OLAT 2021

The self-represented applicant sought $6.0 million in chiropractic services arising from a 2007 motor vehicle accident.

The respondent insurer brought a preliminary issue motion to dismiss the application.

The Tribunal found it lacked jurisdiction to hear the application because the applicant had not submitted a Treatment and Assessment Plan (OCF-18) as required by section 38 of the Schedule.

Without a submitted plan and a subsequent denial by the insurer, there was no 'dispute' within the meaning of section 280 of the Insurance Act.

The application was dismissed.

The respondent sought costs following the dismissal of the applicant's motion to recuse the adjudicator.

The Tribunal found that the applicant acted unreasonably and in bad faith by bringing a motion for relief previously denied with no new grounds, and by making a collateral attack on another Tribunal order.

The applicant was ordered to pay $1,000 in costs to the respondent.

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

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

The adjudicator found that the applicant's injuries, primarily soft tissue sprains and strains, were predominantly minor and that there was insufficient evidence of chronic pain or functional impairment to warrant treatment beyond the MIG limit.

As the MIG limit was exhausted, the treatment plan was not payable, and claims for interest and a special award were dismissed.

The appellant requested a reconsideration of a Tribunal decision confirming the 90-day suspension of his driver's licence for failing to provide a breath sample.

The appellant argued the Tribunal erred in fact by not accepting medical evidence of a sinus fracture as the reason for his failure to provide a sample.

The Tribunal dismissed the request, finding no error in the original conclusion that the medical documents were insufficient to prove his condition prevented him from providing a breath sample.

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

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

The Licence Appeal Tribunal found that the applicant sustained predominantly minor soft tissue injuries and failed to establish that he suffered from chronic pain or a psychological impairment that would remove him from the MIG.

As the $3,500 MIG funding limit had been exhausted, the claims for additional medical benefits were dismissed, along with claims for interest and an award for unreasonable withholding of benefits.

The applicant was involved in a single-vehicle collision after suffering a cardiac arrest and sought an occupational therapy assessment under the Statutory Accident Benefits Schedule.

The respondent insurer denied the benefit, arguing the applicant's brain injury was caused by the cardiac arrest, not accident-related trauma.

The Tribunal found the applicant failed to prove that his impairments would not have occurred but for the accident, noting extensive medical evidence attributing his anoxic brain injury to coronary artery disease.

The application for benefits was dismissed.

The applicant sought reconsideration of a decision denying their motion for the costs of an accounting report obtained to calculate an award.

The applicant argued the Tribunal erred in finding it lacked jurisdiction to order the payment of disbursements under Rule 19 of the Common Rules of Practice and Procedure.

The Vice Chair dismissed the reconsideration request, confirming that following the repeal of section 282(11) of the Insurance Act, the Tribunal has no statutory authority to award disbursements as part of a costs order.

The Vice Chair also found no error in failing to clarify the original decision and concluded the original decision was not based on false evidence.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit and the cost of a psychological assessment.

The Licence Appeal Tribunal found that the applicant failed to demonstrate a substantial inability to perform the essential tasks of her employment, noting she returned to full-time work for several months before being laid off due to a plant relocation.

The Tribunal also found the psychological assessment was not reasonable and necessary, as her symptoms were effectively managed by her family physician and the assessment report lacked a review of her medical records.

The application was dismissed.

The applicant requested a reconsideration of a Tribunal decision which found her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued the adjudicator erred in law by requiring a diagnosis of chronic pain to remove her from the MIG, and erred in fact by failing to consider evidence of functional impairment.

The Tribunal dismissed the request, finding the adjudicator correctly applied the law regarding chronic pain and functional impairment, and adequately considered the evidence.

The applicant sought reconsideration of a decision finding her statute-barred from disputing the denial of an income replacement benefit.

The Vice Chair held that section 7 of the Licence Appeal Tribunal Act applies to extend limitation periods under the Statutory Accident Benefits Schedule.

Applying the four-factor test for extending time, the Vice Chair found that the 13-day delay, caused by a paralegal's failure to follow instructions, did not prejudice the respondent.

The extension was granted, allowing the applicant to proceed with her dispute.

