OLAT 2024

The applicant sought statutory accident benefits after slipping and falling on ice while closing his car door.

The respondent denied the claim, arguing the incident did not meet the definition of an 'accident' under the Schedule.

The Tribunal found that the incident was an accident, as the applicant was actively using his vehicle and the ice was not an intervening event.

The Tribunal also determined that the applicant's fractured elbow removed him from the Minor Injury Guideline.

However, the Tribunal dismissed the claims for an income replacement benefit and specific treatment plans because the applicant failed to provide sufficient medical evidence or copies of the treatment plans to prove entitlement.

The applicant sought statutory accident benefits following a 2019 motor vehicle accident.

The respondent insurer denied benefits and argued the applicant was barred from proceeding to the Tribunal because she failed to submit an application for benefits (OCF-1) within 30 days of receiving the forms, as required by section 32(5) of the Schedule.

The applicant claimed she had submitted the form and alternatively argued her pre-existing brain injury provided a reasonable explanation for any delay.

The Tribunal found the applicant's explanation was not credible, noting a further six-month delay in submitting the OCF-1 even after she retained counsel and was explicitly advised the form was missing.

The application was dismissed pursuant to section 55(1) of the Schedule.

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

The Tribunal found that the applicant's chronic pain condition warranted removal from the Minor Injury Guideline (MIG).

However, the applicant's claims for non-earner benefits, a psychological assessment, and a chronic pain assessment were dismissed.

The Tribunal concluded that the applicant did not suffer a complete inability to carry on a normal life, the psychological assessment was not reasonable and necessary, and the chronic pain assessment was duplicative of an OHIP-funded assessment.

Claims for interest and an award were also dismissed.

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

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

The Tribunal found that the applicant failed to provide compelling medical evidence to warrant removal from the MIG, as her physical and psychological injuries were predominantly minor.

However, the Tribunal ordered the respondent to pay for four of the disputed treatment plans because the respondent's denial notices failed to comply with the requirements of s. 38(8) of the Schedule, lacking specific medical reasons or details about the applicant's condition.

The remaining treatment plans were denied, and interest was awarded on the overdue benefits.

The applicant sought a determination that she sustained a catastrophic impairment and was entitled to attendant care benefits following a motor vehicle accident.

The Tribunal found that the applicant did not sustain a catastrophic impairment, as her psychological and physical impairments did not meet the threshold of three or more marked impairments under Criterion 8.

The Tribunal also denied the claim for attendant care benefits, finding that the applicant failed to prove her spouse suffered an economic loss to provide the care, and therefore the expenses were not incurred.

Claims for interest and a special award were also dismissed.

The appellant appealed the 45-day impoundment of his vehicle after it was stopped while being driven by a co-worker whose licence was suspended.

The appellant argued he exercised due diligence because the co-worker had passed a background check at their shared workplace, which included a driver's licence check, and the co-worker regularly drove vehicles for their employer.

The Tribunal found that the appellant's assumption that the co-worker had a valid licence was reasonable under the circumstances.

The appeal was allowed and the vehicle was ordered released.

The applicant sought statutory accident benefits for chiropractic and massage services, a physiatry assessment, and a chronic pain assessment following a 2015 motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the treatment and assessments were reasonable and necessary.

The Tribunal noted a significant gap of over three years where the applicant did not report accident-related pain to his physicians, breaking the causal link to the accident.

Claims for interest and a special award were also dismissed.

The applicant sought non-earner benefits following a September 2022 motor vehicle accident.

The respondent denied the claim, arguing the applicant's impairments stemmed from pre-existing depression and a prior accident in June 2022.

The Tribunal applied the 'but for' causation test and the Heath framework, finding the applicant failed to prove her impairments were caused by the September accident.

The Tribunal preferred the respondent's section 44 assessors, who properly compared the applicant's functioning before and after both accidents, over the applicant's section 25 assessors, who failed to review pre-accident records or account for the prior accident.

The application was dismissed.

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

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

The Tribunal found that the applicant's injuries were predominantly minor, preferring the respondent's medical evidence which aligned with the clinical notes of the treating family physician and ER records.

The Tribunal gave less weight to the applicant's assessors due to inconsistent self-reporting by the applicant.

As the applicant remained within the MIG, the disputed treatment plans and interest were denied.

The appellant requested a reconsideration of a Licence Appeal Tribunal decision that confirmed the cancellation of its Commercial Vehicle Operator's Registration (CVOR) certificate.

The appellant argued that the Tribunal erred in weighing historical safety data over recent improvements, failed to consider alternative solutions, and demonstrated a reasonable apprehension of bias.

The appellant also sought to introduce new evidence regarding its recent safety performance.

The Tribunal dismissed the request, finding no errors of fact or law, concluding that the new evidence did not meet the criteria for admission, and rejecting the bias allegations as unfounded.

The appellant appealed the 45-day impoundment of his vehicle under the Highway Traffic Act, which occurred after he was caught driving without a required ignition interlock device.

