OLAT 2024

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and reimbursement for prescription medication.

The Licence Appeal Tribunal dismissed the application.

The Tribunal found the applicant was not entitled to an IRB in the first 104 weeks because her pre-accident self-employment resulted in a business loss, entitling her to $0.00.

For the post-104-week period, social media evidence demonstrated the applicant had returned to her self-employment activities as an art teacher.

Claims for prescription medication were also dismissed as the medical records showed the prescriptions were for unrelated conditions or a subsequent accident.

The applicant sought accident benefits for a physiotherapy treatment plan following a motor vehicle accident.

The respondent denied the treatment plan, and the applicant argued the denial notice was non-compliant with s. 38(8) of the Schedule because it was late and lacked sufficient medical reasons.

The Tribunal found that while the notice was one day late, it provided sufficient medical reasons.

Applying the Divisional Court's decision in Catic, the Tribunal held the treatment plan was not payable under s. 38(11) because the expenses were not incurred during the one-day period of non-compliance.

The application was dismissed.

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

The matter proceeded to a written hearing, but the applicant failed to file any submissions or evidence and did not request an extension.

The Tribunal found that the applicant failed to meet the onus of demonstrating removal from the Minor Injury Guideline or entitlement to the disputed assessments, an award, and interest.

The application was dismissed.

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

The respondent denied benefits and requested the applicant attend insurer's examinations under s. 44 of the Schedule.

The applicant failed to attend, citing mental health issues, but provided no medical evidence to support her claim.

The Tribunal found the applicant failed to establish a medical condition rendering her unable to attend the examinations and declined to exercise its discretion to permit the application to proceed.

The application was dismissed pursuant to s. 55 of the Schedule.

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

The respondent denied several treatment plans 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 for removal from the MIG due to a pre-existing back condition, chronic pain, and psychological impairments.

The Tribunal found the applicant failed to provide compelling evidence of a pre-existing condition precluding recovery within the MIG, largely due to non-compliance with production orders.

The Tribunal also preferred the respondent's in-person medical assessments over the applicant's virtual assessments, concluding the applicant did not suffer from chronic pain or a psychological impairment caused by the accident.

The application was dismissed.

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 failed to provide substantive evidence to warrant removal from the MIG.

However, the Tribunal ordered the insurer to pay for a psychological assessment and a psychological pre-screening because the insurer failed to provide compliant denial notices under s. 38(8) of the Schedule before the expenses were incurred.

The remaining treatment plans were denied as they were not incurred prior to the insurer issuing compliant denial notices.

The respondent insurer requested a reconsideration of a Tribunal decision that ordered it to pay for a catastrophic impairment determination assessment.

The insurer argued the Tribunal erred in law by strictly interpreting s. 38(8) of the Schedule to require a medical reason for denying the treatment plan, and by ordering payment of the full proposed amount rather than only the incurred costs under s. 38(11)2.

The Tribunal dismissed the first ground, affirming that s. 38(8) requires insurers to provide a medical reason in addition to any other reasons for denial.

However, the Tribunal granted the reconsideration in part on the second ground, varying the original order to clarify that the insurer's liability under s. 38(11)2 is limited to the $6,780.00 actually incurred by the applicant.

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

The respondent denied several treatment plans for physiotherapy 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 that the MIG no longer applied because the treatment plans were submitted outside the 12-week timeframe, and alternatively, that he should be removed from the MIG due to chronic pain and psychological impairments.

The Tribunal found that the applicant failed to establish accident-related impairments warranting removal from the MIG.

The Tribunal also rejected the applicant's argument that the respondent's initial non-compliant notices rendered the treatment plans payable, as the respondent subsequently provided a compliant notice and no services were incurred during the period of non-compliance.

The application was dismissed.

The appellant appealed a decision by Tarion Warranty Corporation regarding compensation for an unauthorized substitution of a front door by the builder.

The builder installed a smaller doorframe with a transom window instead of the agreed-upon wider doorframe with a side light window.

Tarion initially awarded $195.09, representing the difference in material cost.

The Tribunal found that the transom window was not an equivalent substitution and that the proper measure of damages was the cost to replace the doorframe to accommodate the originally agreed-upon side light door.

