OLAT 2021

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

The respondent denied income replacement benefits (IRB) and various medical and rehabilitation benefits, arguing the applicant failed to comply with requests for information under s. 33 of the Schedule.

The Tribunal found the applicant adequately complied with the s. 33 requests and was procedurally entitled to the IRB.

The Tribunal also found that a proposed mattress and chiropractic treatment were reasonable and necessary, preferring the evidence of the applicant's treating practitioners over the respondent's assessors.

The applicant was awarded the disputed benefits with interest.

The applicant sought statutory accident benefits following a 2015 motor vehicle accident.

In a preliminary issue hearing, the applicant requested production of the adjuster's log notes past the date of the Tribunal application, while the respondent requested production of the applicant's accident benefits file from a prior 2010 accident.

The Tribunal ordered the respondent to produce the log notes, redacted for privilege and reserves, finding them relevant to the ongoing adjustment of the claim and the applicant's claim for an award.

The Tribunal also ordered the applicant to produce the 2010 accident benefits file, finding it relevant to causation and the applicant's pre-accident condition.

Additionally, the Tribunal granted the respondent's motion to issue a summons for an investigator and adjourned the scheduled hearing.

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 failed to provide submissions demonstrating that his injuries, including alleged chronic pain and pre-existing conditions, warranted removal from the MIG.

The Tribunal found the applicant did not meet his burden of proof.

As the MIG limits were exhausted, the treatment plan was not payable, and claims for interest and an award for unreasonable delay were dismissed.

The appellant appealed the 45-day impoundment of her motor vehicle under the Highway Traffic Act after her son, a suspended driver, was caught driving it.

The appellant argued the vehicle was stolen because her son took the keys without her permission while she was sleeping.

The Tribunal dismissed the appeal, finding that while the vehicle was taken without consent, it was not 'stolen' within the meaning of the Act because the son intended to return it and did not intend to deprive the appellant of her property.

The applicant sought statutory accident benefits for a $4,470 physiotherapy treatment plan following a 2018 motor vehicle accident.

The insurer denied the plan on the basis that it was not reasonable and necessary, relying on an independent medical examination which concluded the applicant had reached maximal medical recovery.

The Tribunal agreed with the insurer, finding that the treatment plan was identical to a previously approved plan and the applicant failed to demonstrate why continued facility-based treatment was required given his pre-existing conditions and lack of objective accident-related impairments.

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

The respondent insurer brought a motion to dismiss the applicant's claims for an income replacement benefit and two treatment plans, arguing they were barred by the two-year limitation period under s. 56 of the Statutory Accident Benefits Schedule.

The adjudicator found that the claim for the income replacement benefit was not barred because the limitation period was suspended by O. Reg. 73/20 (the COVID-19 Limitations Regulation) before the two-year mark.

However, the treatment plans were denied more than two years before the application was filed.

The adjudicator held that the Tribunal does not have the authority under s. 7 of the Licence Appeal Tribunal Act to extend limitation periods set out in a regulation such as the Schedule.

Consequently, the applicant was permitted to proceed with the income replacement benefit claim, but the claims for the two treatment plans were dismissed.

The applicant sought payment for a $2,189.98 treatment plan for physiotherapy and massage following a 2014 motor vehicle accident.

The respondent denied the claim.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment was reasonable and necessary or incurred.

The applicant had previously received similar treatment with little reported benefit, and the medical evidence did not support the need for further facility-based treatment.

The application was dismissed.

Jevco Insurance sought repayment of $7,181.76 in Income Replacement Benefits (IRBs) paid to the respondent, alleging he made a material misrepresentation regarding his primary residence to secure lower insurance premiums.

The respondent failed to participate in the hearing.

The Tribunal found that the respondent intentionally misrepresented his address, living in Etobicoke rather than Ottawa, which resulted in a $3,990 reduction in his premium.

The Tribunal ordered the respondent to repay the IRBs with interest, plus $106 in costs.

Four trucking companies appealed a Cancellation and Seizure Order issued by the Registrar of Motor Vehicles, which cancelled their Commercial Vehicle Operator Registration (CVOR) certificates.

The Registrar argued that the companies were related through the common management of a single individual who had a history of operating trucking businesses with poor safety records.

The Tribunal found that the companies were indeed related and that their collective poor safety records, including numerous hours of service violations and collisions, provided reason to believe they would not operate safely.

The Tribunal confirmed the Registrar's order cancelling the CVOR certificates.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, including a neurological assessment, physiotherapy, a dog, medical cannabis, and a dental night guard.

