OLAT 2024

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline (MIG).

The Tribunal excluded the applicant's late-filed medical records due to non-compliance with production orders.

The Tribunal found insufficient evidence of a concussion, chronic pain, or psychological impairment to warrant removal from the MIG.

The applicant was held to the $3,500 MIG limit and was only entitled to the remaining balance of $458.67 for incurred benefits, plus interest.

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

The insurer denied the benefits, and the applicant applied to the Licence Appeal Tribunal.

The insurer raised a preliminary issue that the application was statute-barred because it was filed beyond the two-year limitation period under section 56 of the Statutory Accident Benefits Schedule.

The Tribunal found that the insurer had issued valid denial notices for all disputed benefits, triggering the limitation periods.

As the application was filed after the limitation periods expired and the applicant provided no submissions to justify an extension, the Tribunal dismissed the application as statute-barred.

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

The issues in dispute included entitlement to attendant care benefits, an award for unreasonable delay, interest, and costs.

The adjudicator found the applicant entitled to attendant care benefits at the maximum hourly rate permitted by the Guideline, totaling $745.00, rather than the higher rate claimed.

The claim for an award under s. 10 of Regulation 664 was dismissed, as the insurer's partial payment in accordance with the Guideline was not unreasonable or inflexible.

The respondent's request for costs was also dismissed, as there was no evidence the applicant acted frivolously or vexatiously.

The applicant sought income replacement benefits, medical benefits, interest, and a special award following a motor vehicle accident.

The Licence Appeal Tribunal dismissed all claims.

The Tribunal found the applicant failed to prove a substantial inability to perform the essential tasks of his employment, noting inconsistencies in his medical records, a failure to report pre-accident income, and persuasive insurer examination reports.

The claims for chiropractic, psychological, and occupational therapy treatment plans were also dismissed because the applicant failed to submit the plans into evidence and did not establish that the treatments were reasonable and necessary.

The applicant sought statutory accident benefits after falling when the driver of her hired vehicle stepped backwards into her while loading the trunk.

The respondent insurer denied benefits, arguing the incident did not meet the definition of an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal found that the applicant satisfied both the purpose and causation tests, as loading a vehicle is an ordinary use of an automobile and the driver's push was a normal incident of the risk created by such use.

The Tribunal concluded the applicant was involved in an accident and is entitled to proceed with her claim.

The applicant sought a non-earner benefit following a motor vehicle accident but failed to submit a completed disability certificate (OCF-3) until July 21, 2023.

The insurer denied the benefit for the period prior to the submission of the OCF-3.

The Licence Appeal Tribunal held that under section 36 of the Statutory Accident Benefits Schedule, no non-earner benefit is payable for any period before the OCF-3 is submitted.

The application was dismissed.

The applicant was struck by an unidentified vehicle in November 2018 but did not notify the respondent insurer until February 2022.

The respondent denied the claim for accident benefits on the basis that the applicant failed to provide notice within 7 days as required by section 32(1) of the Schedule.

The Tribunal found that the applicant did not have a reasonable explanation for the delay, noting she could have notified the Motor Vehicle Accident Claims Fund much earlier, as she had retained counsel and reported the accident to healthcare providers shortly after it occurred.

The application was dismissed as statute-barred.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to physiotherapy services, assistive devices, interest, and an award for unreasonable delay under s. 10 of Regulation 664.

The Licence Appeal Tribunal found that the applicant failed to prove the disputed treatment plans were reasonable and necessary, noting a duplication of services and lack of justification for the assistive devices.

The Tribunal also dismissed the claim for a s. 10 award, finding that the insurer did not act unreasonably in delaying the catastrophic impairment determination until it received the necessary diagnostic imaging reports.

The application was dismissed in its entirety.

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

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

The Tribunal found the applicant failed to prove his psychological injuries or insomnia warranted removal from the MIG, noting inconsistencies with treating physician records.

The Tribunal also dismissed the claim for income replacement benefits, finding insufficient evidence of the applicant's essential work tasks or how his injuries impaired his ability to perform them.

All claims for treatment plans, medication, and an award were dismissed.

The applicant sought various statutory accident benefits following a motor vehicle accident, including attendant care, occupational therapy, physiotherapy, chiropractic services, medical cannabis, and psychological services.

The Tribunal denied the claims for attendant care, occupational therapy, and physical therapies, finding the applicant's self-reporting unreliable and noting that physical therapies had previously plateaued without lasting benefit.

However, the Tribunal granted the treatment plans for medical cannabis and psychological services, finding them to be reasonable and necessary untrialed interventions for the applicant's accident-exacerbated chronic pain and adjustment disorder.

The applicant's request for costs was denied.

