OLAT 2021

The applicant was injured in a motor vehicle accident and sought a medical benefit of $2,339.34 for chiropractic treatment under the Statutory Accident Benefits Schedule.

The respondent denied the treatment plan on the basis that it was not reasonable and necessary.

The applicant argued the treatment would mitigate chronic pain and increase the efficacy of psychological treatment for Somatic Symptom Disorder.

The Tribunal found that the applicant failed to provide objective evidence demonstrating that the proposed treatment would reasonably achieve its goals, noting that similar past treatments had not provided significant improvement.

The application was dismissed, and no interest was awarded.

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

The Tribunal found the applicant was not entitled to IRBs prior to February 20, 2019, as he had not submitted a completed application.

For the period between February 20, 2019, and January 11, 2021, the applicant failed to provide sufficient documentation regarding significant post-accident bank deposits, preventing the Tribunal from calculating the quantum of IRBs payable.

The applicant also failed to provide medical evidence to meet the stricter 104-week test for ongoing IRBs.

The application was dismissed in its entirety.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, which the respondent insurer denied.

The Licence Appeal Tribunal found that the applicant was entitled to the cost of a neurological assessment, as his treating physician diagnosed a nerve injury and the insurer's assessors lacked access to those medical records.

However, the Tribunal dismissed the claims for a chronic pain assessment, a Functional Ability Evaluation, psychological treatment, and transportation costs for an orthopaedic assessment, finding them not reasonable and necessary due to pre-existing conditions, lack of contemporaneous evidence, and unpersuasive expert reports.

The claim for a special award under Regulation 664 was also dismissed.

The applicant sought payment of $503.90, representing the denied balance of a $2,200.00 psychological assessment proposed following a motor vehicle accident.

The respondent had partially approved the treatment plan based on a paper review by its psychological expert, who opined that the proposed cost was excessive and that the assessment could be completed for $1,696.10.

The Tribunal found that the applicant failed to discharge the onus of proving the full amount claimed was reasonable and necessary, as no particulars were provided to justify the maximum fee.

The application was dismissed, along with claims for interest and an award.

The applicant requested reconsideration of a preliminary issue decision that dismissed her application under s. 55 of the Statutory Accident Benefits Schedule for failing to attend insurer's examinations.

She argued the Tribunal misinterpreted case law regarding the notice requirements under s. 44(5) and sought costs based on new evidence of late production.

The Tribunal dismissed the request, finding no error of fact or law in the original decision's application of the notice requirements, and concluding that the new evidence did not establish unreasonable conduct warranting a costs award.

The applicant requested a reconsideration of a previous decision denying an award for the respondent's delayed payment of income replacement benefits.

The applicant argued the adjudicator erred in finding the delay was an administrative error and not imprudent conduct.

The adjudicator dismissed the request, finding no significant error of fact or law that would have led to a different result, and noted the applicant was attempting to relitigate arguments that failed at the original hearing.

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).

The Tribunal found that the applicant's physical injuries were limited to soft tissue strains and that she failed to prove any psychological impairment or pre-existing condition that would remove her from the MIG.

As the $3,500 MIG funding limit had already been exhausted, the disputed treatment plans were not payable.

The appellant appealed a Notice of Proposal by the Registrar to revoke her registration as a salesperson under the Real Estate and Business Brokers Act, 2002.

Prior to the scheduled hearing, the parties reached a settlement and requested a consent order.

The Tribunal issued the consent order, suspending the appellant's registration for three months and imposing conditions including mandatory education, a prohibition on arranging mortgage financing for 12 months, and direct supervision of trades for 12 months.

The appellant appealed the 45-day impoundment of his motor vehicle under the Highway Traffic Act after it was caught being driven by an individual with a suspended licence.

The appellant argued the vehicle was stolen, that he exercised due diligence in checking the driver's licence, and that the impoundment caused exceptional hardship.

The Licence Appeal Tribunal dismissed the appeal, finding that the appellant had lent the vehicle to the driver and failed to prove it was stolen, did not take adequate steps to verify the validity of the driver's licence, and had other vehicles available, thereby failing to establish exceptional hardship.

The Registrar brought a motion to lift a stay of the Tribunal's order revoking the appellants' registrations as motor vehicle dealers and salespersons, alleging non-compliance with disclosure conditions.

Prior to the resumption of the motion, the parties agreed to terms to continue the stay.

The Tribunal issued a consent order continuing the stay subject to modified, detailed conditions regarding the disclosure of transaction documents to the Registrar.

