OLAT 2021

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

The respondent insurer raised a preliminary issue that the claim was statute-barred under s. 56 of the Statutory Accident Benefits Schedule because the applicant failed to appeal the denial within the two-year limitation period.

The Tribunal found that the insurer's initial denial letter was clear and unequivocal, triggering the limitation period, which expired nearly a year before the application was filed.

The Tribunal declined to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act due to the significant delay.

The NEB claim was dismissed as statute-barred.

The applicant, who was 76 years old at the time of the motor vehicle accident, sought non-earner benefits, a psychological assessment, and an orthopaedic assessment.

The Licence Appeal Tribunal dismissed the application, finding that the applicant did not suffer a complete inability to carry on a normal life, as his post-accident activities were largely consistent with his pre-accident baseline.

The Tribunal also denied the psychological assessment due to a lack of supporting medical evidence from his family physician, and denied the orthopaedic assessment because it was reasonably available through OHIP.

The respondent insurer requested a reconsideration of a Tribunal decision that awarded the applicant medical benefits for social work counselling and physiotherapy.

The insurer argued the Tribunal erred by disregarding the applicant's Examination Under Oath testimony and by overriding a previous Tribunal decision finding the applicant had reached maximal medical recovery.

The Vice-Chair dismissed the reconsideration request, finding that while the original adjudicator did not fully explain why she discounted the applicant's testimony, her reliance on the medical evidence provided sufficient rationale.

The Vice-Chair also found no error in the adjudicator's assessment of the physiotherapy plan, noting adjudicators are not bound by previous decisions and the adjudicator properly relied on the in-person medical examinations.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming for massage therapy and an attendant care re-assessment.

The Licence Appeal Tribunal found the massage therapy treatment plan partially reasonable and necessary, as the evidence showed it provided temporary relief of pain and improved function.

However, the Tribunal denied the attendant care re-assessment, finding the applicant's reported functional limitations were contradicted by social media evidence showing her traveling and participating in physical activities.

The applicant was awarded interest on the overdue massage therapy benefits but denied an award for unreasonable delay.

The applicant sought reconsideration of a Licence Appeal Tribunal decision denying her claims for a psychological assessment and a special award.

The adjudicator granted the reconsideration in part, finding an error of law in the initial decision regarding the psychological assessment.

Because the insurer provided its denial outside the 10-day period required by s. 38(8) of the Statutory Accident Benefits Schedule, the treatment plan was automatically payable under s. 38(11) without the applicant needing to prove the services were incurred.

However, the adjudicator upheld the initial decision denying a special award, finding the applicant failed to demonstrate an error of law or fact that would have changed the result.

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

The parties resolved the substantive claims for medical and rehabilitation benefits up to the policy limits at a case conference.

The remaining issue was whether the applicant was entitled to an award under s. 10 of O. Reg. 664 for unreasonably withheld or delayed payments.

The Tribunal found that the respondent unreasonably denied an orthopaedic assessment under s. 25 of the Schedule by incorrectly characterizing it as a duplication of an insurer's examination under s. 44.

The Tribunal awarded the applicant a 5% award ($42.43) based on the remaining policy limits.

The applicant sought payment for two chiropractic treatment plans following a motor vehicle accident.

The respondent denied the benefits on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment was reasonable and necessary, noting the lack of recommendation from his family physician and his own reports that his soft tissue injuries had resolved.

The Tribunal also dismissed the applicant's claims for a section 10 award and costs, finding that the applicant's failure to provide timely medical documentation impeded the respondent's ability to adjust the claim.

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

The insurer denied several treatment plans.

The Tribunal found that the insurer failed to comply with the notice requirements under s. 38(8) of the Schedule for the chiropractic and psychological treatment plans, rendering them payable without an analysis of reasonableness and necessity.

However, the insurer later cured the defective notice for the psychological treatment plan, limiting the applicant's entitlement to the period before the cure.

The Tribunal dismissed the claims for the unapproved portions of a driving reintegration assessment and found it lacked jurisdiction over three other treatment plans because they were not submitted in accordance with s. 38(3) of the Schedule.

The claim for an award was dismissed.

The applicant sought to dispute the denial of a chiropractic treatment plan, income replacement benefits (IRBs), and attendant care benefits (ACBs) more than two years after the initial denials.

The Licence Appeal Tribunal found the applicant was statute-barred from disputing the chiropractic treatment plan under section 56 of the Schedule.

However, applying the Manuel factors, the Tribunal exercised its discretion under section 7 of the LAT Act to extend the limitation period for the IRBs.

For the ACBs, the Tribunal found the limitation clock had not started because there was no formal refusal to pay, and directed the parties to address whether section 55 of the Schedule barred the claim at a subsequent case conference.

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

The insurer denied the benefits pending receipt of further medical information.

The applicant brought a preliminary issue hearing arguing the insurer failed to comply with the 10-day response requirement under section 36 of the Statutory Accident Benefits Schedule and should therefore be ordered to pay the benefits pending the substantive hearing.

