OLAT 2023

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries fell outside the Minor Injury Guideline (MIG) due to pre-existing conditions and psychological impairments.

The Tribunal found the applicant failed to establish a pre-existing condition that would preclude recovery within the MIG, noting a lack of supporting medical evidence and relying on uncontradicted insurer's examination reports.

The Tribunal also rejected the applicant's claim of psychological impairment, placing no weight on a pre-screening report based solely on self-reporting.

The application was dismissed, and the applicant was found not entitled to the disputed treatment plans or interest.

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

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

The Tribunal found that the applicant suffers from chronic pain syndrome, removing him from the MIG and entitling him to $65,000 in medical and rehabilitation benefits.

However, the Tribunal dismissed the claim for a non-earner benefit, finding the applicant did not suffer a complete inability to carry on a normal life.

The Tribunal also denied the proposed chiropractic and massage therapy services but granted the cost of a chronic pain assessment.

The applicant sought income replacement benefits and a physiotherapy treatment plan following a motor vehicle accident.

The adjudicator dismissed the application, finding that the applicant failed to meet her burden of proof.

The applicant provided no objective medical evidence, such as clinical notes or an OCF-18, to support her claims.

She relied solely on a psychological report that did not address her ability to work or need for physiotherapy.

Conversely, the respondent's medical examiners opined that the applicant did not suffer a substantial inability to perform her employment tasks and that the treatment was not reasonable and necessary.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found her injuries were predominantly minor and subject to the Minor Injury Guideline.

The applicant argued the Tribunal violated procedural fairness by assigning the same adjudicator to the reconsideration, made errors of fact and law in weighing the evidence, and sought to introduce new medical evidence.

The Tribunal dismissed the request, finding no procedural unfairness in its assignment practices, no errors in the original weighing of evidence, and that the applicant failed to demonstrate why the new evidence could not have been obtained prior to the original hearing.

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

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

The Tribunal found that the applicant sustained predominantly soft-tissue injuries and failed to establish a pre-existing condition or chronic pain syndrome that would warrant removal from the MIG.

However, the Tribunal ordered the insurer to pay for goods and services incurred under one treatment plan because the insurer failed to provide a compliant denial notice within the required 10-business-day period under section 38 of the Schedule.

The appellant appealed a Notice of Proposal to Refuse to Renew Registration issued by the Registrar under the Collections and Debt Settlement Services Act for failing to provide required financial statements.

The parties resolved the dispute and consented to an order renewing the registration subject to conditions.

The Tribunal disposed of the proceeding without a hearing under section 4.1 of the Statutory Powers Procedure Act, ordering the renewal of the registration with conditions requiring the appellant to provide monthly trust account statements for two years and reviewed or audited financial statements annually for four years.

The applicant sought a determination that he sustained a catastrophic impairment due to a traumatic brain injury following a motor vehicle accident.

The Tribunal found that the applicant's medical reports, which relied on a GOS-E assessment conducted by an occupational therapist and a psychiatrist, failed to comply with the Statutory Accident Benefits Schedule.

The Tribunal preferred the respondent's neuropsychological assessment, which concluded the applicant's ability to drive negated a finding of Lower Moderate Disability.

The application was dismissed.

The applicant requested a reconsideration of a decision finding he did not sustain a catastrophic impairment from a motor vehicle accident.

The applicant argued the adjudicator violated procedural fairness by relying on hearsay evidence from medical reports and erred in finding his expert witness recanted his opinion.

The Tribunal dismissed the request, finding no breach of procedural fairness as the hearsay evidence was only one of many factors considered and the applicant had the opportunity to cross-examine on it.

The Tribunal also found no error regarding the expert witness, who admitted during cross-examination that his opinion was inaccurate because he had not reviewed crucial medical records that contradicted the applicant's self-reports.

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 Tribunal found that the applicant sustained predominantly minor injuries, noting a lack of objective evidence for ongoing physical or psychological impairments beyond the MIG.

The disputed treatment plans for physiotherapy and a psychological assessment were deemed not reasonable or necessary.

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

The applicant sought statutory accident benefits for psychological injuries sustained after her husband was struck by a vehicle insured by the respondent.

The respondent denied the claim on the basis that the applicant was not an 'insured person' under section 3(1) of the Schedule.

The Tribunal found that the applicant was not a named insured, specified driver, or spouse of a named insured under the policy.

Furthermore, the Tribunal applied the purpose and causation tests, concluding that the applicant's injuries arose from caring for her husband rather than the direct use or operation of an automobile.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought post-104 weeks income replacement benefits (IRBs), arguing she suffered a complete inability to engage in suitable employment.

