OLAT 2020

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

The insurer denied the benefits on the basis that the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's diagnostic imaging showed pre-existing degenerative changes rather than accident-related impairments.

The applicant failed to prove that her pre-existing conditions, alleged chronic pain, or psychological impairments warranted treatment outside the MIG.

The application was dismissed.

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

The insurer raised a preliminary issue, arguing the applicant was barred from proceeding with her application because she failed to attend a requested psychiatric insurer's examination to assess her entitlement to post-104-week income replacement benefits.

The Tribunal found that the insurer's request for the examination was reasonable and necessary due to a change in circumstances, including the death of the applicant's son and the different statutory test for post-104 benefits.

Because the applicant failed to attend the examination, she was barred from proceeding with her application under section 55(1)(2) of the Schedule.

The applicant sought a Non-Earner Benefit (NEB) and various medical benefits following a motor vehicle accident.

The Tribunal found that while the applicant's life was affected by the accident, she did not suffer a 'complete inability to carry on a normal life' as she continued to engage in substantially all of her pre-accident caregiving activities, albeit with some restrictions and assistance.

The Tribunal approved two physiotherapy treatment plans and an orthopaedic assessment as reasonable and necessary, but denied a third physiotherapy plan, a psychotherapy plan, and a claim for a special award.

Interest was awarded on the approved incurred expenses.

The applicant sought statutory accident benefits following a motor vehicle accident, including costs for physiotherapy, clinical notes and records, and a Disability Certificate.

The matter proceeded to a written hearing, but the applicant failed to file any submissions or evidence.

As the applicant bore the onus of proving entitlement on a balance of probabilities, the adjudicator found that the applicant failed to meet this onus.

The application was dismissed in its entirety, with no benefits, awards, or interest payable.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied a treatment plan for catastrophic impairment assessments.

The applicant argued the Tribunal made errors of fact and law, violated procedural fairness, and improperly relied on hearsay evidence from hospital records.

The applicant also objected to the original adjudicator hearing the reconsideration.

The Tribunal dismissed the request, finding that while minor errors were made (such as misidentifying the form as an OCF-25 instead of an OCF-18 and using the word 'synchronous'), they would not have changed the outcome.

The Tribunal also held that hospital records are admissible as an exception to the hearsay rule and that having the original adjudicator hear the reconsideration does not create a reasonable apprehension of bias.

The applicant sought reconsideration of a decision denying an attendant care benefit and a physiotherapy treatment plan following a motor vehicle accident.

The applicant argued the Tribunal erroneously decided the attendant care issue after it was withdrawn, relied improperly on hearsay evidence to make adverse credibility findings, and made factual errors regarding medical causation.

The Vice-Chair granted the reconsideration in part, amending the decision to remove the order regarding the attendant care benefit, as the Tribunal lacked jurisdiction to decide the withdrawn issue.

However, the Vice-Chair upheld the remainder of the decision, finding the evidence was properly considered for the remaining issues, the applicant had waived procedural fairness concerns by consenting to a written hearing, and the Tribunal's factual findings were supported by the evidence.

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 pre-existing back pain, chronic pain, and psychological impairments removed him from the MIG.

The Tribunal found insufficient medical evidence to support the applicant's claims, noting that his family physician did not diagnose chronic pain or psychological impairment, and preferred the respondent's psychological assessment.

The Tribunal concluded the applicant sustained minor injuries subject to the MIG limit, dismissing the claims for additional medical benefits and examination expenses.

The applicant sought statutory accident benefits for a TMJ assessment and dental services following a rear-end motor vehicle accident.

The respondent denied the benefits on the basis that they were not reasonable and necessary, and raised the issue of causation.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that the accident was a necessary cause of her TMJ impairments, noting a history of pre-existing TMJ pain.

The Tribunal concluded that the requested cost of examination and medical benefits were not reasonable and necessary, and dismissed the application.

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

The insurer determined the injuries fell within the Minor Injury Guideline and denied treatment plans exceeding the monetary limit.

The insurer requested an Insurer's Examination to determine if the injuries were predominantly minor, which the applicant refused to attend.

The Tribunal found that the insurer's notice met the requirements of section 44(5) of the Schedule and that the applicant failed to provide a valid reason for non-attendance.

Consequently, the applicant was statute-barred from proceeding under section 55(1), and the application was dismissed.

The applicant was injured in a motor vehicle accident and sought a catastrophic impairment designation under s. 3.1(1)2(iii) of the Statutory Accident Benefits Schedule based on a temporary Spinal Cord Independence Measure (SCIM) score of four.

The respondent denied the claim, arguing the impairment must be permanent.

The Tribunal agreed with the respondent, finding that a plain reading and purposive analysis of the Schedule requires a permanent alteration of function, measured by a permanent SCIM score between zero and five.