The respondent denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to meet her burden of proving that the claimed expenses were reasonable and necessary as a result of accident-related injuries, noting her pre-existing chronic pain and fibromyalgia.

The appellant, a registered gaming assistant, was suspended by the Registrar after being charged with sexual interference and sexual assault.

The appellant appealed the suspension to the Licence Appeal Tribunal.

The Tribunal found that, given the serious nature of the outstanding charges, allowing the appellant to maintain his registration would undermine public confidence in the gaming industry.

The Tribunal confirmed the Registrar's order of suspension as necessary in the public interest.

The appellant, a residential care licensee, brought a motion to adjourn its appeal of licence conditions before the Licence Appeal Tribunal until the Divisional Court decided its related application for judicial review regarding a cap on the number of children in its care.

The Tribunal denied the adjournment, finding that the legislative scheme deliberately created parallel remedial processes for licence conditions and capacity caps.

The Tribunal concluded that an adjournment was not necessary to permit an adequate hearing and would contravene the public interest in the expeditious resolution of administrative proceedings.

The applicant filed a Request for Reconsideration of a Tribunal decision that denied her claim for post-104 week income replacement benefits (IRBs).

The applicant argued that the adjudicator made significant errors of law and fact by misapprehending the evidence regarding her volunteer work, wedding planning activities, and medical limitations, and that the decision violated procedural fairness.

The Tribunal dismissed the request, finding that the adjudicator had properly weighed the evidence, including the applicant's post-accident activities and the medical reports.

The Tribunal concluded that the applicant failed to demonstrate a complete inability to engage in any employment for which she was reasonably suited by education, training, or experience, and that no error was made that would have led to a different result.

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

The insurer denied funding for physical therapy and a chronic pain assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained only minor soft tissue injuries and gave no weight to the applicant's expert reports diagnosing chronic pain and post-concussion syndrome due to outdated criteria and lack of qualifications.

The application was dismissed as the $3,500 MIG funding limit had been exhausted.

The applicant sought reconsideration of a Licence Appeal Tribunal decision that dismissed her claims for income replacement and medical benefits, finding her injuries fell within the Minor Injury Guideline.

The Vice-Chair granted the reconsideration, finding that the original adjudicator misapprehended key evidence from the applicant's family physician and occupational therapist, and provided inadequate reasons that failed to meet the standards of justification, transparency, and intelligibility set out in Vavilov.

The matter was referred back to the original adjudicator for a redetermination on the existing record.

The applicant was injured in a motor vehicle accident and sought an income replacement benefit (IRB).

The respondent insurer delayed payment of the IRB for over a year despite receiving all necessary documentation.

The Tribunal found the insurer's conduct in handling the claim was imprudent, immoderate, and unyielding.

The Tribunal ordered a special award under s. 10 of O. Reg. 664 in the amount of $4,025.00, representing 25% of the total IRB payable, plus interest.

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

The respondent determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied income replacement benefits (IRB) and certain treatment plans.

The Tribunal found that the applicant's injuries were predominantly minor and that he failed to prove a pre-existing condition, psychological injury, or chronic pain that would remove him from the MIG.

The Tribunal also found the applicant was not entitled to an IRB as he did not suffer a substantial inability to perform the essential tasks of his pre-accident employment.

However, the Tribunal found the disputed physiotherapy treatment plans were reasonable and necessary, and ordered them payable up to the $3,500 MIG limit, less amounts already paid.

The applicant was injured in a motor vehicle accident and sought $2,200 for an attendant care assessment under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal dismissed the claim, finding the applicant's occupational therapy report unpersuasive due to its reliance on self-reporting and internal contradictions.

The Tribunal preferred the respondent's insurer's examination report, which was based on objective testing and concluded the applicant was independent with her personal care tasks.

As no benefits were payable, the claim for interest was also dismissed.

The respondent insurer requested a reconsideration of a previous Tribunal decision that awarded the applicant various medical and rehabilitation benefits, including physical therapy, a chronic pain assessment, a chronic pain program, and a disability certificate.

The insurer alleged several factual and legal errors, including the Tribunal's treatment of expert evidence and the legal test applied.

The adjudicator dismissed the request, finding that while there were minor errors in the original decision, none were significant enough that they would have likely led to a different result.

The adjudicator also clarified that under s. 25(1) of the Schedule, an insurer is not required to request a disability certificate before it becomes payable.

The applicant sought medical benefits following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered from an accident-related psychological impairment, removing him from the MIG.

However, while the Tribunal ordered payment for a psychological assessment, it denied the claims for physical therapy and psychological services, finding the physical therapy had plateaued and the psychological services were reasonably available through OHIP.