OLAT 2022

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

The respondent denied a treatment plan for $3,353.40 on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued the denial lacked sufficient medical reasons under s. 38(8) of the Schedule and that he suffered from chronic pain warranting removal from the MIG.

The Tribunal found the respondent's denial was compliant and that the applicant failed to provide sufficient evidence of chronic pain causing functional impairment.

The application was dismissed.

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

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

The applicant claimed to suffer from chronic pain and psychological impairments that removed him from the MIG.

The Tribunal found that the applicant's injuries were predominantly soft tissue in nature and that a subsequent workplace accident was an intervening factor.

The Tribunal concluded the applicant did not meet the burden of proving chronic pain caused by the motor vehicle accident, and therefore his injuries remained within the MIG.

The claims for a chronic pain assessment, treatment program, and interest were dismissed.

The applicant sought a non-earner benefit and a medical benefit for occupational therapy following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application.

The adjudicator found the applicant failed to prove a complete inability to carry on a normal life, noting she had resumed many pre-accident activities such as driving long distances and attending exercise classes.

The adjudicator also denied the occupational therapy treatment plan, finding it was submitted specifically for whiplash-associated disorder, whereas the applicant's evidence supporting the need for therapy related entirely to cognitive deficits from a concussion.

Claims for interest and a special award were consequently dismissed.

The applicant sought an income replacement benefit following a motor vehicle accident.

The respondent argued the applicant was barred from proceeding under section 55(1) of the Statutory Accident Benefits Schedule because he failed to submit a completed disability certificate (OCF-3) for the subject accident.

The Tribunal found that the applicant's initial OCF-3 was unclear as it contained information relating to a previous accident, and the applicant subsequently withdrew it without submitting a new one for the subject accident.

As the applicant failed to submit a completed OCF-3, he was barred from proceeding with his application for an income replacement benefit.

The respondent insurer brought a motion to bar the applicant from proceeding with his claim for income replacement benefits due to his failure to attend insurer's examinations under section 44 of the Statutory Accident Benefits Schedule.

The Tribunal found that the notices of examination provided by the respondent were deficient as they lacked specific medical and other reasons for the examinations, failing to comply with section 44(5).

Consequently, the applicant was not barred from proceeding with his claim.

Both parties' requests for costs were denied.

The applicant requested a reconsideration of a motion order that dismissed her application for accident benefits on the basis of res judicata.

The applicant argued that the Tribunal violated procedural fairness by proceeding with a written hearing instead of a videoconference, and that it erred in law and fact by failing to consider fresh evidence and whether res judicata should be waived.

The Adjudicator dismissed the request, finding no breach of procedural fairness as the applicant had a full opportunity to present her case in writing.

Furthermore, the Adjudicator found no error of law or fact, noting that the applicant was attempting to re-litigate issues already decided.

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

The insurer argued the applicant was barred from proceeding because he failed to submit an Election of Income Replacement, Non-Earner Benefit or Caregiver Benefit (OCF-10) form.

The Tribunal found that the applicant's initial application documents provided conflicting information about his employment status, creating ambiguity as to whether he was entitled to income replacement or non-earner benefits.

Because of this ambiguity, the insurer's request for an OCF-10 was valid.

As the applicant failed to submit the required form, he was barred from proceeding with his claim for non-earner benefits.

The respondent insurer sought an adjournment of the hearing because it had not completed its insurer examinations regarding the applicant's catastrophic impairment claim.

The adjudicator granted the adjournment orally, prompting the applicant to bring a motion for the adjudicator to recuse herself based on a reasonable apprehension of bias.

The adjudicator dismissed the recusal motion, finding no evidence of bias and noting that the adjournment was necessary to ensure procedural fairness, as the respondent would otherwise be unable to defend the case.

The hearing was adjourned for 120 days.

The applicant sought $6,644.45 for a home modification assessment following a motor vehicle accident.

The respondent partially approved the assessment up to the $2,000 cap under s. 25(5)(a) of the Statutory Accident Benefits Schedule.

The applicant argued that a home modification analysis is not an assessment subject to the cap.

The Tribunal found that the home modification assessment involves an appraisal of the applicant's health status and functional limitations, and is therefore subject to the $2,000 cap.

The application was dismissed.

The applicant sought a determination that she sustained a catastrophic impairment due to mental and behavioural disorders following a 2016 motor vehicle accident.

The adjudicator found inconsistencies in the applicant's self-reporting to various assessors, including failing to disclose a post-accident trip to Hawaii, criminal charges, and a subsequent motor vehicle accident.

The adjudicator concluded the applicant failed to prove she suffered a marked impairment in three spheres of functioning.

Furthermore, the applicant failed to satisfy the 'but for' causation test, as the evidence did not establish the 2016 accident was a necessary cause of her psychological impairments.

