OLAT 2022

The applicants, three brothers involved in separate motor vehicle accidents, brought a motion seeking to disqualify the respondent insurer's counsel and adjuster, alleging breaches of privacy and a conflict of interest due to the sharing of information between their related accident benefits claims.

The Licence Appeal Tribunal held that while it has jurisdiction to disqualify counsel for a conflict of interest, it lacks the authority to disqualify an adjuster.

On the merits, the Tribunal found that the applicants had expressly consented to the sharing and pooling of their information for the purpose of investigating and verifying their claims when they signed the OCF-1 forms.

The Tribunal concluded there was no breach of privacy and no disqualifying conflict of interest, and dismissed the motion.

The applicant was injured in a motor vehicle accident and sought a non-earner benefit, which the respondent insurer denied.

The applicant filed an application for dispute resolution with the Licence Appeal Tribunal more than nine months after the two-year limitation period expired.

The respondent raised a preliminary issue that the claim was statute-barred.

The Tribunal applied the four Manuel factors under section 7 of the Licence Appeal Tribunal Act and granted an extension of time, finding that the applicant had a bona fide intention to appeal, the delay was explained by her declining function and reliance on counsel, the respondent suffered no prejudice, and the appeal had merit given the applicant's catastrophic impairment designation.

The appellant appealed the Registrar of Motor Vehicles' decision to suspend his driver's licence for medical reasons.

The suspension was based on a Medical Condition Report indicating a substance use disorder involving opioids and driving under the influence.

The appellant failed to provide a requested Substance Use Assessment form to rebut the medical evidence.

The Licence Appeal Tribunal found that the appellant is addicted to a drug to an extent likely to significantly interfere with his ability to drive safely and confirmed the suspension.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, which the respondent insurer denied.

The respondent scheduled an insurer's examination under section 44 of the Schedule, which the applicant failed to attend, arguing the notice was non-compliant.

The Tribunal found that while the first notice was deficient, the second notice complied with the Schedule's requirements.

Because the applicant failed to provide a reasonable explanation for his non-attendance at the rescheduled examination, he was barred from proceeding with his application under section 55 of the Schedule.

The application was dismissed.

The applicant sought statutory accident benefits after a vehicle crashed into his house while he was sleeping in another room.

He claimed to have suffered psychological and emotional injuries as a result of the incident.

The respondent denied the claim on the basis that the applicant was not 'involved' in the accident.

The Licence Appeal Tribunal found that the applicant did not witness the accident, was not physically injured, and was not related to anyone involved in the accident.

Consequently, he did not meet the definition of an 'insured person' involved in an accident under section 3(1) of the Statutory Accident Benefits Schedule.

The application was dismissed.

The respondent insurer brought a motion on preliminary issues seeking to permanently bar the applicant from proceeding with claims for two treatment plans because the applicant failed to attend scheduled independent examinations (IEs).

The respondent also argued the Tribunal lacked jurisdiction to determine the applicability of the Minor Injury Guideline (MIG) as a standalone issue.

The Tribunal found that while the applicant missed the IEs, a complete bar was disproportionate given the applicant's explanation of a family emergency abroad and her agreement to attend the rescheduled IEs.

The Tribunal dismissed the request to bar the claims and instead stayed the application for 60 days pending the applicant's attendance at the IEs.

The request regarding the MIG issue was also dismissed, to be determined by the hearing adjudicator if necessary.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found his injuries fell within the Minor Injury Guideline (MIG).

The applicant argued the Tribunal erred in preferring the respondent's medical evidence over his own experts and in its assessment of his pre-existing back pain and chronic pain.

The adjudicator found no significant error of law or fact, noting that the original decision appropriately weighed the medical evidence, including the timing of the assessments and the applicant's own medical records.

The request for reconsideration was denied.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRB) and a psychological treatment plan.

The respondent insurer delayed paying the IRB for over a year, demanding documentation that was not required to determine eligibility, despite having received the necessary OCF-2 and OCF-3 forms.

The Tribunal found the respondent's conduct in withholding the IRB to be imprudent, stubborn, and inflexible, and ordered an award of 50% of the delayed IRB amount under s. 10 of Regulation 664.

The Tribunal also found the disputed psychological treatment plan to be reasonable and necessary, noting it was not duplicative of the applicant's psychiatric consultations, and ordered it payable with interest.

The appellant appealed the Registrar of Motor Vehicles' decision to suspend his Class A driver's licence for medical reasons following an unsolicited Medical Condition Report.

The report was submitted by an emergency physician after the appellant crashed a tanker truck and refused further medical workup to rule out syncope or seizure.

The Licence Appeal Tribunal found that the Registrar established on a balance of probabilities that the appellant suffers from syncope or loss of consciousness, which is likely to significantly interfere with his ability to drive safely.

The Tribunal confirmed the Registrar's decision to suspend the licence.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing her injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain and psychological impairments.

The Tribunal found that the applicant's injuries were predominantly minor and subject to the $3,500 MIG limit.

Relying on the respondent's expert assessments, which included validity testing indicating symptom magnification, the Tribunal concluded the applicant did not suffer from a psychological impairment or chronic pain syndrome.

The Tribunal approved two physiotherapy treatment plans and prescription expenses as reasonable and necessary within the MIG limit, but denied a third physiotherapy plan, a psychological assessment, and a chronic pain assessment.

