OLAT 2023

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

The respondent denied the claims, asserting the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant failed to provide sufficient medical evidence to warrant removal from the MIG, and thus the disputed medical and rehabilitation benefits were not reasonable and necessary.

However, the Tribunal found the respondent failed to comply with the notice requirements under s. 36(4) of the Schedule regarding the non-earner benefit.

Consequently, the applicant was awarded the non-earner benefit for the period of non-compliance, along with interest.

The Tribunal also ordered a $500 award against the respondent under s. 10 of O. Reg. 664 for unreasonably delaying the non-earner benefit payment.

The applicant sought repayment of income replacement benefits (IRBs) that the insurer had suspended and deducted due to an alleged overpayment and non-compliance with requests for post-accident income information.

The Tribunal found that while the insurer could not rely on section 287 of the Insurance Act or section 52 of the Schedule to unilaterally reduce benefits based on an alleged error without an agreement or order, it was entitled to suspend benefits under section 33 of the Schedule due to the applicant's failure to provide requested income documentation.

The applicant's claims for repayment and a special award were dismissed.

The respondent insurer requested a reconsideration of a previous Licence Appeal Tribunal decision, arguing the Tribunal erred in fact and law and exceeded its jurisdiction by adjudicating the applicant's entitlement to and quantum of income replacement benefits (IRB) at and beyond age 65.

The Tribunal agreed, finding that IRB entitlement was never in dispute and that the insurer had not yet made a determination on post-65 benefits.

The Tribunal granted the reconsideration, varying the previous decision to remove references to entitlement and post-65 IRB, while maintaining the applicant's ongoing IRB entitlement subject to the Insurance Act.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and a psychological assessment outside the Minor Injury Guideline (MIG).

The insurer denied the benefits, arguing the injuries were predominantly minor.

The Tribunal found the applicant's medical evidence unpersuasive and preferred the respondent's insurer's examination report, which concluded the injuries were minor soft-tissue injuries with no exacerbating pre-existing conditions.

The Tribunal held the applicant's injuries fell within the MIG and dismissed the application for the disputed treatment plans and interest.

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

The respondent argued the applicant was statute-barred from proceeding with his claim for psychological services because he failed to commence his application within two years of the denial, and statute-barred from claiming other medical benefits because he failed to attend a scheduled independent examination under s. 44 of the Schedule.

The Tribunal found the applicant failed to provide evidence justifying an extension of the limitation period under s. 7 of the LAT Act and failed to establish that his heart surgery prevented him from attending the independent examination.

The application was dismissed as statute-barred.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit.

A three-day videoconference hearing was scheduled, but the applicant failed to attend despite receiving notice.

The Tribunal proceeded in the applicant's absence pursuant to s. 7(3) of the Statutory Powers Procedure Act.

As the applicant tendered no evidence and made no submissions, he failed to meet his onus of proof.

The application was dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought entitlement to four treatment plans (OCF-18s) for chiropractic and kinesiology treatment totaling over $12,000.

The respondent denied the plans based on an insurer's examination which concluded the treatment was not reasonable and necessary.

The Tribunal found that the applicant had already received extensive physical therapy with minimal improvement, and that the proposed treatment was excessive and unlikely to achieve its stated goals.

The Tribunal also noted inconsistencies in the applicant's evidence regarding his post-accident limitations.

The application for the treatment plans was dismissed.

The applicant insurer sought repayment of $8,909.00 from the respondent, alleging the motor vehicle incident was staged and the respondent wilfully misrepresented the facts to claim statutory accident benefits.

The respondent did not participate in the hearing.

The Tribunal found that the incident was staged based on the respondent's own admission during an Examination Under Oath and a forensic reconstruction report.

Consequently, the respondent was not involved in an 'accident' and engaged in wilful misrepresentation.

However, the Tribunal held that the insurer's investigative fees did not constitute 'benefits' under s. 52 of the Schedule and were not subject to repayment.

The respondent was ordered to repay only $200.00 for form completion costs.

The insurer's request for costs was denied.

The applicant sought statutory accident benefits for chiropractic services following a rear-end motor vehicle accident.

The insurer denied the treatment plan, relying on an insurer's examination which concluded the injuries were minor and had resolved.

The Tribunal found that the applicant failed to prove the treatment was reasonable and necessary, noting a significant gap in medical treatment.

The application for benefits, along with claims for an award and interest, was dismissed.

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 rheumatoid arthritis, psychological impairments, and chronic pain.

The Tribunal found the applicant's rheumatoid arthritis was in remission and did not prevent maximal recovery.

The Tribunal preferred the respondent's expert evidence, concluding the applicant did not suffer from a psychological impairment or chronic pain syndrome that would warrant removal from the MIG.

The applicant's physical injuries were deemed predominantly minor.

The disputed treatment plans were deemed reasonable and necessary only up to the remaining MIG limits.

The applicant's claim for a special award was dismissed for failing to provide particulars.

The applicant sought accident benefits for a motor vehicle accident that occurred on March 21, 1999.