The application was dismissed.

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

The insurer raised several preliminary issues.

The Tribunal found the applicant was barred from proceeding with disputes over four treatment plans due to her failure to attend scheduled insurer examinations, but was not barred regarding a fifth plan.

The Tribunal also held that the claim for attendant care benefits was not premature, as the insurer's failure to agree to pay constituted a dispute.

Finally, the Tribunal found the applicant was time-barred from disputing the denial of income replacement benefits and was precluded from claiming them for the period prior to submitting a disability certificate.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits.

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

The Licence Appeal Tribunal found that the applicant's physical injuries had developed into chronic pain, removing her from the MIG.

However, the Tribunal dismissed the claim for a non-earner benefit, finding the applicant was not continuously prevented from engaging in substantially all of her pre-accident activities.

The Tribunal approved treatment plans for a chronic pain program and assessment as reasonable and necessary, but denied claims for a psychological assessment and other medical expenses due to a lack of evidence of psychological impairment and failure to submit proper treatment plans.

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

The respondent denied several treatment plans for physiotherapy and psychological services, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) limit of $3,500.

The Tribunal found that the applicant did not suffer a psychological impairment that would warrant removal from the MIG, preferring the respondent's psychological assessment over the applicant's internally inconsistent expert report.

As the applicant had exhausted the $3,500 limit, the claims for additional treatment plans, a disability certificate, an award, and interest were dismissed.

The applicant requested a reconsideration of a decision that dismissed his claims for catastrophic impairment, attendant care benefits, and medical and rehabilitation benefits following a motor vehicle accident.

The applicant argued the adjudicator erred by allowing the respondent's psychiatric expert to testify outside the scope of her report, by limiting the evidence of the applicant's chiropractor regarding psychological impairments, and by failing to properly consider the meaning of 'useful function'.

The adjudicator dismissed the reconsideration request, finding no errors of law or fact.

The adjudicator held that the respondent's expert evidence was latent in her report, the chiropractor was not qualified to opine on psychological impairments, and the applicant was improperly attempting to relitigate findings of fact.

The applicant sought a determination that her accident-related impairments met the catastrophic impairment definition under the Statutory Accident Benefits Schedule, together with various accident benefits, interest, and an award.

The Tribunal applied the Sabadash causation analysis and the Pastore three-step framework for mental and behavioural catastrophic impairment claims.

Although the adjudicator accepted that the applicant suffered some psychological impairment related to the accident, the evidence was found to establish only moderate, not marked or extreme, impairment in concentration, persistence and pace, and adaptation, with significant functional limitations attributed to pain and unrelated life stressors.

The catastrophic impairment claim failed, the remaining benefits were found not payable, no interest or award was granted, and the insurer’s costs request was refused.

The applicant sought a medical benefit of $2,680.00 for a chronic pain assessment following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant had a significant history of chronic pain prior to the accident, and there was no evidence that the accident exacerbated this pre-existing condition.

Consequently, the Tribunal concluded that the proposed assessment was not reasonable or necessary as it was not related to the subject accident.

The application was dismissed, and no interest was payable.

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

The respondent initially placed the applicant in the Minor Injury Guideline but later removed him.

The Tribunal found that proposed chiropractic treatments were not reasonable and necessary, as the applicant had reached maximum medical recovery and past treatments provided little relief.

However, the Tribunal approved a chronic pain assessment, finding it reasonable and necessary because the applicant met the AMA Guides criteria for chronic pain syndrome and had been diagnosed with chronic pain by multiple practitioners.

Claims for a special award and costs were dismissed.

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

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

The Tribunal found that the applicant's physical injuries were predominantly soft-tissue strains and that she failed to establish on a balance of probabilities that she suffered from a psychological impairment or chronic pain that would warrant removal from the MIG.

As the applicant had exhausted the $3,500 MIG limit, the disputed treatment plans for chiropractic services and a psychological assessment were not payable.

The application was dismissed, and claims for an award and interest were denied.

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

The parties settled the issues in dispute on a full and final basis prior to the conclusion of the hearing.

The Tribunal closed the file.

The respondent insurer raised a preliminary issue arguing the applicant was barred from proceeding with her claim for home modification benefits because she failed to attend scheduled insurer examinations (IEs) under section 44 of the Statutory Accident Benefits Schedule.

The applicant argued the IE notices were deficient and that the insurer could not request an IE after the LAT application was filed.

The Tribunal found that while the first IE notice was deficient, the second and third notices complied with the Schedule.

The Tribunal also held that an insurer is not precluded from requesting an IE after a LAT application is filed.

Because the applicant failed to provide a reasonable explanation for her non-attendance at the validly scheduled IEs, she was barred from proceeding under section 55 of the Schedule, and her application was dismissed.