The Tribunal preferred the respondent's expert evidence, finding the applicant retained the functional capacity for sedentary work and did not meet the complete inability test.

The Tribunal also held that the respondent correctly deducted the applicant's maternity leave Employment Insurance benefits from her pre-104 weeks IRBs, as they constitute gross employment income under the Schedule.

Finally, the Tribunal dismissed the claim for a special award, finding the respondent's handling of the claim and temporary stoppages of benefits pending further medical information were not unreasonable.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to several treatment plans for psychological and chiropractic services, as well as a chronic pain assessment.

The respondent 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 prove their injuries warranted removal from the MIG, noting inconsistencies between the applicant's chronic pain assessment, their own submissions, and their family physician's clinical notes.

As the $3,500 MIG limit had been exhausted, the application for the disputed treatment plans and interest was dismissed.

The applicant requested a reconsideration of a preliminary issue decision which found that the Settlement Disclosure Notice (SDN) was not defective.

The applicant argued that the Tribunal made errors of law and fact regarding the onus of proof and the compliance of the SDN with Regulation 664.

The adjudicator dismissed the request, finding that the applicant was attempting to re-argue her case and failed to establish any error of law or fact that would meet the high threshold for reconsideration.

The applicant sought statutory accident benefits after falling while exiting her parked vehicle.

She required assistance due to polio and fell when her right leg collapsed while shuffling away from the van with her husband.

The respondent denied benefits on the basis that the incident was not an 'accident' under s. 3(1) of the Schedule.

The Licence Appeal Tribunal applied the purpose and causation tests, finding that while parking is an ordinary use of a vehicle, the use or operation of the automobile did not directly cause the injuries.

The intervening cause was the applicant's leg collapsing, which was the dominant feature of the incident.

The application was dismissed.

The applicant sought statutory accident benefits following a 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 psychological impairments, including driving-related anxiety and depression, warranted removal from the MIG, preferring the applicant's psychological expert over the respondent's.

However, the Tribunal dismissed the claims for the specific disputed treatment plans because the applicant failed to provide the actual treatment plans (OCF-18s) or make submissions demonstrating that the proposed treatments were reasonable and necessary.

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

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

The Tribunal found that the applicant's pre-existing and accident-related psychological conditions warranted removal from the MIG.

The Tribunal ordered the respondent to pay for several psychological and social work assessments and treatments, as well as one chiropractic treatment plan, finding them reasonable and necessary.

The Tribunal also ordered a $1,000 special award under s. 10 of O. Reg. 664, finding that the respondent unreasonably maintained the applicant in the MIG despite its own assessor's opinion to the contrary.

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

The insurer initially denied the claim but failed to provide sufficient medical or other reasons in its denial letter, violating s. 36(4)(b) of the Schedule.

The Tribunal found the applicant was entitled to NEB for the period between the application and the date a compliant notice was finally provided.

However, the applicant failed to prove a complete inability to carry on a normal life for the remainder of the period, as the medical evidence was largely subjective and inconsistent.

The Tribunal awarded a 10% special award under s. 10 of O. Reg 664 due to the insurer's unreasonable withholding of benefits through defective notice.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming funding for psychological services and a catastrophic impairment assessment.

The respondent denied the claims on the basis that they were not reasonable and necessary.

The Tribunal found that the respondent provided sufficient medical reasons for its denials and complied with the notice requirements under the Schedule.

The Tribunal concluded that the applicant failed to meet his evidentiary burden to prove the treatments and assessments were reasonable and necessary, particularly given the lack of response to prior psychological treatment and the absence of evidence supporting a neurological impairment.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a concussion, psychological injuries, and exacerbation of a pre-existing condition that warranted removal from the Minor Injury Guideline (MIG).

The respondent denied the claims, relying on insurer examinations which concluded the injuries were predominantly minor.

The Tribunal found the applicant failed to provide sufficient medical evidence, such as a formal diagnosis or neurological testing, to prove she suffered a concussion or other non-minor injuries.

The Tribunal concluded the applicant's injuries fell within the MIG, dismissing her claims for treatment plans outside the $3,500 limit, interest, and a special award.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident.

The respondent brought a motion to bar the application on the basis of res judicata, arguing the Tribunal had already determined in a prior proceeding that the accident did not cause the applicant's physical impairments.

The Tribunal found that the four preconditions for res judicata were met and no exceptions applied.

The application was dismissed, and the applicant's request for costs was denied.