OLAT 2021

The appellant brought a motion for an extension of time to appeal the impoundment of her motor vehicle, which was driven by her son-in-law whose licence was suspended.

The appeal was filed two days late.

The Tribunal found that the appellant did not receive adequate notice of her right to appeal or the process for doing so, despite making ongoing efforts to retrieve her vehicle.

Applying the factors from Manuel, the Tribunal concluded that the appellant had a bona fide intention to appeal, the delay was minimal, and there was no prejudice to the Registrar.

The extension of time was granted.

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

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

The Tribunal found that the applicant sustained only minor soft tissue injuries and failed to prove chronic pain or a psychological impairment warranting removal from the MIG.

As the MIG limits were exhausted, the disputed treatment plan was not reasonable and necessary, and no benefits or interest were payable.

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

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

The applicant argued that pre-existing conditions and psychological impairments warranted removal from the MIG.

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

However, as the MIG limit had not been exhausted, the Tribunal approved the physiotherapy treatment plan up to the remaining limit.

Claims for a psychological assessment, an award, and costs were dismissed.

The applicant sought ongoing Income Replacement Benefits (IRBs) and a psychological assessment following a motor vehicle accident.

The insurer terminated IRBs after 104 weeks, arguing the applicant no longer met the test for entitlement.

The Tribunal found that while the applicant suffered from accident-related physical and psychological impairments, he failed to prove a substantial or complete inability to work as a real estate agent.

The applicant's credibility was significantly undermined by a forensic accounting report revealing he misrepresented his pre- and post-accident income to all assessors, and that he actually earned more in the year following the accident.

Consequently, the claim for ongoing IRBs was dismissed.

However, the Tribunal granted the $2,000 psychological assessment, finding it reasonable and necessary to address the applicant's ongoing psychological impairment.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit, removal from the Minor Injury Guideline (MIG), and approval of various treatment plans.

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, relying on insurer examinations and surveillance evidence that contradicted her testimony.

Furthermore, the Tribunal concluded that the applicant sustained predominantly minor injuries and failed to provide compelling evidence of a pre-existing condition, psychological impairment, or chronic pain that would warrant removal from the MIG.

Consequently, the disputed treatment plans and claims for an award and interest were also denied.

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

The respondent denied several treatment plans for physiotherapy, physical rehabilitation, assistive devices, and a psychological assessment.

The Tribunal found that the applicant was entitled to the initial physiotherapy treatment plan to address ongoing pain symptoms, supported by her treating physician's records.

However, the Tribunal dismissed the claims for subsequent physical rehabilitation, assistive devices, and a psychological assessment, finding that the applicant had reached maximum medical improvement and her psychological conditions were in remission.

The applicant was awarded interest on the approved treatment plan.

The applicant sought an income replacement benefit (IRB) and funding for psychological treatment following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove a substantial inability to perform the essential tasks of his employment, as he provided no job description or details of his essential tasks.

The Tribunal also denied the psychological treatment plans, concluding they were not reasonable and necessary because they duplicated OHIP-funded psychiatric services the applicant was already receiving.

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

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

The applicant applied to the Licence Appeal Tribunal, claiming her injuries warranted removal from the MIG due to chronic pain and psychological impairments.

The Tribunal found the applicant failed to provide sufficient medical evidence to support removal from the MIG, noting her physical injuries were soft-tissue in nature and her psychological symptoms resolved shortly after the accident.

The application was dismissed, and claims for interest and a section 10 award were denied.

The applicant sought statutory accident benefits for chiropractic treatment and a chronic pain assessment following a 2017 motor vehicle accident.

The insurer denied the treatment plans on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant failed to meet her burden of proving the treatments were reasonable and necessary, noting a lack of objective musculoskeletal impairment and evidence that the applicant had returned to normal activities.

The application was dismissed.

The applicant requested a reconsideration of a decision finding his application for Non-Earner Benefits statute-barred due to an expired limitation period.

The applicant argued the Tribunal erred in its findings regarding the respondent's duty to re-adjust the file when he reached the age of majority, its reliance on early medical records, and its conclusion that three valid denials triggered the limitation period.

The Tribunal dismissed the request, finding no errors of law or fact that would have led to a different result, noting the preliminary hearing focused solely on the limitation period and formal documentation rather than the substantive merits of the claim.

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

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

The applicant argued for removal from the MIG based on chronic pain.