He argued the impoundment caused exceptional hardship because he needed the vehicle for work.

The Licence Appeal Tribunal dismissed the appeal, finding that the appellant had reasonable alternatives to the impounded vehicle, such as sharing a vehicle with his mother and securely storing his tools at job sites to use public transit.

The appellant company appealed the 45-day impoundment of its commercial vehicle, which was seized after being operated by a suspended driver.

The appellant argued the impoundment caused exceptional hardship because the vehicle was specially equipped for pest control.

The Tribunal dismissed the appeal, finding the appellant failed to demonstrate exceptional hardship as it had a second similarly equipped vehicle and could adjust its business operations to mitigate the loss.

The appellant purchased travel services for Hajj 2022 from a registered travel agent.

Due to COVID-19 restrictions, the appellant could not attend and agreed to postpone the trip to Hajj 2023.

Before the 2023 trip, the travel agent ceased carrying on business and could not be located.

The appellant filed a claim with the Travel Industry Compensation Fund, which was denied on the basis that the agent was still operating in 2022 when the original services were not provided.

The Tribunal allowed the appeal, finding that the appellant's agreement to postpone the trip did not disentitle him to reimbursement under the Regulation.

The appellant was awarded the maximum allowable compensation of $5,000.

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

The appellant argued the impoundment would cause exceptional hardship because she needed the vehicle to transport her cousin to cancer treatments and her cousin's children to school.

However, the appellant failed to attend the hearing.

The Tribunal found the appellant did not prove there were no alternatives to the impounded vehicle, noting evidence that she had two other registered vehicles.

The appeal was dismissed and the impoundment confirmed.

The applicant requested a reconsideration of a preliminary issue decision which found his claim for Income Replacement Benefits (IRBs) was statute-barred.

The applicant argued the adjudicator erred in finding the insurer's denial letter was clear and unequivocal, and in refusing to extend the limitation period under section 7 of the Licence Appeal Tribunal Act.

The Tribunal dismissed the request, finding the applicant was attempting to relitigate the initial decision and failed to establish any errors of law or fact that would have changed the outcome.

The Tribunal also rejected the applicant's attempt to introduce an undated resignation letter as new evidence.

The applicant was injured in a bicycle/motor vehicle collision and sought attendant care benefits and an award for unreasonably delayed treatment plans.

The Tribunal found the applicant was not entitled to attendant care benefits as she had regained independence in her activities of daily living.

However, the Tribunal found the insurer unreasonably delayed approving four treatment plans by keeping the applicant in the Minor Injury Guideline despite receiving a neurologist's report diagnosing a concussion.

The Tribunal awarded 25% of the value of the delayed plans ($2,657.54) plus interest.

The applicant sought a determination that she was catastrophically impaired under Criterions 7 and 8 of the Statutory Accident Benefits Schedule following a 2017 motor vehicle accident, along with payment for disputed treatment and assessment plans.

The Tribunal found that the applicant's expert on visual impairment failed to follow the AMA Guides' testing methods, resulting in the rejection of the 24% WPI rating for diplopia.

The Tribunal also adjusted the applicant's psychological impairment ratings, finding them inconsistent with her demonstrated functional abilities.

Consequently, the applicant did not meet the threshold for catastrophic impairment under either criterion.

The claims for psychological services and catastrophic impairment assessments were dismissed for lack of evidence demonstrating they were reasonable and necessary.

The respondent's request for costs due to the applicant's late withdrawal of Criterion 4 was also dismissed.

The applicant sought entitlement to statutory accident benefits following a motor vehicle accident, including multiple treatment plans for physiotherapy, chiropractic, and psychological services, as well as attendant care benefits.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove on a balance of probabilities that the disputed treatment plans and attendant care expenses were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's independent examiners over the applicant's assessors and noted the applicant's failure to provide requested information to the insurer.

Claims for interest and an award under s. 10 of Reg. 664 were also dismissed.

The applicant requested a reconsideration of a previous Tribunal decision that denied his claim for an income replacement benefit.

The applicant argued that the Tribunal committed a breach of procedural fairness regarding interpretation services, made errors of fact regarding his self-employment income and travel, and failed to consider new evidence regarding his business ownership.

The Tribunal dismissed the request, finding that procedural fairness was maintained, the minor factual error regarding his 2020 tax income would not have changed the outcome, and the new evidence was previously obtainable and immaterial.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a cognitive communication assessment and psychological services.

The respondent denied the assessment and partially approved the psychological services at a lower hourly rate.

The Tribunal found the cognitive communication assessment was reasonable and necessary based on contemporaneous medical evidence of cognitive symptoms.

For the psychological services, the Tribunal found an hourly rate of $130.00 was reasonable for a registered psychotherapist providing cognitive behavioural therapy under the supervision of a psychologist.

The Tribunal also approved preparation fees but denied brokerage and documentation support fees.