The applicant sought a $10,000 death benefit under the Statutory Accident Benefits Schedule following the death of her father in a motor vehicle accident.

The respondent denied the benefit on the basis that the deceased was not an insured person under his father's policy.

The Tribunal found that the applicant failed to prove the deceased was principally dependent on his father or stepmother for financial support or care.

As the deceased was not a dependent, he was not an insured person under the policy, and the applicant was not entitled to the death benefit.

The applicant sought a $10,000 death benefit from the respondent insurer following the death of her father in a motor vehicle accident.

The respondent denied the claim on the basis that the deceased was not an "insured person" under the policy issued to the applicant's mother.

The Tribunal found that the deceased was not a named insured, a specified driver, a spouse of the named insured, or a dependent of the named insured.

As the applicant failed to prove the deceased was an insured person under the respondent's policy, the application for a death benefit was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB) and chiropractic treatment.

The respondent denied the benefits and sought repayment of past IRBs, alleging wilful misrepresentation regarding the applicant's receipt of long-term disability benefits.

The Tribunal found that the applicant failed to prove entitlement to the IRB and chiropractic treatment, as the medical evidence did not establish a substantial inability to perform the essential tasks of his employment or that the treatment was reasonable and necessary.

However, the Tribunal dismissed the respondent's claim for repayment, finding that the overpayment was due to an adjuster error rather than wilful misrepresentation, and the notice of repayment was provided outside the 12-month limitation period.

Claims for interest and a special award were also dismissed.

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

The insurer denied a treatment plan for chiropractic services, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered from an accident-related psychological impairment (PTSD) that warranted removal from the MIG.

The Tribunal also found the proposed chiropractic treatment plan to be reasonable and necessary, ordering the insurer to pay the benefit with interest.

The applicant's claim for an award for unreasonable delay was dismissed.

The applicant sought statutory accident benefits following an incident where she was assaulted by her husband while driving, causing her to veer off the road and mount a curb.

The Tribunal found that the incident met the definition of an "accident" under s. 3(1) of the Schedule, as the operation of the vehicle was the dominant feature causing her psychological injuries, which exacerbated pre-existing conditions.

Consequently, the applicant's injuries were removed from the Minor Injury Guideline.

However, the applicant's claims for an income replacement benefit, various treatment plans, attendant care benefits, and a special award were dismissed because she failed to provide sufficient medical evidence or establish that the expenses were reasonable, necessary, and incurred.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident, claiming physical and psychological impairments prevented her from working.

The Tribunal reviewed conflicting medical assessments and found the applicant's presentation of pain and limitation to be inconsistent and lacking full effort.

Preferring the respondent's medical evidence, the Tribunal concluded the applicant did not suffer a substantial inability to perform the essential tasks of her employment.

The application for IRBs, interest, and a special award was dismissed.

The appellant appealed the 45-day impoundment of her vehicle, which was seized when driven by a suspended driver.

She argued the impoundment caused exceptional hardship due to her and her husband's medical conditions and mobility issues.

The Licence Appeal Tribunal dismissed the appeal, finding that reasonable alternative transportation options were available, including her husband's vehicle, ride-sharing services, public transit, and assistance from friends.

As alternatives existed, the test for exceptional hardship under the Highway Traffic Act was not met.

The applicant was injured in a motor vehicle accident and sought payment for three treatment plans for psychological services.

The insurer approved the plans but disputed the 1.5-hour session length, arguing for 1-hour sessions.

The Tribunal found the 1.5-hour sessions reasonable and necessary, noting that both the treating psychologist and the insurer's assessor agreed the applicant was improving and needed additional sessions.

The Tribunal ordered payment of the disputed balances and interest, but denied the applicant's request for a special award, finding the insurer did not act unreasonably in questioning the session length.

The applicant sought entitlement to statutory accident benefits for various treatment plans following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant was entitled to a treatment plan for physiotherapy services aimed at treating post-concussion syndrome, preferring the evidence of the applicant's assessors who conducted in-person and comprehensive evaluations over the respondent's virtual assessment.

However, the Tribunal dismissed the claims for other physiotherapy, chiropractic, massage, exercise therapy, and prescription eyewear, finding insufficient contemporaneous medical evidence to establish that they were reasonable and necessary.

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

The respondent denied the benefit and raised a preliminary issue that the applicant failed to submit a completed disability certificate (OCF-3) within 104 weeks of the accident.

The Tribunal found that the OCF-3 was not submitted until 240 weeks after the accident.

Applying the Statutory Accident Benefits Schedule, the Tribunal held that the failure to submit the OCF-3 within the 104-week period barred the claim.

The application was dismissed.