OLAT 2023

The applicant requested a reconsideration of a Tribunal decision that denied her entitlement to post-104 week income replacement benefits (IRBs).

The applicant argued the Tribunal made errors of law and fact, including misapprehending the medical reasons for the IRB stoppage, failing to consider both physical and psychological impairments, and failing to quantify her entitlement.

The Tribunal dismissed the request, finding no errors of law, fact, or procedural fairness that would have changed the outcome.

The Tribunal also rejected the applicant's attempt to introduce a recent Court of Appeal decision as new evidence, noting that case law does not constitute evidence under the reconsideration rules.

The applicant sought reconsideration of a decision finding he made a material misrepresentation on his automobile insurance application, which excluded him from income replacement benefits and required him to repay $72,881.74 to the insurer.

The applicant argued the Tribunal lacked jurisdiction, violated procedural fairness, made factual errors, and that new evidence was available.

The adjudicator dismissed the request, finding no procedural unfairness, confirming the Tribunal's jurisdiction over the dispute, and concluding the applicant was improperly attempting to relitigate the initial findings.

The adjudicator also held that the alleged new evidence could have been obtained prior to the initial hearing with due diligence.

The applicant sought statutory accident benefits following a motor vehicle accident, including chiropractic services, a home exercise program, a psychological assessment, and a chronic pain assessment.

The adjudicator found that the applicant failed to prove the chiropractic services, home exercise program, and chronic pain assessment were reasonable and necessary.

The adjudicator rejected the applicant's argument that the treatment plans were payable due to the respondent's late denial notices, holding that the expenses had not been incurred prior to the notices being delivered.

The psychological assessment was found payable in part, and the claims for a special award and costs were dismissed.

The appellant requested a reconsideration of a Tribunal decision confirming the 45-day impoundment of her motor vehicle.

The vehicle was impounded after her partner drove it while subject to an ignition interlock condition.

The appellant sought reconsideration based on new evidence of financial and emotional hardship.

The Tribunal denied the request, finding that the new evidence would not have affected the original result because the appellant had failed to demonstrate that there were no reasonable alternatives to the impounded vehicle.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his injuries, including pulsatile tinnitus, warranted treatment beyond the $3,500 Minor Injury Guideline (MIG) limit.

The Licence Appeal Tribunal found insufficient medical evidence to substantiate the tinnitus or prove it was caused by the accident.

Relying on independent medical examinations, the Tribunal concluded the applicant's physical injuries were uncomplicated soft tissue injuries that fell within the MIG.

The disputed chiropractic treatment plans were deemed neither reasonable nor necessary, and the application was dismissed.

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

The insurer denied benefits and scheduled insurer examinations under section 44 of the Schedule.

The applicant failed to attend the scheduled examinations and provided no medical evidence or reasonable explanation for her non-attendance.

The Tribunal found that the insurer provided proper notice and that the applicant's failure to attend prejudiced the insurer's ability to assess the claims.

Consequently, the applicant is statute-barred from proceeding with her application pursuant to section 55(1)2 of the Schedule.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's denial of multiple treatment plans for occupational therapy and physiotherapy.

The Tribunal found the applicant was barred from proceeding with the occupational therapy claim due to her unjustified non-attendance at a reasonably necessary insurer's examination.

The Tribunal denied three general physiotherapy plans for lack of supporting medical evidence, but approved a vestibular physiotherapy plan specifically recommended by a concussion clinic to address ongoing neurological symptoms.

Claims for a bad faith award and costs were dismissed.

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 applicant argued that pre-existing psychological conditions and chronic pain warranted removal from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence that his pre-existing conditions prevented maximal recovery under the MIG.

The Tribunal accepted the respondent's medical assessment that the injuries were predominantly minor.

The application for additional physiotherapy and interest was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to four treatment plans for medical devices, a physiatry assessment, and massage and chiropractic treatments.

The respondent insurer denied the benefits based on insurer's examinations.

The Tribunal found that the applicant demonstrated the treatment plans were reasonable and necessary, supported by consistent medical evidence including MRI results showing a rotator cuff tear.

The Tribunal also found the insurer failed to provide sufficient medical reasons for denying the medical devices plan under s. 38(8) of the Schedule.

The applicant was awarded the treatment plans and interest, but the claim for an award under s. 10 of O. Reg. 664 was dismissed as the insurer's conduct amounted to a difference of medical opinion rather than unreasonable behaviour.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits and a treatment plan for an ocular assessment.

The Licence Appeal Tribunal dismissed the application.

The adjudicator found the applicant failed to prove that the attendant care services provided by her mother were 'incurred' under s. 3(7)(e) of the Schedule, as no evidence of economic loss was provided.

