OLAT 2024

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

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

The Tribunal found that the applicant sustained soft tissue injuries and did not suffer from chronic pain or a psychological injury caused by the accident.

Consequently, the applicant was subject to the MIG and its funding limits, precluding entitlement to the disputed medical and attendant care benefits.

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 applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of two physiotherapy treatment plans and a portion of a psychological treatment plan.

The respondent argued the applicant was barred from proceeding with one physiotherapy claim due to non-attendance at an insurer's examination, but the Tribunal found no prejudice as the applicant attended a subsequent examination.

On the merits, the Tribunal dismissed the application, finding the physiotherapy plans were not proven reasonable and necessary given the lack of objective medical evidence and an unopposed independent medical examination.

The Tribunal also upheld the respondent's reduced hourly rate for the psychological services provided by an unregulated social worker.

The applicant withdrew their application for statutory accident benefits three days prior to the scheduled hearing.

The respondent sought costs under Rule 19 of the Licence Appeal Tribunal Rules to cover the late cancellation fee for a court reporter, arguing the applicant failed to adhere to deadlines and was uncommunicative.

The Tribunal dismissed the request, finding that the applicant's conduct did not meet the high threshold of being unreasonable, frivolous, vexatious, or in bad faith, and noted that the late withdrawal caused little prejudice to the respondent.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically a chronic pain assessment and a standing desk.

The insurer denied the benefits, arguing the applicant's physical injuries fell within the Minor Injury Guideline (MIG) and that the standing desk expense was incurred before a treatment plan was submitted.

The Tribunal found the applicant had been removed from the MIG for psychological impairments, granting access to non-MIG funding for all reasonable and necessary treatments.

Based on medical records documenting ongoing pain, the Tribunal approved the chronic pain assessment.

However, the claim for the standing desk was dismissed under s. 38(2) of the Schedule because the expense was incurred before a treatment plan was submitted and did not meet the statutory exceptions.

The applicant sought statutory accident benefits following two motor vehicle accidents.

The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The Tribunal found that the applicant failed to prove that his physical injuries, alleged pre-existing conditions, or psychological impairments warranted removal from the MIG.

As the MIG limits were exhausted, the claims for additional physiotherapy and psychological assessments were dismissed, along with claims for interest and an award for unreasonable delay.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the denial of treatment plans for a bio-feedback assessment, occupational therapy assessments and services, and assistive devices.

The Tribunal found the occupational therapy assessment and portions of the occupational therapy services and assistive devices to be reasonable and necessary, noting that some devices were duplicative of those already provided to the applicant's spouse.

The claim for the bio-feedback assessment was dismissed as the applicant failed to establish entitlement to the denied portion.

The Tribunal also denied the applicant's request for a special award, finding the insurer's conduct was not unreasonable.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit, a physiotherapy treatment plan, interest, and an award for unreasonable delay.

The adjudicator found that the applicant failed to demonstrate a complete inability to carry on a normal life, as medical assessments indicated he remained independent in his daily activities, including driving, working, and exercising.

Furthermore, the applicant did not prove the physiotherapy treatment plan was reasonable and necessary, as his own treating surgeon recommended exercise rather than physiotherapy.

The application was dismissed in its entirety.

The applicant sought various statutory accident benefits following a motor vehicle accident, including a non-earner benefit, attendant care benefits, lost educational expenses, and medical benefits for assistive devices and chiropractic services.

The Tribunal found that the applicant failed to prove he suffered a complete inability to carry on a normal life, as required for the non-earner benefit.

The Tribunal also dismissed the claims for attendant care benefits because the expenses were not incurred and the respondent had not unreasonably withheld payment.

The claims for lost educational expenses and medical benefits were similarly dismissed for lack of sufficient evidence.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming $3,413.01 for a chiropractic treatment plan (OCF-18).

The respondent denied the claim, arguing the treatment was not reasonable and necessary and relying on a section 44 physiatry assessment.

The Tribunal found that while the accident exacerbated the applicant's pre-existing chronic pain, the applicant failed to provide sufficient evidence that the proposed treatment goals were being met or that he sustained any benefit from prior treatment.

The application was dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, which were denied by the respondent insurer.

The applicant applied to the Licence Appeal Tribunal to dispute the denial of a non-earner benefit, various treatment plans, and the determination that his injuries fell within the Minor Injury Guideline (MIG).

The adjudicator found that the applicant's injuries were predominantly minor, as there was no compelling evidence of a pre-existing condition or that the injuries fell outside the MIG.

