Tribunal found that one of the treatment plans was statute-barred as the applicant failed to apply within the two-year limitation period under s. 56 of the Schedule.

For the remaining plans, the Tribunal held that the applicant failed to prove the treatments were reasonable and necessary as a result of the accident, noting the lack of evidence connecting the physical therapy to his psychological complaints and the impact of an intervening slip and fall injury.

The application was dismissed.

The applicant sought income replacement benefits and interest on overdue medical benefits following a motor vehicle accident.

The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered a substantial inability to perform the essential tasks of his pre-accident employment, as the evidence regarding his job duties was contradictory and unclear.

Consequently, the claim for income replacement benefits was dismissed.

However, the Tribunal ordered the respondent to pay interest on the previously resolved claims for a chronic pain assessment and physiotherapy, payable once those expenses were incurred.

The applicant sought statutory accident benefits 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).

The applicant argued that her pre-existing conditions, chronic pain, and Graves' disease warranted removal from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence that her pre-existing conditions or alleged chronic pain prevented her from reaching maximal recovery within the MIG.

As the MIG limits were exhausted, the disputed treatment and assessment plans were deemed not reasonable and necessary, and the application was dismissed.

The applicant sought reconsideration of a decision finding he sustained a minor injury and was not entitled to non-earner benefits.

He argued the adjudicator erred in law by allowing the respondent to file insurer's examination reports and violated procedural fairness by failing to impartially assess his evidence.

The adjudicator dismissed the request, finding no error in law or breach of procedural fairness, as the applicant failed to properly identify the evidence he sought to exclude and failed to meet his burden of proof regarding his entitlement to benefits.

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

The respondent brought a preliminary motion to dismiss the application as abandoned because the applicant failed to file written submissions.

The adjudicator dismissed the motion because the respondent's supporting evidence related to a different file.

However, proceeding with the written hearing, the adjudicator dismissed the application for benefits because the applicant failed to file any evidence or submissions, thereby failing to discharge his burden of proving a complete inability to carry on a normal life.

The applicant sought an income replacement benefit (IRB) for the period of September 15, 2016 to March 1, 2017, following a motor vehicle accident.

The applicant had returned to modified duties as a delivery driver but was subsequently terminated for reasons unrelated to his injuries.

The Tribunal found that the applicant failed to provide objective medical evidence demonstrating a substantial inability to perform the essential tasks of his pre-accident employment during the disputed period.

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

The respondent insurer requested a reconsideration of a Tribunal decision that awarded the applicant 1.5 hours of psychological treatment per session.

The insurer argued the Tribunal reversed the burden of proof and failed to consider relevant evidence regarding the applicant's psychological condition.

The adjudicator granted the reconsideration, finding that while the burden of proof was not reversed, the Tribunal had erred by failing to consider evidence of the applicant's post-accident personal difficulties, including a relationship breakdown and a family member's illness.

Upon reviewing this evidence, the adjudicator concluded the applicant failed to prove the motor vehicle accident caused the need for the additional 0.5 hours of treatment, and varied the original decision.

The appellant appealed the suspension of his driver's licence by the Registrar of Motor Vehicles under section 47(1) of the Highway Traffic Act.

The suspension was based on a medical report indicating the appellant suffered a seizure due to alcohol withdrawal.

The Licence Appeal Tribunal found that while the appellant did suffer an alcohol withdrawal seizure, he had subsequently reduced his alcohol consumption to very low levels and remained seizure-free for nearly 18 months.

The Tribunal concluded the condition was not likely to significantly interfere with his ability to drive safely and set aside the suspension.

The applicant sought statutory accident benefits after being shot in the hand by her husband while sitting on a stopped ATV during a hunting trip.

The respondent insurer denied the claim on the basis that the incident did not meet the definition of an 'accident' under the Statutory Accident Benefits Schedule.

The Tribunal held a preliminary issue hearing and found that while the purpose test was met, the causation test was not.

The shooting was an intervening act that broke the chain of causation, and the use or operation of the ATV did not directly cause the applicant's impairment.

The application was dismissed.

The applicant was struck by a vehicle while riding his bicycle in 2013 but did not apply for statutory accident benefits until 2019.

The insurer denied the claim on the basis that the applicant failed to notify it of the accident and apply for benefits within the prescribed time limits.

The Tribunal found that the applicant's transient circumstances, including periods of incarceration, homelessness, severe mental illness, and addiction, provided a reasonable explanation for the delay under section 34 of the Schedule.

The applicant was permitted to proceed with his application.

The applicant brought a motion requesting the Vice-Chair recuse himself due to a reasonable apprehension of bias arising from a remark made two years prior, and a motion to reconsider a previous interlocutory decision.

The Tribunal dismissed the recusal motion, finding no reasonable apprehension of bias given the context and an unreserved apology, and noting the motion was brought after an unexplained seven-month delay following an adverse decision.

The request for reconsideration was also dismissed as the Tribunal's rules do not permit reconsideration of interlocutory orders, and there was no denial of procedural fairness.

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

The respondent insurer denied a treatment plan for a chronic pain assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant sought to be removed from the MIG based on a diagnosis of chronic pain syndrome provided by a chiropractor.

The Licence Appeal Tribunal found that a chiropractor is not qualified to diagnose chronic pain syndrome.

As the applicant provided no other medical evidence, she failed to prove she should be removed from the MIG.

The application for the chronic pain assessment and interest was dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits and funding for a chiropractic treatment plan from her insurer.

The insurer denied the benefits, and the applicant applied to the Licence Appeal Tribunal.

The adjudicator found that the applicant failed to prove she was substantially unable to perform the essential tasks of her pre-accident employment as a supermarket cashier.

The adjudicator also found that the proposed chiropractic treatment plan was not reasonable and necessary, as there was insufficient medical evidence supporting it.

The application was dismissed.

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

The respondent denied several treatment plans, leading the applicant to apply to the Licence Appeal Tribunal.

The adjudicator found that the occupational therapy, psychological, and one chiropractic treatment plan were partially or fully reasonable and necessary, subject to the applicant's $50,000 funding limit.

The optometric treatment plan and a second chiropractic treatment plan were deemed not reasonable and necessary.

The adjudicator also held that the applicant was entitled to interest on incurred expenses but declined to deem any expenses incurred due to unreasonable delay.

The applicant sought statutory accident benefits, claiming he was injured in a motor vehicle accident.

The insurer denied the claim, alleging the accident was staged and the applicant was not a passenger in the vehicle.

At a preliminary issue hearing, the adjudicator found the applicant's evidence inconsistent and unreliable, drawing a negative inference from his failure to call corroborating witnesses.

Cell phone records also proved the applicant was not at the location of the alleged accident.

The adjudicator concluded the applicant was not involved in an accident under s. 3(1) of the Schedule and had willfully misrepresented material facts.

The applicant's claim was dismissed, and he was ordered to repay $8,884.29 in accident benefits to the insurer.

The insurer requested a reconsideration of a decision granting the insured partial payment for multidisciplinary catastrophic impairment assessments.

The insurer argued the OCF-18 was invalid because it was completed by a chiropractor recommending assessments outside her scope of practice, and that the assessments were unpayable 'rebuttal' reports.

The Adjudicator dismissed the reconsideration, finding that a chiropractor may recommend assessments by other specialists and that the reports were the insured's first set of assessments, not rebuttals.

Although a procedural error occurred regarding post-hearing submissions, it was remedied on reconsideration.

The insurer's request was dismissed, and the insured's request for costs was denied.