The appellants requested a reconsideration of a Tribunal decision that found they failed to prove the parapet walls on their new home were not constructed in a workmanlike manner or constituted an unauthorized substitution under the Ontario New Home Warranties Plan Act.

The Tribunal dismissed the request, finding no error of fact or law, no evidence that false testimony affected the result, and that the proposed new evidence could have been obtained earlier and was irrelevant to the outcome.

The Registrar of Motor Vehicles suspended the appellant's driver's licence under section 47(1) of the Highway Traffic Act after receiving an unsolicited medical report from a psychiatrist indicating a mental health condition.

The appellant appealed the suspension to the Licence Appeal Tribunal.

The Tribunal found that while the appellant has a mental health condition, it is stable and she has the functional ability, attention, insight, and concentration to drive safely.

The Tribunal set aside the Registrar's decision to suspend the licence.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits and several treatment plans for physiotherapy, Botox, and chronic pain.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to provide sufficient medical evidence to prove the disputed benefits were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's assessors and the applicant's treating neurologist, which did not support the proposed treatments.

Claims for a special award and interest were also dismissed as no benefits were payable and there was no evidence of unreasonable delay.

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

The insurer determined her injuries fell within the Minor Injury Guideline (MIG) and denied several treatment and assessment plans.

The Tribunal found that the applicant's ongoing knee and back pain were likely due to pre-existing degenerative changes, and her psychological symptoms did not rise to a level that would remove her from the MIG.

As the applicant had already exhausted the $3,500 funding limit for minor injuries, she was not entitled to the disputed plans or interest.

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

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

The Tribunal found that the applicant sustained a psychological impairment as a result of the accident, entitling her to treatment outside the MIG framework.

The Tribunal partially approved a treatment plan for massage therapy and fully approved a psychological assessment, but denied the remaining claims for physical therapy and various other assessments due to lack of evidence of reasonableness and necessity.

The respondent's request for costs was also denied.

The applicant was injured in a motor vehicle accident while working as a personal support worker.

The respondent insurer argued the applicant was precluded from claiming statutory accident benefits because she opted out of WSIB benefits solely to claim accident benefits.

The Tribunal found the applicant had a bona fide intent to pursue a tort action and was not precluded under s. 61(2) of the Schedule.

However, the Tribunal concluded the applicant's impairments fell within the Minor Injury Guideline (MIG), rejecting her claims of chronic pain, mild traumatic brain injury, and psychological impairment due to a lack of objective medical evidence.

As the $3,500 MIG limit was exhausted and the insurer's denial notices were compliant with s. 38(8), the applicant was not entitled to the disputed treatment plans or assessments.

The applicant sought a section 10 award and costs, arguing the insurer unreasonably delayed removing him from the Minor Injury Guideline (MIG) and approving treatment plans following a motor vehicle accident.

The insurer had initially denied the plans based on section 44 examinations but later approved them upon receiving updated medical information.

The Tribunal found the insurer's initial reliance on its medical examinations was permissible and its subsequent approval of benefits demonstrated a continual assessment of the file, not unreasonable conduct.

The claims for an award and costs were dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought medical and rehabilitation benefits.

The respondent insurer denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) $3,500 limit.

The Licence Appeal Tribunal found that the applicant's pre-existing physical conditions, including chronic back pain and degenerative disc disease, prevented her from achieving maximal medical recovery within the MIG limits.

Consequently, the Tribunal approved four physiotherapy treatment plans as reasonable and necessary for ongoing pain relief.

However, the Tribunal dismissed claims for psychological services and a mental health assessment, finding that the applicant's psychological issues were primarily related to pre-existing workplace problems and that she had successfully returned to driving.

Interest was awarded on the overdue physiotherapy payments.

The appellant's motor vehicle was impounded for 45 days after her son was caught driving it with a suspended licence.

The appellant appealed the impoundment, arguing that she believed the licence was valid and had exercised due diligence by asking to see it months prior.

The Licence Appeal Tribunal dismissed the appeal, finding that the licence was objectively suspended and that the appellant failed to exercise due diligence, as she only took a cursory look at an expired licence where the expiry date was covered.

The appellant appealed the impoundment of her motor vehicle under the Highway Traffic Act.

As a preliminary matter, she requested a confidentiality order to omit her name from the proceedings, arguing that publication could negatively impact her position in an unrelated civil action.

The Tribunal applied the Sherman Estate test and denied the request, finding that the appellant failed to prove that openness posed a serious risk to an important public interest.

Following the denial, the appellant withdrew her appeal, and the matter was concluded.