Claims for an award for unreasonable delay were dismissed, though interest was awarded on the approved benefits.

The applicant sought resolution of a dispute regarding the hourly rate at which Attendant Care Benefits (ACB) would be paid, despite the insurer having approved the submitted Form 1s in full.

The insurer raised a preliminary issue arguing the Licence Appeal Tribunal lacked jurisdiction under s. 280 of the Insurance Act because there was no live dispute over entitlement or the amount of the benefit.

The Tribunal agreed, finding that since the insurer approved the ACB in full and there was no denial, there was no dispute within the meaning of s. 280.

The application was dismissed for lack of jurisdiction.

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

The respondent determined the applicant sustained a minor injury and was subject to the Minor Injury Guideline (MIG) limit of $3,500, denying several treatment plans.

The applicant argued his psychological impairments and chronic pain removed him from the MIG.

The Tribunal found the applicant's psychological evidence inconsistent and preferred the respondent's psychological assessment, which concluded the impairments were minor.

The Tribunal also found the applicant did not meet the criteria for chronic pain under the AMA Guides and had achieved full functional recovery.

As the applicant sustained a minor injury and had exhausted the MIG funding limit, the disputed treatment plans and interest were denied.

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

The respondent denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's consistent self-reporting of lower back pain for over four years, which interfered with her ability to walk and work, established a chronic pain impairment sufficient to remove her from the MIG.

The Tribunal awarded two treatment plans for chiropractic services from 2015 as reasonable and necessary, but denied a 2020 treatment plan and a psychological assessment.

The applicant was also awarded interest on the overdue benefits, but her claim for an award under Regulation 664 was dismissed.

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

The respondent determined the applicant's injuries were minor and subject to the $3,500 funding limit under the Minor Injury Guideline (MIG), denying several treatment and assessment plans.

The applicant argued she suffered from psychological impairments and chronic pain.

The Tribunal found the applicant did not sustain a psychological impairment, preferring the respondent's psychological assessment over the applicant's evidence.

The Tribunal also found the applicant did not meet the criteria for chronic pain syndrome, preferring the respondent's musculoskeletal assessments over the family doctor's diagnosis.

As the injuries were minor and the funding limit was exhausted, the disputed treatment plans were not payable.

Claims for interest and costs were dismissed.

The applicant, who was a minor at the time of the motor vehicle accident, sought a non-earner benefit and medical/rehabilitation benefits.

The insurer denied the benefits, and the applicant filed an application with the Licence Appeal Tribunal more than two years after the denials.

The applicant argued that the limitation period for the non-earner benefit should only commence upon turning 18, relying on the rule of discoverability.

The Tribunal held that the limitation period is triggered by the insurer's refusal to pay, regardless of the applicant's age.

The Tribunal declined to extend the limitation period under section 7 of the Licence Appeal Tribunal Act, finding no bona fide intention to appeal within the time limit, an excessive and unexplained delay, prejudice to the respondent, and a lack of merit.

The application was dismissed as statute-barred.

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

The respondent insurer denied the benefits after an insurer's examination found no residual physical impairments.

The Tribunal found that the applicant failed to prove on a balance of probabilities that she suffered a substantial inability to perform the essential tasks of her employment as a cashier.

The Tribunal relied on the objective findings of the respondent's physiatrist and noted the applicant had returned to work and travelled extensively post-accident.

The application for IRBs, a special award, and interest was dismissed.

The respondent's request for costs was also dismissed.

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

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

The Tribunal found that the applicant's physical and psychological injuries were predominantly minor, preferring the evidence of the respondent's experts over the applicant's experts.

Because the applicant's injuries fell within the MIG and the $3,500 limit had already been exhausted, the Tribunal concluded it was unnecessary to determine the reasonableness and necessity of the disputed treatment plans.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that his injuries fell within the Minor Injury Guideline.

A written hearing was scheduled, but the applicant failed to file any submissions or evidence by the required deadlines and did not participate in the proceeding for a full year.

The respondent brought a motion to dismiss the application as abandoned.

The Tribunal found that the applicant failed to meet his evidentiary burden on the substantive issues and also concluded that the application had been abandoned pursuant to Rule 3.4(d) of the Common Rules of Practice and Procedure.

The application was dismissed.

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

The respondent denied the claim, arguing the applicant failed to comply with section 33 requests for information regarding a potential address misrepresentation, and alternatively, that the applicant did not meet the disability test.

The Tribunal found the applicant did not have a reasonable explanation for failing to provide most of the requested documents, justifying the respondent's withholding of benefits.

Substantively, relying on the respondent's insurer's examinations, the Tribunal concluded the applicant did not suffer a substantial inability to perform the essential tasks of his pre-accident employment as a cleaner.

The claims for IRBs, an award, interest, and costs were dismissed.

The applicant sought statutory accident benefits, including attendant care benefits, following the death of her husband in a motor vehicle accident.

The insurer requested that the applicant attend psychological and occupational therapy insurer's examinations (IEs) to assess her entitlement.

The applicant failed to attend the scheduled IEs, arguing the notices were deficient and the examinations were not reasonably necessary.

The Tribunal found the insurer's notices complied with section 44 of the Schedule and the requests were reasonable.

Consequently, the Tribunal held the applicant was barred from proceeding with her application for attendant care benefits and a related assessment plan pursuant to section 55(1)2 of the Schedule.