The Tribunal ordered Tarion to pay the appellant $8,907.45 plus HST, based on an estimate provided by Tarion's estimator.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision regarding her entitlement to attendant care benefits.

She argued the Tribunal made errors of law by finding it lacked jurisdiction to determine the rate for attendant care, by applying the ratio method to calculate payments, and by breaching procedural fairness through inadequate reasons.

The adjudicator dismissed the request, finding no errors of law or breaches of procedural fairness, as the original decision correctly applied the statutory scheme and provided sufficient reasons for its findings.

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

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

The applicant argued for removal from the MIG based on a pre-existing right shoulder injury, multiple morbidities, and chronic pain.

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

Furthermore, applying the AMA Guides, the Tribunal concluded the applicant did not demonstrate chronic pain with functional impairment.

The disputed treatment plans for chiropractic services and the cost of an OCF-3 were deemed not reasonable and necessary.

The application was dismissed.

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

The respondent 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 physical injuries were soft tissue in nature and that she failed to establish a psychological impairment that would remove her from the MIG.

Because the MIG limit was exhausted and the respondent's denial notices complied with the Schedule, the applicant was not entitled to the disputed treatment plans.

The appellant appealed the 45-day impoundment of her vehicle after it was stopped while being driven by an individual with a suspended licence.

The Tribunal found that the appellant failed to exercise due diligence, as she did not properly review the driver's licence renewal document or check his licence status.

The Tribunal also found that the impoundment would not result in exceptional hardship, as the appellant had access to reasonable transportation alternatives, including her son's vehicle and assistance from friends.

The impoundment order was confirmed.

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

The insurer denied 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 knee condition, which included degenerative osteoarthritis and meniscus tears, was exacerbated by the accident, precluding recovery within the MIG.

The Tribunal ordered the applicant removed from the MIG and approved the disputed treatment plans for chiropractic services, along with interest on overdue payments.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and several treatment plans.

The Licence Appeal Tribunal dismissed the application.

The Tribunal found the applicant was excluded from receiving a non-earner benefit under s. 31(1)(a)(ii) of the Schedule because she was driving with a suspended licence at the time of the accident.

The claims for treatment plans were also dismissed as the applicant failed to provide sufficient medical evidence to prove they were reasonable and necessary.

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

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

The applicant argued for removal from the MIG due to chronic pain and a pre-existing degenerative disc disease.

The Tribunal found the applicant did not meet the burden of proving chronic pain syndrome or that a pre-existing condition precluded recovery within the MIG.

As the MIG limits were exhausted, the disputed treatment plans were not payable.

The Tribunal also found that a procedurally defective denial of one treatment plan did not render it payable because the expenses were incurred before the plan was submitted.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to non-earner benefits and various treatment plans outside the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on pre-existing conditions, chronic pain, and psychological impairments.

The Tribunal found that the applicant failed to prove on a balance of probabilities that his injuries warranted removal from the MIG, preferring the respondent's insurer examination reports which found no compelling evidence of chronic pain or a psychological condition.

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

The application was dismissed in its entirety.

The appellant appealed a decision by Tarion Warranty Corporation regarding compensation for warranted defects in her condominium's bathrooms.

While Tarion had already provided $19,336.62 to repair the defects, the appellant sought an additional $14,600.00 after a contractor discovered a defective shower membrane during the repair process.

The Licence Appeal Tribunal dismissed the claim for additional compensation, finding that the membrane issue was unrelated to the specific warranted items under appeal and that the compensation already provided was sufficient to address the original defects.

The appellant appealed the 45-day impoundment of its vehicle under the Highway Traffic Act, arguing that the impoundment would cause exceptional hardship to its snow removal business.

The Licence Appeal Tribunal found that the appellant failed to establish exceptional hardship because it had the alternative of hiring subcontractors to complete its snow removal contracts during the impoundment period.

The appeal was dismissed and the impoundment was confirmed.

The appellant appealed the 45-day impoundment of her vehicle, which occurred after her son was caught driving it without a valid licence.

She argued the impoundment caused exceptional hardship due to her need to attend daily medical appointments and financial constraints.

The Licence Appeal Tribunal dismissed the appeal, finding that the appellant had an alternative vehicle (a 2016 GMC truck) and occasional rides from a friend, meaning she failed to meet the statutory requirement of having no alternative transportation.