The Tribunal found the applicant failed to prove their injuries warranted removal from the MIG, noting the lack of a chronic pain diagnosis, no prescription medication, and a return to full-time pre-accident employment.

The application for an orthopaedic assessment, interest, and an award under O. Reg. 664 was dismissed.

The applicants sought reconsideration of a decision finding they were not entitled to accident benefits.

They witnessed a close relative being struck by a vehicle and claimed nervous shock, arguing they were 'involved in an accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The adjudicator dismissed the request, affirming that nervous shock claims are limited to the named insured and their family members under definition (a)(ii) of 'insured person', and the applicants did not fall into these categories.

The applicant sought statutory accident benefits for chiropractic treatment and various medical expenses following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the chiropractic treatment plan was not reasonable and necessary as the medical evidence did not support the claimed functional limitations.

Furthermore, the Tribunal denied the OCF-6 expenses because the applicant, an international student, failed to first submit the claims to her available collateral benefits provider (UHIP) as required by section 47(2) of the Schedule.

The applicant sought $2,818.14 for psychotherapy services following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plan was reasonable and necessary, noting that the applicant had already received 51 sessions and the supporting psychological report lacked specifics on the necessity, frequency, and duration of further treatment.

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

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

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

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

The applicant argued for removal from the MIG due to a pre-existing condition, chronic pain, and the fact that the respondent had already paid benefits in excess of the MIG limit following a priority dispute with another insurer.

The Tribunal found that the applicant failed to provide compelling evidence of a pre-existing condition or chronic pain affecting functionality.

The Tribunal also held that payments made in excess of the MIG limit to another insurer did not automatically entitle the applicant to treatment beyond the MIG.

As the MIG limits were exhausted, the claims for treatment plans, an award, and interest were dismissed.

The respondent's claim for repayment of benefits under s. 52 was also dismissed because the repayment was made to the other insurer, not the applicant.

The applicant requested a reconsideration of a Tribunal decision that found her injuries fell within the Minor Injury Guidelines (MIG) and denied her claims for a treatment plan and psychological examination.

The applicant argued the Tribunal erred in fact and law and sought to introduce a new psychological assessment.

The Vice Chair dismissed the request, finding no errors in the original decision's weighing of evidence or factual findings.

The Vice Chair also rejected the new evidence, noting it could have been obtained prior to the original hearing.

The respondent insurer sought reconsideration of a preliminary issue decision which found that the applicant was not statute-barred from proceeding with her claim for income replacement benefits.

The adjudicator dismissed the request for reconsideration.

Under Rule 18.1 of the Common Rules of Practice and Procedure, the Tribunal will only reconsider a decision that finally disposes of an appeal.

Because the applicant was successful on the preliminary issue, her appeal was not finally disposed of, rendering the decision interlocutory and ineligible for reconsideration.

The applicant was involved in a severe motor vehicle accident resulting in catastrophic impairment, including a brain injury.

He sought attendant care benefits and housekeeping and home maintenance benefits, which the respondent insurer denied.

The Licence Appeal Tribunal found that while the applicant was physically capable of performing tasks, his brain injury caused significant emotional and motivational limitations.

The Tribunal concluded that the applicant was entitled to attendant care benefits for comfort, safety, and security, calculated at 240 minutes per week, as well as housekeeping and home maintenance benefits of $100 per week, plus interest on overdue amounts.

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

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

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

The Tribunal found that the applicant failed to meet his burden of proving that his injuries warranted treatment beyond the MIG or that the proposed treatment plans were reasonable and necessary.

The application was dismissed.

The respondent's request for costs was also denied, as the applicant's failure to participate did not rise to the level of unreasonable, frivolous, vexatious, or bad faith conduct.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including Income Replacement Benefits (IRBs) and chiropractic treatment, which the respondent insurer denied.

The Licence Appeal Tribunal found that the applicant suffered a concussion and was substantially unable to perform the essential tasks of his employment, entitling him to IRBs for the first 104 weeks post-accident.

However, the applicant failed to prove a complete inability to engage in any suitable employment, precluding IRB entitlement beyond 104 weeks.

The Tribunal also held that the chiropractic treatment plan was not reasonable and necessary.

Notably, the Tribunal determined that the Canada Emergency Response Benefit (CERB) received by the applicant is tantamount to "other remuneration from employment" under the Schedule and is therefore deductible from the IRB entitlement.

The claim for an award was dismissed as the insurer's denial was not unreasonable.