OLAT 2021

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, which the insurer denied or partially approved based on the Minor Injury Guideline.

The applicant applied to the Licence Appeal Tribunal to dispute the denials.

The Tribunal found that the applicant was entitled to payment for a physiatry assessment, as well as interest on overdue payments for psychological and physiotherapy treatments.

Furthermore, the Tribunal awarded the applicant $1,500 under s. 10 of O. Reg. 664, finding that the insurer unreasonably withheld and delayed the payment of the applicant's income replacement benefit and psychological treatment.

The applicant was involved in two motor vehicle accidents and sought statutory accident benefits, including non-earner benefits and medical benefits.

The respondent terminated the non-earner benefits and denied several treatment plans.

The Tribunal found that the respondent breached the Statutory Accident Benefits Schedule by failing to provide proper notice when terminating the non-earner benefits, entitling the applicant to payment for the disputed period.

The Tribunal also found that the applicant's pre-existing lupus was aggravated by the accident, satisfying the causation test.

The physiotherapy treatment plans were deemed reasonable and necessary, but the claims for orthopaedic and psychological assessments were dismissed because they were incurred before the treatment plans were submitted.

The applicant's request for a special award was denied.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy, psychological treatment, clinical notes, and a chronic pain assessment.

The respondent insurer denied the treatment plans.

The Licence Appeal Tribunal found that the insurer's initial denials for the physiotherapy and psychological treatment plans were non-compliant with section 38 of the Schedule, but subsequent denials cured the defects.

On the merits, the Tribunal held that the psychological treatment and chronic pain assessment were reasonable and necessary, relying on the applicant's ongoing symptoms and the reports of his treating practitioners.

The claims for physiotherapy and clinical notes were dismissed.

Interest was awarded on the overdue payments for the approved plans.

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

The respondent denied certain treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit was exhausted.

The applicant argued his injuries were outside the MIG due to a concussion and chronic pain syndrome.

The Tribunal found the medical evidence did not support a diagnosis of concussion or chronic pain syndrome, preferring the evidence of neurologists over the family physician.

The Tribunal concluded the applicant sustained predominantly minor injuries, and since the MIG limit was exhausted, the disputed treatment plans were not payable.

The application was dismissed.

The applicant sought payment for a $2,065.00 chiropractic treatment plan following a 2016 motor vehicle accident.

The respondent insurer denied the benefit, arguing the applicant had reached maximum medical recovery.

The Tribunal found that the applicant failed to prove the treatment was reasonable and necessary, noting that her ongoing pain was likely attributable to pre-existing juvenile rheumatoid arthritis rather than the accident.

The application was dismissed.

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

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

The Tribunal found that the applicant's injuries were predominantly minor and that he failed to prove chronic pain or psychological impairments that would remove him from the MIG.

However, the Tribunal held that the respondent failed to provide adequate medical and other reasons for denying the treatment plans, violating s. 38(8) of the Schedule.

Applying Ferawana and Zheng, the Tribunal ordered the respondent to pay for the disputed treatment plans, provided they were incurred before proper notice was given.

The claim for interest was denied.

The respondent insurer brought a motion seeking to compel the applicant to attend an Examination Under Oath (EUO) and to suspend her accident benefits for failing to attend a previously scheduled EUO.

The Tribunal held that it lacks the statutory authority to order an insured person to attend an EUO.

However, because the applicant failed to attend a properly requested EUO without a reasonable explanation, the Tribunal ordered that she is not entitled to any payment of benefits under the Schedule from the date of her non-attendance onwards, until she complies.

The applicant sought statutory accident benefits for a neurological assessment and two physiotherapy treatment plans following a motor vehicle accident.

The respondent denied the claims.

The Tribunal found that the claim for the neurological assessment was barred by the two-year limitation period under s. 56 of the Schedule, and the applicant failed to establish reasonable grounds for an extension under s. 7 of the LAT Act.

The Tribunal also dismissed the claims for physiotherapy, finding that the applicant had reached maximum medical recovery from facility-based treatment and that further sessions were not reasonable and necessary, preferring the respondent's medical evidence recommending a home-based exercise program.

The applicant was injured in a motor vehicle accident and sought medical benefits for physiotherapy.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that his injuries warranted removal from the MIG due to a pre-existing condition and chronic pain syndrome.

The Tribunal found that the applicant failed to demonstrate that his injuries fell outside the MIG or that he suffered from chronic pain syndrome.

As the MIG limits were exhausted, the benefits and an award for unreasonable delay were denied.

The applicant was injured in a motor vehicle accident and sought medical benefits for optometric services and an occupational therapy assessment under the Statutory Accident Benefits Schedule.

The respondent denied the benefits, arguing the applicant's impairments were caused by a pre-existing brain aneurysm and other life stressors rather than the accident.