The Tribunal found the insurer responded within the required timeframe and reasonably requested further information under section 33.

The preliminary issue was dismissed.

The applicant requested a reconsideration of a preliminary issue decision which found her application for an income replacement benefit premature due to her failure to submit a Disability Certificate (OCF-3).

The applicant argued that the adjudicator made material errors of fact and law regarding the delivery of the OCF-3 to the insurer.

The Tribunal dismissed the request, finding that the applicant was merely attempting to relitigate the matter and reweigh the evidence, and failed to identify any material error that would have changed the outcome.

The appellants appealed a decision by Tarion Warranty Corporation denying their second-year warranty claims for disintegrating front precast steps and water penetration in their new home.

The Licence Appeal Tribunal admitted the evidence of Tarion's warranty services representative as a participant expert.

The Tribunal found that the damage to the steps was caused by the appellants' use of salt or de-icer, which is excluded from warranty coverage as improper maintenance.

The Tribunal also held that the water penetration claim was statute-barred because it was not raised within the two-year warranty period.

In the alternative, the Tribunal found the water penetration was caused by ice damming rather than a warrantable construction defect.

The appeal was dismissed.

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

The respondent insurer raised a preliminary issue, arguing the applicant was barred from proceeding to a hearing for an income replacement benefit because he failed to attend three insurer's examinations.

The Tribunal found that the requested examinations were duplicative and unreasonable, as the applicant had attended examinations with the exact same assessors just two months prior, and there was no rational connection between a suspected change in employment status and a new round of physical examinations.

The Tribunal held that the requests did not comply with s. 44 of the Schedule, and therefore the s. 55 procedural bar did not apply.

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

The Tribunal found that the applicant's application for IRBs was not properly delivered to the respondent's designated contact person until April 25, 2019.

The respondent failed to provide a compliant denial notice under s. 36(4) of the Schedule until February 24, 2020, entitling the applicant to IRBs for that period.

However, the applicant failed to provide sufficient financial documentation, including tax returns, to allow the Tribunal to calculate the quantum of IRBs payable.

Claims for an award and interest were dismissed.

The appellant appealed the 45-day impoundment of his motor vehicle under the Highway Traffic Act after his brother was caught driving it with a suspended licence.

The Licence Appeal Tribunal dismissed the appeal, finding the appellant failed to exercise due diligence because he did not ask to see a valid licence despite his brother's history of driving suspensions.

The Tribunal also found no exceptional hardship, as the appellant failed to prove that reasonable alternatives to the impounded vehicle were unavailable.

The appellant appealed a Notice of Proposal issued by the Registrar under the Motor Vehicle Dealers Act, 2002 to revoke her registration as a motor vehicle salesperson.

The parties reached a settlement and requested a Consent Order.

The Licence Appeal Tribunal waived the hearing requirement and ordered that the appellant be bound by the terms of the consent agreement, which included conditions on her registration for a period of two years.

The respondent brought a motion to strike the applicant's sur-reply submissions, arguing they were filed without leave and contained no relevant information.

The applicant contended that leave was not required under the Tribunal's rules and that the submissions were necessary to correct misleading statements.

The Tribunal held that leave is required to file sur-reply submissions to ensure procedural fairness, finality, and efficiency.

However, given the severe potential consequence of the preliminary issue—a complete bar to benefits under s. 55 of the Schedule—the Tribunal admitted the sur-reply submissions and granted the respondent an opportunity to file a brief reply.

The appellant appealed the 45-day impoundment of her vehicle under section 50.2 of the Highway Traffic Act on the ground of exceptional hardship.

The vehicle was impounded after being driven by a person whose licence was suspended for a Criminal Code conviction.

The Tribunal found that the appellant had alternative means of transportation during the impoundment period, including assistance from family, friends, and taxis.

As the appellant failed to meet the initial requirement of showing no alternative transportation was available, the appeal was dismissed and the impoundment was confirmed.

The Registrar of the Motor Vehicle Dealers Act, 2002 issued a Notice of Proposal to revoke the registrations of the appellants as a motor vehicle dealer and salesperson.

The parties reached a resolution and executed Minutes of Settlement.

The Licence Appeal Tribunal issued a Consent Order continuing the appellants' registrations subject to the terms and conditions set out in the Minutes of Settlement, and the appeal was withdrawn.

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

The respondent insurer determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied non-earner benefits and certain treatment plans.

The Licence Appeal Tribunal found that the applicant's physical injuries were predominantly soft tissue injuries falling within the MIG, and she failed to prove that pre-existing conditions, chronic pain, or psychological injuries warranted removal from the MIG.

The Tribunal also dismissed the claim for non-earner benefits, finding the applicant did not suffer a complete inability to carry on a normal life, as she continued to perform many pre-accident activities.

The disputed chiropractic treatment plans were deemed not reasonable and necessary, and claims for a special award and interest were dismissed.