As the applicant's mobility impairment was temporary, she did not meet the criteria for a catastrophic impairment.

The applicant brought a motion to compel the respondent's adjuster to answer questions refused during a cross-examination on her affidavit.

The respondent argued that the questions had already been answered during a subsequent day of the cross-examination.

The Tribunal found that the adjuster had indeed answered the disputed questions regarding communications about undertakings and refusals.

The motion to compel was dismissed.

The appellant appealed a 90-day driver's licence suspension imposed after he failed to provide a breath sample during a traffic stop.

The appellant argued he was unable to provide the sample due to medical conditions, including a pacemaker and chronic bronchitis.

The Licence Appeal Tribunal reviewed the medical evidence and the testimony of the arresting officer.

The Tribunal found that the appellant's medical records did not support his claim of a respiratory condition that would prevent him from providing a breath sample, noting his lungs were clear and he had no difficulty with daily activities.

The appeal was dismissed and the licence suspension was confirmed.

The appellant appealed the 45-day impoundment of his motor vehicle under the Highway Traffic Act.

The vehicle was impounded because the appellant was driving in Ontario without an ignition interlock device, contrary to a condition on his Ontario driving record, despite holding a valid Alberta driver's licence.

The appellant argued the impoundment was unlawful because his licence was not suspended.

The Tribunal dismissed the appeal, finding that the lack of a licence suspension is not a valid ground for appeal when the impoundment was based on a contravention of an ignition interlock condition.

The appellant appealed the Registrar of Motor Vehicles' decision to suspend his Class C driver's licence for medical reasons under section 47(1) of the Highway Traffic Act.

The suspension followed a mandatory medical report from a psychiatrist who diagnosed the appellant with schizophrenia during an involuntary hospital admission.

The Licence Appeal Tribunal found that the appellant suffers from a mental health condition and lacks insight into his illness, making him unable to understand how it may impair his functional ability to drive.

The Tribunal confirmed the Registrar's decision to suspend the licence, prioritizing public road safety.

The appellant appealed the 45-day impoundment of her vehicle, which was impounded because it was driven by a person with a suspended licence.

The appellant argued the impoundment caused exceptional hardship.

The Tribunal found that the appellant had alternative modes of transportation available, as a friend assisted with shopping and her boyfriend transported her son to school.

The appeal was dismissed and the impoundment order confirmed.

The appellant appealed the Minister of Transportation's decision to downgrade his commercial driver's licence for medical reasons after he lost consciousness while working.

The appellant claimed the collapse was caused by an allergic reaction to an insect sting, but emergency medical records indicated he had suffered a seizure.

The Licence Appeal Tribunal found substantial evidence that a seizure occurred, including witness reports of convulsions and elevated blood lactate levels.

The Tribunal upheld the Minister's decision, finding it reasonable to require the appellant to remain seizure-free for one year before considering reinstatement of his commercial licence.

The applicant sought payment for a psychological assessment and a chronic pain assessment following a motor vehicle accident.

The Tribunal denied the psychological assessment because the applicant incurred the cost before the treatment plan was properly submitted to the respondent, violating s. 38(2) of the Schedule.

However, the Tribunal granted the chronic pain assessment, finding it reasonable and necessary given the applicant's exacerbation of pre-existing pain and functional limitations.

The claim for an award under s. 10 of O. Reg. 664 was dismissed as the insurer's denials were not unreasonable.

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

The respondent insurer denied the benefits and the applicant filed an application with the Licence Appeal Tribunal.

The respondent raised a preliminary issue that the application was statute-barred because it was commenced more than two years after the clear and unequivocal denial.

The Tribunal found the application was filed after the two-year limitation period expired and declined to extend the time under section 7 of the Licence Appeal Tribunal Act, noting the applicant provided no evidence of a bona fide intention to appeal or the merits of the claim.

The application was dismissed.

The applicant sought medical benefits for chiropractic, physiotherapy, and occupational therapy services following a motor vehicle accident.

The respondent denied the benefits, initially arguing the injuries fell within the Minor Injury Guideline (MIG), though it later removed the applicant from the MIG.

The Tribunal found that the applicant failed to establish on a balance of probabilities that the disputed treatment plans were reasonable and necessary.

The evidence showed the applicant had returned to work and regular activities shortly after the accident, and there was insufficient current medical evidence to support the need for the proposed passive therapies and assessments months or years post-accident.

The application was dismissed.

The appellant appealed Tarion's decision to disallow her claim for a deposit refund out of the guarantee fund under s. 14(1) of the Ontario New Home Warranties Plan Act.

The appellant had previously litigated the return of her deposit against the vendor in the Superior Court of Justice and the Court of Appeal, both of which found that she, not the vendor, had breached the agreement of purchase and sale.

The Tribunal held that it was bound by the courts' findings and that the appellant could not relitigate the issue.

The appeal was dismissed.