OLAT 2021

The applicant sought statutory accident benefits, including an income replacement benefit (IRB) and medical benefits for physiotherapy and psychotherapy, after allegedly being struck by a reversing vehicle.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove she was employed at the time of the accident or that she suffered a substantial inability to perform the essential tasks of her employment.

The Tribunal also denied the treatment plans, preferring the respondent's section 44 assessments which found no objective musculoskeletal or psychological impairments, and noting a lack of contemporaneous complaints in the applicant's medical records.

The respondent insurer requested a reconsideration of the Tribunal's decision to close the file after the applicant withdrew her application for statutory accident benefits.

The respondent argued the Tribunal breached procedural fairness by failing to adjudicate its prior motion, which sought to bar the applicant for failing to attend insurer's examinations.

The Tribunal dismissed the reconsideration request, finding that the withdrawal rendered the respondent's motion moot.

Unlike previous cases where a failure to address a costs request constituted a breach of procedural fairness, the respondent had not sought costs in its original motion.

The Tribunal also denied the respondent's new request for costs, noting it was improperly raised in reply submissions and did not meet the high threshold for unreasonable conduct.

The applicant was injured in a motor vehicle accident and sought medical benefits beyond the $3,500 Minor Injury Guideline (MIG) limit.

The respondent denied the treatment plans, arguing the injuries were minor.

The Tribunal found insufficient evidence of psychological injuries or chronic pain that would warrant removal from the MIG.

The application was dismissed, and the applicant was found not entitled to the disputed treatment plans or interest.

The applicant sought a special award and interest under the Statutory Accident Benefits Schedule, alleging the respondent insurer unreasonably delayed and withheld payment of non-earner and medical benefits.

The Licence Appeal Tribunal found that while the insurer made adjusting errors, including a 44-day delay in initial payment and a 7-month delay in providing section 44 assessment reports, these errors did not amount to unreasonable withholding or delay of benefits.

The application was dismissed, and no award or additional interest was ordered.

The applicant sought accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed entitlement to income replacement benefits (IRBs), various medical and rehabilitation benefits, and examination costs.

The Licence Appeal Tribunal found that the applicant failed to prove her injuries, including alleged chronic pain and psychological impairments, warranted removal from the MIG.

As the MIG limits were exhausted, the disputed medical benefits were not payable.

The claim for IRBs was dismissed because the applicant failed to submit the required application form in a timely manner.

The application was dismissed in its entirety.

The applicant, who sustained catastrophic impairments in a motor vehicle accident, sought payment for various medical and rehabilitation benefits, including a 3D mattress system, a portable modulation stimulator, naturopathic treatments, and an infrared sauna.

The respondent denied the claims primarily on the basis that the expenses were incurred prior to the submission of treatment plans (OCF-18s) or were experimental and not reasonable and necessary.

The Tribunal found that section 38 of the Schedule barred recovery for most of the expenses incurred prior to submission.

The Tribunal also accepted the respondent's expert evidence that certain treatments were experimental.

The application was allowed in part for an eye exam and specific wellness products, but the majority of the claims and the request for costs were dismissed.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, which the respondent insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant argued her physical injuries, chronic pain, and psychological impairments warranted removal from the MIG.

The Tribunal found the applicant's physical injuries were soft-tissue in nature and she failed to provide a medical diagnosis of chronic pain.

The Tribunal preferred the respondent's psychological assessment over the applicant's, finding no clinically significant accident-related psychological impairment.

The application was dismissed, and the disputed treatment plans were found not reasonable and necessary.

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

The insurer determined the injuries fell within the Minor Injury Guideline (MIG) and denied several treatment plans for psychological and chiropractic care.

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor soft-tissue injuries and that there was insufficient evidence of chronic pain or psychological impairment to warrant removal from the MIG.

As the disputed treatment plans proposed treatment outside the MIG limits, they were denied.

The claim for interest was also dismissed.

The applicant sought statutory accident benefits following a 2015 motor vehicle accident, including attendant care benefits and funding for three medical assessments.

The Tribunal dismissed the claim for attendant care benefits because the applicant was not catastrophically impaired and the 104-week post-accident period had expired.

The claims for an orthopedic and home site assessment were dismissed due to a lack of supporting medical evidence.

The respondent conceded the neuropsychological assessment was reasonable and necessary, which the Tribunal ordered, but no interest was awarded as the expense had not been incurred.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and chiropractic treatment plans.

The respondent insurer denied the treatment plans.

The Licence Appeal Tribunal found that the applicant failed to provide compelling contemporaneous medical evidence to support the ongoing treatment.

The applicant's medical records and the insurer's examination report indicated she had reached maximal medical recovery for her physical injuries and had successfully reintegrated into her community.