Furthermore, the proposed ocular assessment was deemed not reasonable and necessary, as it was recommended by a chiropractor outside their scope of practice and unsupported by the applicant's treating specialists or the respondent's s. 44 neurological assessment.

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

The respondent insurer denied benefits and argued the applicant was barred from proceeding before the Tribunal under section 55(1)2 of the Schedule for failing to attend insurer examinations.

The Tribunal found the notices for the non-earner benefit examinations were compliant and the applicant lacked a reasonable excuse for non-attendance, barring her claim for that benefit.

However, the notices for the physiotherapy and chiropractic treatment plans were found to be deficient, meaning the applicant was not barred from proceeding with those claims.

The applicant was injured in a rear-end motor vehicle accident and sought a non-earner benefit and funding for rehabilitation therapy under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal found the applicant was not entitled to a non-earner benefit because she did not suffer a complete inability to carry on a normal life, as she continued to care for her animals, perform chores, and socialize.

However, the Tribunal granted the claim for rehabilitation therapy, finding it reasonable and necessary to assist with community reintegration and anxiety, and awarded interest on the overdue payment.

The applicant sought statutory accident benefits but withdrew his application after the respondent filed its submissions.

The respondent sought costs, arguing the applicant acted unreasonably and withheld information.

The Tribunal denied the costs request because it failed to specify the amount requested or the number of days of attendance, as required by Rule 19.3 of the Common Rules of Practice and Procedure.

The application was dismissed and the file closed.

The applicant was involved in a motorcycle accident and sustained a traumatic brain injury.

He applied for a catastrophic impairment determination under Criterion 4 of the Statutory Accident Benefits Schedule, relying on the Extended Glasgow Outcome Scale (GOS-E).

The adjudicator found that the applicant met the threshold for a lower moderate disability, primarily due to his inability to return to work in his previous capacity, and thus qualified for catastrophic impairment status.

The adjudicator also awarded partial attendant care benefits and approved several treatment plans for occupational therapy, psychological services, and a laptop, while denying other claimed medical benefits and a claim for a special award.

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

The respondent denied several treatment plans, arguing that the applicant's right ankle fracture was caused by a subsequent fall and relying on section 44 assessments to deny other treatments.

The Tribunal found that the right ankle fracture was caused by the accident.

The Tribunal also found the treatment plans for an ADL assessment, physiotherapy, and a neurological assessment were reasonable and necessary, noting the respondent's assessors failed to review the complete medical file.

Furthermore, the Tribunal ordered payment for psychological services because the respondent failed to provide a compliant denial notice under section 38(8) of the Schedule.

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

The insurer denied several treatment plans for physiotherapy, psychological services, and a chronic pain assessment, arguing the applicant's physical injuries fell within the Minor Injury Guideline (MIG) and the psychological treatment plans were excessive.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove that his pre-existing conditions or accident-related physical injuries precluded maximal recovery within the MIG.

The Tribunal preferred the insurer's expert evidence, which found no objective physical impairments and concluded the proposed psychological treatments and chronic pain assessment were not reasonable and necessary.

The applicant was struck by a vehicle while riding her bicycle and sought statutory accident benefits.

The insurer terminated her income replacement benefits (IRBs) and denied a physiotherapy treatment plan.

The Tribunal found the applicant was entitled to post-104-week IRBs, as her cognitive impairments, fatigue, and required pacing strategies rendered her completely unable to engage in any employment for which she was reasonably suited.

However, the Tribunal denied the physiotherapy treatment plan, finding no ongoing physical impairments that necessitated it.

The claim for an award for unreasonable delay was also dismissed, as the insurer reasonably relied on its assessors' medical opinions.

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

The respondent denied the income replacement benefit and raised a preliminary issue that the applicant failed to submit a Disability Certificate (OCF-3) within the prescribed time.

The Tribunal found that the applicant did not submit the OCF-3 and provided no reasonable explanation for the delay.

Consequently, under the Statutory Accident Benefits Schedule, the applicant was barred from proceeding to a hearing for the income replacement benefit.

The application was dismissed.

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

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 doctrine of res judicata applied, as a previous Tribunal decision had already determined the applicant's injuries were minor.

The applicant failed to provide fresh evidence that would conclusively impeach the original results or demonstrate a deterioration in his condition.

Consequently, the application for benefits, an award, and interest was dismissed.

The respondent's request for costs was also denied.

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

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

The applicant argued for removal from the MIG due to psychological impairments, chronic pain, and headaches.

The Tribunal found that the applicant's psychological symptoms were subclinical, there was no evidence of functional impairment from chronic pain, and the headaches did not warrant removal from the MIG.

The application was dismissed, and the disputed treatment plans and interest were denied.