OLAT 2021

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

The insurer determined the injuries fell within the Minor Injury Guideline (MIG) and denied a treatment plan for chiropractic services.

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor and that he failed to provide compelling evidence of a pre-existing right ankle condition or psychological injury that would remove him from the MIG.

The Tribunal also concluded that the disputed treatment plan was not reasonable and necessary, as it lacked support from the applicant's treating physicians.

The application was dismissed.

The appellant requested a reconsideration of a Tribunal decision that confirmed the impoundment of his motor vehicle for driving while suspended.

The request was delivered almost six months late, and the appellant sought an extension of time, claiming ignorance of the 21-day deadline.

The Tribunal dismissed the request, finding that ignorance of the rules was not a sufficient basis for an extension.

Furthermore, the Tribunal noted the request lacked merit, as the appellant's argument regarding exceptional hardship due to the COVID-19 pandemic was moot since the 45-day impoundment period had already ended and the vehicle had been recovered.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries, including chronic pain and a pre-existing knee condition, warranted removal from the Minor Injury Guideline (MIG).

The applicant passed away before the decision was rendered, but the Tribunal found the proceeding was not moot as a decision could impact deemed incurred expenses.

The Tribunal held that the applicant failed to establish on a balance of probabilities that his injuries fell outside the MIG, noting a significant 14-15 month gap in treatment and compelling medical evidence attributing his worsening pain to degenerative changes.

However, the Tribunal found the respondent failed to deny a February 2017 treatment plan within the required 10 business days under s. 38(8) of the Schedule, precluding it from relying on the MIG to deny that specific plan.

No interest was awarded.

The applicant sought statutory accident benefits for the prescription medication Saxenda, arguing that her type 1 diabetes was triggered by emotional stress following a motor vehicle accident.

The adjudicator found that the applicant failed to prove on a balance of probabilities that the accident caused her diabetes, as her own medical expert could not determine the exact initiation of the condition.

In the alternative, the adjudicator held that the applicant failed to prove the medication was reasonable and necessary, noting it was an off-label treatment for weight loss and no evidence of her body mass index was provided.

The application was dismissed.

The appellant, a vehicle leasing company, appealed the impoundment of a truck leased to a driver whose licence was suspended.

The appellant argued it exercised due diligence by checking the driver's licence and insurance at the time the lease was signed.

The Licence Appeal Tribunal dismissed the appeal, finding that the Highway Traffic Act requires due diligence to be exercised at or near the time the vehicle is impounded, which the appellant failed to demonstrate.

The applicant, who was injured in a motorcycle accident, sought payment for two physiotherapy treatment plans that were denied by the respondent insurer.

The insurer denied the plans based on section 44 insurer's examinations which concluded the treatments were not reasonable and necessary.

The Tribunal found that the applicant failed to meet his burden of proving the treatments were reasonable and necessary, noting that the applicant spent half the year in Florida without facility-based treatment and lacked objective medical evidence supporting the need for ongoing treatment.

The application was dismissed.

The applicant was injured as a pedestrian in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The adjudicator held a written hearing to determine entitlement to attendant care benefits, physiotherapy, occupational therapy, and psychological services.

The adjudicator denied the claim for attendant care benefits, finding that the applicant failed to prove the expenses were incurred under s. 3(7)(e) of the Schedule, as there was no evidence of economic loss by the family member providing care.

The adjudicator partially allowed the claims for physiotherapy, finding that provider travel time was reasonable and necessary given the applicant's mobility limitations, but denied funding for planning services and mileage.

The claims for occupational therapy and psychological services were dismissed for lack of evidence demonstrating reasonableness and necessity.

The appellant appealed the Registrar of Motor Vehicles' decision to suspend his driver's licence due to a psychiatric condition.

The Registrar suspended the licence after receiving medical reports indicating the appellant suffered from schizophrenia with ongoing delusions and lacked insight into his condition.

The Licence Appeal Tribunal found that the appellant's medical condition was likely to significantly interfere with his ability to drive safely, noting the Canadian Council of Motor Transport Administrators Medical Standards for Drivers.

The Tribunal confirmed the Registrar's decision to suspend the licence until a period of stability could be established.

The applicant sought statutory accident benefits for psychological treatment to address post-traumatic stress disorder following a motor vehicle accident.

The respondent partially denied two treatment plans, arguing that the proposed length and number of sessions were excessive and that a local treatment provider should be used to reduce travel expenses.

The Tribunal found that the applicant's treating psychologist was the preferred option due to his extensive experience and established patient-psychologist relationship, and that surveillance evidence did not undermine the applicant's psychological impairments.

The Tribunal concluded that the treatment plans were partially reasonable and necessary, awarding portions of the claimed amounts along with interest on overdue payments.

The respondent insurer sought reconsideration of a preliminary issue decision which found that the applicant was a dependent of his mother and therefore an insured under her policy.