The application was dismissed, and no interest was payable.

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

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

The Tribunal found that the applicant failed to provide evidence demonstrating his injuries warranted removal from the MIG.

However, the Tribunal determined that the insurer's initial denial notice was defective under section 38(8) of the Schedule for failing to provide medical reasons.

A subsequent denial notice was found to be compliant.

As a result, the insurer was ordered to pay for any treatment incurred between the 11th business day after receiving the plan and the date of the compliant denial.

The claim for a section 10 award was dismissed.

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

The respondent denied the benefits and raised a preliminary issue that the applicant was barred from proceeding with her appeal because she failed to attend an insurer examination (IE) under section 44 of the Schedule.

The Tribunal found that the respondent's notice requiring the IE was deficient because it failed to provide sufficient medical and other reasons for the denial and the need for the IE, as required by sections 38(8) and 44(5).

Consequently, the applicant was not barred from proceeding with her appeal.

The applicant sought payment for the costs of an accounting report obtained to calculate her income replacement benefit following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the accounting report was not reasonable and necessary because the calculation of the applicant's income was straightforward and did not require professional expertise.

The Tribunal also dismissed the applicant's request for a costs award, as there was no evidence of unreasonable, frivolous, vexatious, or bad faith conduct by the respondent.

The applicant requested a reconsideration of a decision that denied his claim for income replacement benefits (IRB) and an award.

The applicant argued that the adjudicator made errors of law and fact, violated procedural fairness, and acted outside their jurisdiction.

The Vice Chair dismissed the request, finding no errors in the original decision's assessment of the evidence, including the applicant's return to work and medical reports.

The Vice Chair also declined to award costs to the respondent, as the applicant's conduct did not meet the threshold for a costs award.

The applicant sought reconsideration of a preliminary issue decision that barred him from proceeding with his application for statutory accident benefits due to his failure to attend a section 44 insurer's examination.

The applicant argued the adjudicator erred by permanently precluding him from disputing whether his injuries fell within the Minor Injury Guideline (MIG) and that the Tribunal erred in refusing to clarify the decision.

The adjudicator dismissed the reconsideration request, finding that the original decision properly applied section 55(2) of the Schedule and that the issue of future applications or MIG status was not before the original adjudicator.

The request to reconsider the refusal to clarify was also dismissed as there was no ambiguity in the original decision.

Both parties' requests for costs were denied.

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

The respondent insurer denied the benefits and sought repayment of previously paid IRB, arguing the applicant was excluded under s. 31(1)(a)(i) of the Schedule because he knew or ought reasonably to have known he was operating the vehicle without valid insurance.

The Tribunal found the applicant's testimony that he believed he had purchased valid insurance from a 'broker' to be not credible, given his prior experience with insurance and the suspicious circumstances of the transaction.

The Tribunal dismissed the applicant's claims for IRB, interest, and a special award, and ordered the applicant to repay $19,177.60 in IRB to the respondent.

The applicant sought reconsideration of a decision denying him income replacement benefits.

The applicant had signed a contract for future employment prior to the accident but had not yet started working.

The adjudicator found no error of law in the original decision, which held that the definition of 'employed at the time of the accident' under the current Statutory Accident Benefits Schedule does not include individuals with contracts for future employment.

The request for reconsideration was dismissed.

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

The respondent raised a preliminary issue that the applicant was statute-barred from proceeding with her claim because she failed to submit a Disability Certificate (OCF-3) within 104 weeks of the accident.

The Tribunal found that the applicant did not submit the OCF-3 until well after the 104-week period expired.

Applying sections 12(3)(c), 36(2), and 36(3) of the Statutory Accident Benefits Schedule, the Tribunal held that the language is compulsory and provides no exceptions.

The applicant's claim for non-earner benefits was dismissed as statute-barred.

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

The suspension followed an unsolicited Medical Condition Report from an emergency room physician indicating the appellant suffered an alcohol withdrawal seizure.

The Licence Appeal Tribunal found that the appellant suffered from an unaddressed substance use disorder that was likely to significantly interfere with his ability to safely operate a motor vehicle.

The appeal was dismissed and the licence suspension was confirmed.

The appellant brought a motion seeking particulars, further disclosure, and costs.

Prior to the motion hearing, the respondent provided the requested disclosure, leaving only the issue of costs to be decided.

The appellant sought costs of $2,000 under Rule 19 of the Tribunal's Rules of Practice, arguing the respondent's delay in providing disclosure was unreasonable.

The Tribunal dismissed the request for costs, finding that the delay was reasonably explained by pandemic-related remote work challenges, did not prejudice the appellant's ability to have a fair hearing, and did not amount to vexatious or bad faith conduct.