The respondent insurer first became aware of the accident on July 23, 2020, over 20 years later.

The respondent brought a preliminary issue hearing arguing the applicant was statute-barred from proceeding for failing to submit an application for benefits within the prescribed timelines.

The Tribunal found that the applicant failed to notify the respondent within 30 days of the accident and failed to submit an OCF-1 application within the prescribed timelines.

The applicant did not provide a reasonable explanation for the delay.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a chiropractic treatment plan and a chronic pain assessment.

The insurer denied the benefits, arguing they were not reasonable and necessary.

The Licence Appeal Tribunal found that the chiropractic treatment plan was not reasonable and necessary, as the applicant had already received similar treatment for two years with little improvement.

However, the Tribunal found the chronic pain assessment was reasonable and necessary as a diagnostic tool to evaluate the applicant's ongoing pain symptoms following hand fractures sustained in the accident.

The applicant was awarded the cost of the chronic pain assessment plus interest.

The applicant sought statutory accident benefits following a 2007 motor vehicle accident.

The Tribunal dismissed the application in its entirety.

The claim for an income replacement benefit was barred because the applicant failed to provide the respondent with requested financial information regarding her self-employment income for over a decade, without a reasonable explanation.

The claims for various medical and rehabilitation benefits, including physiotherapy and vocational training, were dismissed because the applicant failed to submit the required treatment plans (OCF-18s) to the respondent via the Health Claims for Auto Insurance (HCAI) system, as required by the Statutory Accident Benefits Schedule and the FSCO Guidelines.

Both parties' requests for costs were denied.

The appellant appealed the suspension of her driver's licence by the Registrar of Motor Vehicles.

The suspension was based on a physician's report diagnosing the appellant with an uncontrolled substance use disorder involving alcohol and cannabis.

The appellant denied the diagnosis but provided no medical evidence to contradict the physician's report.

The Tribunal found that the appellant has a substance use disorder that is likely to significantly interfere with her ability to drive safely and confirmed the Registrar's decision to suspend the licence.

The appellant appealed the 45-day impoundment of her motor vehicle under the Highway Traffic Act, arguing that the driver at the time of impoundment was not suspended and that the impoundment caused exceptional hardship.

The Tribunal found the appellant failed to prove on a balance of probabilities that her stepsister, rather than the suspended driver, was operating the vehicle.

The Tribunal also found the appellant failed to demonstrate that no alternatives to the impounded vehicle were available, as she was able to use public transit, taxis, and ride-sharing to commute to work.

The appeal was dismissed and the impoundment confirmed.

The applicant sought reconsideration of a Licence Appeal Tribunal decision finding he was not catastrophically impaired.

The applicant argued the Tribunal erred by failing to decide on his diagnosis, omitting mention of a psychiatric report, and failing to account for his reports of pain in assessing his psychological impairments.

The Tribunal denied the request, finding no errors of fact or law that would have altered the outcome.

Even when explicitly considering the applicant's pain disorder under the Pastore framework, the evidence demonstrated at most a moderate impairment in adaptation, falling short of the marked impairment required for a catastrophic designation.

The respondent's cross-request to reconsider a costs award for interfering with a witness was also dismissed.

The applicant sought a non-earner benefit of $185 per week following a motor vehicle accident, along with interest and costs.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to submit a completed disability certificate (OCF-3) supporting his entitlement, as required by section 36 of the Statutory Accident Benefits Schedule.

Furthermore, the Tribunal held that the applicant failed to prove on a balance of probabilities that his accident-related impairments continuously prevented him from engaging in substantially all of his pre-accident activities.

The appellant appealed a Notice of Proposal to revoke her registration as a real estate salesperson.

The Registrar alleged that the appellant engaged in a campaign of abuse and harassment against former business partners and other registrants, resulting in criminal charges which she failed to disclose as required.

The Tribunal found that the appellant's past conduct, including sending vile and threatening messages, breaching release conditions, and attempting to influence witness testimony, afforded reasonable grounds for the belief that she would not carry on business in accordance with the law and with integrity and honesty.

The Tribunal ordered the Registrar to carry out the proposal to revoke the appellant's registration.

The appellant appealed the 45-day impoundment of its commercial motor vehicle under section 50.2 of the Highway Traffic Act on the ground of exceptional hardship.

The vehicle was impounded after police discovered it being driven by an individual with a suspended licence who was test-driving the vehicle for a potential buyer.

The Licence Appeal Tribunal dismissed the appeal, finding that the appellant owned multiple other vehicles and failed to demonstrate that there were no alternatives to the impounded vehicle available, which is a mandatory prerequisite for establishing exceptional hardship.

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

The insurer raised a preliminary issue that the claim was statute-barred because the applicant failed to submit a Disability Certificate (OCF-3) within 104 weeks of the accident and failed to dispute the denial within the two-year limitation period.

The Tribunal found that the applicant did not submit a qualifying OCF-3 until over four years after the accident and failed to appeal the denial within two years.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act, finding the delay unreasonable and prejudicial to the insurer.

The claim for non-earner benefits was dismissed as statute-barred.