OLAT 2021

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and various medical and rehabilitation benefits.

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

The Tribunal found that the applicant failed to demonstrate on a balance of probabilities that her physical or psychological injuries warranted removal from the MIG.

The Tribunal preferred the evidence of the respondent's section 44 assessors over the applicant's treating practitioners and psychological report.

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

The claim for IRBs was also dismissed as the applicant failed to establish a substantial inability to perform the essential tasks of her employment.

The applicant sought various medical and rehabilitation benefits following a 2015 motor vehicle accident.

The Licence Appeal Tribunal reviewed treatment plans for psychological services, an audiometric assessment, an optometric assessment, and a driving assessment.

The Tribunal found that the applicant failed to prove the psychological, audiometric, and optometric plans were reasonable and necessary, largely relying on the respondent's section 44 medical examination reports.

However, the Tribunal approved the driving assessment, finding it reasonable and necessary to address the applicant's well-documented driving anxiety.

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

The respondent denied medical benefits beyond the $3,500 Minor Injury Guideline limit.

The applicant argued his injuries, including chronic pain, exceeded the minor injury definition and that pre-existing conditions warranted removal from the guideline.

The Tribunal found the applicant's injuries were predominantly minor soft tissue injuries and rejected the evidence of his chiropractor regarding chronic pain.

The Tribunal also found the respondent's denial notices complied with the statutory timelines.

The application was dismissed.

The applicant sought statutory accident benefits after an altercation with a motorcyclist.

The applicant walked into the street to confront the motorcyclist about noise, grabbed the motorcycle's handlebars, and was subsequently assaulted by the motorcyclist.

The respondent denied benefits on the basis that the incident was not an 'accident' under the Schedule.

The Tribunal agreed, finding that the incident was an assault that broke the chain of causation and did not arise out of the ordinary and well-known activities for which motorcycles are used.

The application was dismissed.

The insurer requested a reconsideration of a Licence Appeal Tribunal decision that found the insured entitled to two treatment plans due to the insurer's non-compliant denial notices under sections 38(8) and 38(9) of the Statutory Accident Benefits Schedule.

The insurer argued the adjudicator breached procedural fairness by citing unsubmitted case law, erred by denying the opportunity to cure the defective notices, and misapplied section 38(11).

The adjudicator dismissed the procedural fairness and notice arguments but granted the reconsideration in part to clarify that the treatment plans are payable only after an invoice is submitted.

The insurer's request for costs was denied.

The applicant was struck by a vehicle as a pedestrian, sustaining a fractured toe.

He sought statutory accident benefits for psychological treatment, orthotics, a chronic pain assessment, and a physiatry assessment.

The insurer denied the treatment plans.

The Tribunal found the orthotics and physiatry assessment to be reasonable and necessary, noting the applicant's ongoing altered gait and need for custom footwear.

The claims for psychological treatment and a chronic pain assessment were dismissed due to insufficient evidence and the applicant's disinterest in further psychological care.

The Tribunal also found the insurer's initial denial notices for two plans were deficient under s. 38(8) of the Schedule, making the insurer liable for services incurred during the period of deficiency, but declined to order an award under s. 10 of O. Reg. 664.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for an occupational therapy assessment, physiotherapy, chiropractic treatment, massage therapy, and craniosacral therapy.

The respondent denied the claims.

The Licence Appeal Tribunal dismissed the application, finding that the occupational therapy assessment was not reasonable and necessary as there was no evidence of attendant care needs.

The Tribunal also found that the proposed physiotherapy, chiropractic, and massage treatments were either a duplication of previously approved services or lacked compelling contemporaneous evidence.

Finally, the claims for craniosacral therapy were dismissed because the expenses were incurred before a treatment plan was submitted, contrary to section 38(2) of the Schedule.

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 further treatment plans.

The Tribunal found the applicant's injuries were predominantly minor and subject to the MIG.

However, the insurer failed to provide a timely denial notice for a physical therapy treatment plan under s. 38(8) of the Schedule.

As a result, the insurer was ordered to pay $168.00 for expenses incurred during the 'shall pay' period under s. 38(11).

The remaining claims for chiropractic treatment and a psychological assessment were dismissed as they were validly denied and the MIG limit was exhausted.

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

The respondent determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied further treatment plans and income replacement benefits (IRB) after the $3,500 limit was exhausted.

The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain or psychological injuries caused by the accident that would remove him from the MIG, noting he withheld information about a subsequent shooting incident from his assessors.

The Tribunal also found the applicant did not suffer a substantial inability to perform the essential tasks of his employment.

The application was dismissed.

The appellant's vehicle was impounded for 45 days after he was caught driving with a suspended licence.

He filed an appeal of the impoundment over three weeks after the 15-day statutory deadline had passed.

The Licence Appeal Tribunal applied the four-factor test for an extension of time and found that the appellant lacked a bona fide intention to appeal within the time limit, the delay was significant, the Registrar would suffer prejudice, and the appeal lacked merit.

The motion for an extension of time was denied.

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

The insurer scheduled section 44 Insurer's Examinations to assess the claims for neurological, sleep study, and neuropsychological assessments, but the applicant failed to attend.