The respondent insurer requested a reconsideration of a Tribunal decision which found that assessments to determine catastrophic impairment are excluded from the $50,000 limit for medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The respondent argued the Tribunal erred in law in its interpretation of section 18(5) and by concluding that catastrophic impairment assessments are not benefits.

The Tribunal dismissed the request, finding no error of law in its holistic interpretation of the legislation or its conclusion that such assessments are not a benefit or payment to an insured person.

The appellant appealed the Registrar of Motor Vehicles' decision to suspend their class G driver's licence due to an alleged alcohol use disorder.

The suspension was based on an unsolicited medical report from an emergency physician.

The appellant argued the report was invalid due to clerical errors regarding their address and date of birth, and refused to answer any questions during the hearing.

The Tribunal found the clerical errors did not invalidate the report and drew an adverse inference from the appellant's refusal to provide medical information or answer questions.

The Tribunal concluded the appellant suffers from an alcohol use disorder likely to significantly interfere with their ability to drive safely, and confirmed the licence suspension.

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

A written hearing was scheduled, but the applicant failed to file written submissions or respond to communications from the Tribunal.

The respondent requested that the application be dismissed as abandoned.

The Tribunal found that the applicant had abandoned his application and failed to meet his burden of proof.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought various medical and assessment benefits from the respondent insurer.

The insurer denied the treatment plans, arguing they were not reasonable and necessary.

The Tribunal found that the physiotherapy and chronic pain assessment were reasonable and necessary, noting the insurer's failure to comply with the notice requirements under section 38 of the Schedule for the chronic pain assessment.

The orthopaedic and psychological assessments were denied.

The Tribunal also awarded $300 to the applicant due to the insurer's unreasonable delay in responding to the treatment plans and failure to adjust the file with new medical evidence.

The appellant requested a reconsideration of a Tribunal decision that confirmed a Proposal to refuse its registration as a lottery ticket seller under the Gaming Control Act, 1992.

The appellant argued that its paralegal at the original hearing did not allow the president to give evidence.

The adjudicator dismissed the request, noting that the appellant had retained counsel after the evidence was presented, and those subsequent submissions did not raise the issue of inadequate representation or denial of the opportunity to testify.

The request did not meet the criteria for reconsideration under the Tribunal's rules.

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

The parties reached a settlement and requested a consent order.

The Licence Appeal Tribunal issued the consent order, vacating the scheduled hearing and imposing conditions on the appellants' registrations, including requirements related to premises, books and records, and disclosure.

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

The insurer raised a preliminary issue, arguing the application was statute-barred under s. 56 of the Statutory Accident Benefits Schedule because it was filed more than two years after the insurer allegedly sent a notice terminating the benefits.

The Tribunal found that the insurer failed to prove on a balance of probabilities that it delivered the termination notice to the applicant or her representatives by mail or fax in accordance with s. 64 of the Schedule.

The notice was only properly delivered via email years later.

Therefore, the limitation period had not expired, and the applicant's claim was permitted to proceed.

The respondent insurer requested a reconsideration of a decision finding the applicant entitled to income replacement benefits during a period of suspension.

The insurer argued the Tribunal erred in law by misinterpreting 'reasonable explanation' under s. 33(8)(b) of the Schedule, as the applicant's explanation was only offered at the hearing.

The Adjudicator dismissed the request, finding no error of law, as the Schedule does not impose a time limitation for providing a reasonable explanation and the Tribunal had properly weighed the evidence in finding the explanation credible.

The applicant was injured in a motor vehicle accident and sought payment for two chiropractic treatment plans for chronic shoulder pain.

The respondent insurer denied the plans based on an insurer's examination report.

The Tribunal found the treatment plans reasonable and necessary, preferring the evidence of the applicant's treating physicians and chronic pain program over the insurer's assessor.

The Tribunal also awarded a 10% special award under s. 10 of O. Reg. 664, finding the respondent unreasonably withheld benefits by failing to adjust the claim when presented with updated medical records.

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

The respondent denied a treatment plan for a psychological assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The Tribunal found that the applicant's physical injuries were predominantly minor and that there was insufficient evidence of a psychological impairment caused by the accident to remove him from the MIG.

As the MIG limit was exhausted, the applicant was not entitled to the disputed treatment plan or interest.