The Tribunal applied the 'but-for' test for causation and found the accident was a necessary cause of the applicant's increased symptoms.

The Tribunal preferred the evidence of the applicant's treating practitioners over the respondent's assessor, concluding the proposed treatment plans were reasonable and necessary.

The applicant was awarded the claimed benefits.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that awarded the applicant attendant care benefits for meal preparation and medical benefits for Whole Therapy.

The Vice Chair dismissed the request regarding attendant care, finding the adjudicator properly weighed the evidence and applied the 'but for' causation test.

However, the Vice Chair granted the request regarding the Whole Therapy expenses, finding the adjudicator erred in law by relying on the insurer's previous approval of travel expenses to determine the treatment was reasonable and necessary.

The Vice Chair denied the Whole Therapy expenses because the applicant failed to submit a treatment plan prior to incurring the expenses, contrary to s. 38(2) of the Schedule.

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

The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's physical injuries were predominantly minor soft tissue injuries and that he failed to establish a psychological impairment that would remove him from the MIG.

As the $3,500 MIG limit had already been exhausted, the Tribunal concluded the applicant was not entitled to the claimed treatment plans.

The applicant sought payment for a chiropractic treatment plan in the amount of $2,670.00 following a motor vehicle accident.

The insurer denied the claim based on a section 44 assessment indicating that further passive facility-based treatment was not reasonable and necessary.

The Tribunal found that the applicant failed to meet her burden of proof, noting her significant pre-accident history of chronic pain and the lack of evidence showing the proposed treatment provided benefit.

The claims for the treatment plan, interest, and an award for unreasonable delay were dismissed.

The applicant was struck by a vehicle while riding his bicycle and applied for a determination of catastrophic impairment based on mental and behavioural disorders, specifically in the sphere of Adaptation.

The Tribunal weighed competing expert evidence, noting the applicant's upward trajectory in employment and poor validity testing results.

The Tribunal gave little weight to the applicant's occupational therapy assessment, finding the simulated work tasks unrealistic compared to his actual sustained employment.

Preferring the respondent's psychiatric evidence, the Tribunal found the applicant's impairments did not rise to the level of a marked impairment and dismissed the application.

The applicant sought a medical and rehabilitation benefit of $2,165.00 for physiotherapy treatment following a 2014 motor vehicle accident.

The respondent denied the benefit.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that her ongoing shoulder and back pain were caused by the accident, noting potential work-related causes and a pre-existing cyst.

The Tribunal also found the treatment was not reasonable and necessary as maximum medical recovery had likely been reached.

The application was dismissed, with no interest or award payable.

The applicant sought entitlement to several treatment plans for physiotherapy and a chronic pain assessment following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the treatment plans were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's medical assessor, who concluded the applicant suffered uncomplicated soft-tissue injuries that would not benefit from further facility-based therapy, over the applicant's treating physician and assessor.

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

The insurer denied certain medical benefits and requested a preliminary issue hearing to determine if the applicant was barred from proceeding with her application because she failed to attend section 44 insurer's examinations.

The Tribunal found that the applicant failed to attend multiple scheduled examinations without a reasonable explanation.

Consequently, the applicant was barred from proceeding with her application under section 55 of the Schedule.

The applicant requested a reconsideration of a decision finding his injuries fell within the Minor Injury Guideline (MIG) and denying his claim for income replacement benefits.

The applicant argued the adjudicator failed to properly consider medical evidence and pre-existing conditions.

The Vice Chair dismissed the request, finding no errors of law or fact in the original decision.

The adjudicator had properly weighed the evidence and the applicant was attempting to reargue his case, which is not permitted on reconsideration.

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

The respondent insurer suspended the IRBs after the applicant failed to attend a scheduled orthopaedic insurer's examination (IE).

The applicant argued the IE was not reasonably necessary and sought payment of the withheld IRBs, an award, and interest.

The Tribunal found that the requested orthopaedic IE was reasonably necessary given new medical evidence (an MRI showing an annular tear) and that the applicant failed to provide a reasonable explanation for his non-attendance.

Consequently, the insurer was not required to pay IRBs for the period of non-compliance.

However, the Tribunal awarded the applicant $250 in costs due to the insurer's unreasonable and bad faith conduct in evading service of a summons for its adjuster.

The insurer's request for costs was denied.

The appellant appealed the Minister of Transportation's decision to downgrade his commercial Class D driver's licence to a Class GM licence for medical reasons.

The downgrade followed a motor vehicle accident where the appellant suffered a generalized seizure with loss of consciousness while driving.

The Tribunal found that the appellant suffers from the medical condition of seizures, which is likely to significantly interfere with his ability to drive a commercial vehicle safely.

The Tribunal noted the appellant's lack of insight into his condition and the inability to compensate for sudden episodic impairment.

The Minister's decision to change the class of the appellant's driver's licence was confirmed.