The insurer raised a preliminary issue that the applicant was statute-barred from proceeding.

The Tribunal found that the insurer's requests for the examinations were reasonably necessary and the notices were proper.

Because the applicant failed to attend the properly scheduled examinations, he was statute-barred from proceeding with his claims under section 55(1)2 of the Schedule.

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

After the applicant's counsel was removed from the record due to an inability to communicate with the applicant, the applicant failed to attend the scheduled videoconference hearing despite receiving notice.

The Licence Appeal Tribunal found that the applicant had abandoned the application pursuant to Rule 3.4 of the Tribunal's Rules of Practice and Procedure and dismissed the claim.

The appellant appealed the 45-day impoundment of its company truck under the Highway Traffic Act, arguing that the impoundment would result in exceptional hardship to its business.

The vehicle was impounded after being driven by an employee with a suspended licence.

The Licence Appeal Tribunal dismissed the appeal, finding that the appellant failed to demonstrate that there was no alternative to the impounded vehicle, a prerequisite for establishing exceptional hardship under O. Reg. 631/98.

The Tribunal noted that the appellant had other vehicles available and had not adequately considered renting a replacement.

The appellant appealed the Registrar of Motor Vehicles' decision to suspend his driver's licence following a medical condition report indicating acute psychosis.

The appellant argued his condition was stable and attributed the episode to a vaccine reaction, while his treating psychiatrist noted a history of substance use disorder and medication non-adherence.

The Licence Appeal Tribunal confirmed the suspension, finding that the appellant suffers from a mental and substance use disorder likely to significantly interfere with his ability to drive safely, and agreed with the Registrar that further medical information and a longer period of stability were required.

The applicant sought an adjournment of the hearing pending an appeal to the Divisional Court regarding a prior preliminary decision, and to allow for the completion of ongoing section 44 insurer's examinations.

The respondent opposed the adjournment, arguing the request was untimely and the appeal vexatious.

The Tribunal granted the adjournment and stayed the application, noting that under section 25(1) of the Statutory Powers and Procedures Act, an appeal to the Divisional Court operates as an automatic stay.

The Tribunal also found that waiting for the completion of the insurer's examinations would prevent the bifurcation of issues and promote efficiency.

The applicant sought reconsideration of a Licence Appeal Tribunal decision which found that the respondent was not liable to pay for a $2,600 treatment plan despite issuing a late denial notice under s. 38(8) of the Statutory Accident Benefits Schedule.

The applicant argued that the Tribunal erred in law by conducting a reasonableness and necessity analysis, relying on the Divisional Court's decision in Kyrylenko.

The Vice-Chair dismissed the reconsideration request, distinguishing Kyrylenko and finding that because the late denial notice was issued on the 11th day, the mandatory 'shall pay' period under s. 38(11) ended the same day it began.

Therefore, no expenses were incurred during the penalty period, and the Tribunal correctly required the applicant to prove the treatment was reasonable and necessary under s. 15.

The applicant sought statutory accident benefits following an incident where he was punched in the face by another driver after a road rage encounter.

The Licence Appeal Tribunal held that the incident was not an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

Applying the Purpose and Causation tests, the Tribunal found that the applicant's vehicle was merely the venue for the assault, and the use or operation of the vehicle was not the direct cause of his impairments.

The assault was an intervening act that broke the chain of causation.

The applicant sought income replacement benefits (IRBs) and medical benefits for chiropractic treatment following a motor vehicle accident.

The adjudicator dismissed the application, finding the applicant lacked credibility due to contradictory evidence regarding his return to work and pre-existing chronic back pain.

The applicant failed to prove a substantial inability to perform the essential tasks of his pre-accident employment as a driver.

Furthermore, the adjudicator found the disputed treatment plans were not reasonable and necessary, as the applicant provided insufficient medical evidence linking his ongoing complaints to the accident.

The applicant sought a non-earner benefit following a 2014 motor vehicle accident.

The insurer denied the benefit in July 2014.

The applicant applied to the Licence Appeal Tribunal in December 2019, over five years later.

The insurer brought a preliminary motion arguing the claim was barred by the two-year limitation period under the Insurance Act and the Statutory Accident Benefits Schedule.

The applicant argued the denial was equivocal, the discoverability principle applied, and alternatively sought an extension under s. 7 of the Licence Appeal Tribunal Act.

The Tribunal found the July 2014 denial was clear and unequivocal, the discoverability principle did not apply as the applicant had all necessary facts, and declined to extend the limitation period due to the lengthy delay and resulting prejudice to the insurer.

The appeal was dismissed.

The applicant was injured in a motor vehicle accident and sought removal from the Minor Injury Guideline (MIG) due to chronic pain and a suspected frozen shoulder, as well as entitlement to an income replacement benefit (IRB).

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor, as medical imaging was unremarkable and no definitive diagnosis outside the MIG was established.

The Tribunal also dismissed the claim for an IRB, finding insufficient objective evidence that the applicant suffered a substantial inability to perform the essential tasks of her pre-accident employment at a restaurant.

Claims for an award and interest were consequently dismissed.