The Tribunal dismissed the request for reconsideration, holding that under Rule 18.1 of the Licence Appeal Tribunal Rules, reconsideration is only available for decisions that finally dispose of an appeal.

Because the preliminary issue decision allowed the applicant's claim to proceed, it was not a final disposition, and the request was premature.

The applicant sought statutory accident benefits after tripping and falling on a raised ledge near a displayed vehicle at an auto show.

The respondent denied the benefits, arguing the incident was not an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal held a preliminary issue hearing and found that the applicant's injuries did not arise out of the ordinary use or operation of an automobile.

The Tribunal concluded the purpose test was not met, as the display of a vehicle at an auto show does not constitute ordinary use or operation, and dismissed the application.

The applicant was injured in a motor vehicle accident and sought payment for 11 treatment plans under the Statutory Accident Benefits Schedule.

The respondent insurer denied the plans as not reasonable and necessary.

The Licence Appeal Tribunal reviewed the medical evidence, including reports from various assessors and treating practitioners.

The Tribunal found that the applicant sustained a mild traumatic brain injury and granted the $7,808.97 treatment plan for occupational therapy, along with interest.

The remaining 10 treatment plans, including those for orthotics, case management, rock climbing therapy, medical cannabis, and various physical therapies, were dismissed for lack of supporting objective medical evidence.

The applicant sought accident benefits following a motor vehicle accident.

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

The Tribunal found that the applicant sustained a concussion and psychological injuries, including driving anxiety, which removed him from the MIG.

The Tribunal ordered the insurer to pay for the psychological assessment, finding it reasonable and necessary.

The applicant's claim for an award for unreasonable delay was dismissed because the compelling medical evidence was only provided during the hearing.

The applicant requested a reconsideration of a decision denying an examination expense of $24,400 for catastrophic impairment assessments.

The applicant argued the adjudicator erred in fact by believing the assessments only concerned criterion 8, and erred in law by failing to apply the Saadati principles.

The adjudicator found that while there was an error in fact regarding the scope of the assessments, it would not have changed the outcome as the applicant failed to establish a reasonable need for the assessments under any criteria.

The request for reconsideration was dismissed.

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 contended that her pre-existing migraines and back pain were exacerbated by the accident, and that she suffered from chronic pain and a possible concussion, warranting removal from the MIG.

The Tribunal found insufficient medical evidence to support removal from the MIG, noting the applicant's functional abilities remained intact and there was no formal diagnosis of a concussion or chronic pain syndrome.

As the MIG limits were exhausted, the disputed treatment plan was deemed not reasonable and necessary.

The applicant was struck by a vehicle in a parking lot, sustaining crush injuries to her feet.

She sought $900 for chiropractic treatment to address low back and pelvic pain, which the respondent insurer denied on the basis that the pain was caused by pre-existing arthritis rather than the accident.

The Tribunal found that the applicant's altered gait from her foot injuries caused overcompensation resulting in low back pain, satisfying the 'but for' test for causation.

The Tribunal held the treatment was reasonable and necessary, ordering the respondent to pay the $900 plus interest, but denied the applicant's request for costs.

The applicant sought an income replacement benefit (IRB) and a medical treatment plan following a 2017 motor vehicle accident.

The insurer paid IRBs until February 2018 based on the applicant's reported income to the CRA, but denied further benefits based on section 44 assessments.

The Tribunal found the insurer correctly calculated the IRB quantum using the CRA reported income, as the Schedule prohibits relying on unreported income.

The Tribunal also found the applicant failed to prove ongoing substantial inability to perform the essential tasks of his pre-accident employment, and failed to prove the treatment plan was reasonable and necessary.

The application was dismissed.

The applicant sought accident benefits following a 2012 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, psychological impairments, and a pre-existing condition.

The Tribunal found the applicant failed to provide sufficient medical evidence to warrant removal from the MIG, noting the injuries were predominantly soft tissue and there was no objective evidence of chronic pain or psychological impairment attributable to the accident.

Consequently, the disputed treatment plans for a psychological examination and catastrophic assessments were deemed not reasonable and necessary.

The application was dismissed.

The applicant insurer brought a preliminary issue hearing to determine if the respondent was involved in an 'accident' as defined under s. 3(1) of the Statutory Accident Benefits Schedule.

The respondent alleged he was struck by a vehicle while riding his bicycle.

The Tribunal preferred the evidence of an independent police officer and the driver, finding that the vehicle was stationary and the respondent simply lost his balance and fell.

The Tribunal concluded the incident did not meet the purpose test, as the injuries did not arise out of the use or operation of an automobile.

The respondent was found not to have been involved in an accident.

The appellant appealed the 45-day impoundment of her motor vehicle under the Highway Traffic Act, arguing exceptional hardship.

The vehicle was impounded after the appellant's friend was caught driving it with a suspended licence.

The Tribunal found that while the appellant demonstrated no alternative transportation was available and she would lose some babysitting income, she failed to prove the financial loss would be significant and lasting.

The appeal was dismissed and the impoundment confirmed.