The adjudicator also dismissed the claim for a non-earner benefit, noting the applicant returned to work as an Uber driver shortly after the accident and failed to demonstrate a complete inability to carry on a normal life.

Consequently, the disputed treatment plans were denied as they exceeded the exhausted MIG limits, and no interest was awarded.

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

The respondent denied the benefits on the basis that the applicant had exhausted her non-catastrophic policy limits and had not been determined to be catastrophically impaired.

The Tribunal held that the application for benefits was premature, as the applicant could not be entitled to further benefits without a catastrophic impairment designation.

The claims for benefits were dismissed without prejudice.

However, the Tribunal allowed the applicant to proceed to a hearing on her standalone claim for an award under Regulation 664.

The respondent's request for costs was dismissed.

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

The Tribunal found the applicant failed to prove her injuries warranted removal from the Minor Injury Guideline.

However, due to the respondent's failure to provide compliant denial notices under the Statutory Accident Benefits Schedule, the applicant was awarded payment for a treatment plan dated March 30, 2022, and non-earner benefits for a limited period from May 7, 2020, to February 9, 2021.

The claim for a special award under O. Reg. 664 was dismissed.

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 applicant claimed entitlement to income replacement benefits (IRBs), chiropractic services, and a chronic pain assessment.

The Tribunal found that the applicant failed to provide compelling medical evidence to establish that his pre-existing conditions, chronic pain, or psychological injuries warranted removal from the MIG.

Furthermore, the applicant did not prove a substantial inability to perform the essential tasks of his pre-accident employment as a plumber's apprentice.

The application was dismissed, and no further benefits or interest were awarded.

The applicant was involved in a motor vehicle accident that was also a workplace accident.

He elected to claim WSIB benefits and his claim was accepted.

The respondent raised a preliminary issue that the applicant was barred from claiming statutory accident benefits under section 61 of the Schedule.

The applicant's representative was removed from the record and no submissions were filed on his behalf.

The Tribunal found that the applicant was barred from pursuing his claim for accident benefits because he was entitled to receive WSIB benefits and had not opted out to pursue a tort action.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including a determination of catastrophic impairment and a chiropractic assessment.

The insurer raised preliminary issues regarding the applicant's failure to attend insurer examinations and the expiry of the limitation period.

The Tribunal found that the applicant failed to submit to the insurer examinations without a reasonable explanation and was therefore barred from proceeding with the catastrophic impairment issue.

The Tribunal also found that the applicant failed to dispute the denial of the chiropractic assessment within the two-year limitation period.

The application was dismissed.

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

The Licence Appeal Tribunal found that the applicant failed to meet the burden of proving eligibility for an IRB under section 5(1) of the Statutory Accident Benefits Schedule.

The applicant did not provide corroborating documentation to establish that he was receiving employment insurance at the time of the accident or that he had worked for at least 26 weeks in the 52 weeks prior to the accident.

The application was dismissed, and no interest was payable.

The applicant, a self-employed auto mechanic, was injured when a vehicle he was inspecting fell from a hoist due to a mechanical failure.

He sought statutory accident benefits, but the respondent denied the claim on the basis that the incident was not an 'accident' under s. 3(1) of the Schedule.

The Tribunal found that while the purpose test was met, the causation test failed because the malfunctioning hoist was an intervening act that broke the chain of causation.

The application was dismissed.

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

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

The Tribunal found that the applicant's injuries were predominantly minor, preferring the insurer's medical examinations which showed the applicant's pain did not significantly impede his function and that he had returned to physical work.

As the applicant remained within the MIG and the disputed plans exceeded the $3,500 limit, the application for the treatment plans and interest was dismissed.

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

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

The applicant applied to the Licence Appeal Tribunal, arguing her injuries warranted removal from the MIG due to chronic pain and psychological impairment.

The Tribunal found that the applicant failed to demonstrate injuries outside the MIG, preferring the respondent's insurer examination reports over the applicant's medical evidence, which lacked objective support and was inconsistent with clinical records.

The application was dismissed, and the applicant remained subject to the $3,500 MIG limit.

The applicant requested reconsideration of a Tribunal decision that found her impairments subject to the Minor Injury Guideline and denied two treatment plans and a special award.

The applicant argued the adjudicator erred in law or fact by failing to address the inadequacy of the medical and other reasons in the respondent's denial notices under s. 38(8) of the Schedule.

The adjudicator dismissed the request, finding no error regarding the first notice, and concluding that while an error was made in failing to specifically address the sufficiency of the second notice, the notice was ultimately compliant and the error would not have changed the result.