OLAT 2024

The Licence Appeal Tribunal initiated a reconsideration of a decision after discovering the former adjudicator had accepted an offer of employment with the respondent insurer, Aviva, prior to hearing the matter.

The Associate Chair found that the former adjudicator's failure to disclose this conflict and recuse herself created a reasonable apprehension of bias, violating the rules of procedural fairness.

The original decision was cancelled and a rehearing in writing was ordered before a different adjudicator.

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

The insurer denied the benefits, arguing the injuries fell within the Minor Injury Guideline and raising preliminary issues of non-compliance with s. 33 (failure to produce medical records) and s. 55 (failure to attend insurer examinations).

The Tribunal found the applicant failed to comply with s. 33 requests for medical records, relieving the insurer of liability to pay the disputed benefits.

Furthermore, the applicant failed to adduce evidence that his injuries fell outside the Minor Injury Guideline or that the requested treatment was reasonable and necessary.

The application was dismissed.

The applicant insurer sought repayment of $48,628.57 in Income Replacement Benefits (IRB) paid to the respondent, alleging the benefits were paid due to wilful misrepresentation and fraud.

The respondent failed to participate in the written hearing or comply with Tribunal orders to produce employment and income records.

The Tribunal drew an adverse inference from the respondent's non-compliance and relied on surveillance evidence showing the respondent working as a manual labourer while claiming IRB.

The Tribunal ordered the respondent to repay the full amount of the IRB plus interest pursuant to section 52 of the Statutory Accident Benefits Schedule.

The appellant appealed the Registrar of Motor Vehicles' decision to suspend their Class G driver's licence due to a medical condition, specifically epilepsy with a medication change.

During the hearing, the appellant acknowledged their medical condition and agreed with the Registrar's decision to suspend the licence pending a period of stability on the new medication.

The Tribunal confirmed the Registrar's decision, finding that the medical condition is likely to significantly interfere with the appellant's ability to drive safely.

The applicant insurer sought repayment of $7,585.00 in non-earner benefits paid to the respondent, alleging the respondent wilfully misrepresented material facts when applying for automobile insurance.

The respondent failed to attend the hearing.

The Tribunal found that the respondent wilfully misrepresented that he owned the insured vehicle, that it was not financed, and that it would not be used for commercial purposes.

However, because the applicant's notice of repayment only specified $2,035.00, the Tribunal limited the repayment order to that amount.

The respondent was ordered to repay $2,035.00 plus interest.

The Licence Appeal Tribunal initiated a reconsideration of a previous decision after discovering the former adjudicator had accepted an offer of employment with the respondent's parent company, Aviva, prior to hearing the matter.

The Associate Chair found that the former adjudicator's failure to disclose this conflict and recuse herself created a reasonable apprehension of bias, violating the rules of procedural fairness.

The original decision was cancelled, and a new oral hearing with a different adjudicator was ordered.

The applicant insurer sought repayment of $3,328.34 in income replacement benefits (IRB) paid to the respondent, alleging wilful misrepresentation.

The respondent failed to participate in the written hearing.

The Licence Appeal Tribunal found that the respondent wilfully misrepresented his employment status by failing to disclose income from a second job while receiving IRB.

The Tribunal ordered the respondent to repay the IRB with interest, but declined to award costs to the insurer.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to various treatment plans for chiropractic, psychological, and chronic pain services.

The Licence Appeal Tribunal dismissed the application, finding that the cost of personal protective equipment was not covered, the proposed hourly rate for a psychotherapist was not justified, and the applicant had reached maximum medical recovery.

The Tribunal preferred the respondent's medical evidence, concluding that the applicant did not meet the criteria for chronic pain and that her ongoing knee issues were related to pre-existing conditions rather than the accident.

The appellant sought reconsideration of a decision confirming the impoundment of his vehicle for driving without a required ignition interlock device.

The appellant argued exceptional hardship and lack of awareness of the licence condition.

The Tribunal dismissed the request, finding the appellant failed to establish any error of law or fact, or breach of procedural fairness under Rule 18.2 of the Licence Appeal Tribunal Rules 2023.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming catastrophic impairment and entitlement to a non-earner benefit.

The applicant failed to attend the scheduled videoconference hearing despite receiving notice and having previously missed a case conference.

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

As the applicant presented no evidence to satisfy his burden of proof, the application was dismissed.

The appellants brought a motion to set aside a case conference order requiring them to provide access to their property for a roof inspection by the respondent.

The Tribunal dismissed the motion, finding that the appellants raised no new information that was not known to them when they consented to the order at the case conference.

Furthermore, the Tribunal noted that its rules do not provide for the reconsideration of interim orders.

The appellants appealed Tarion Warranty Corporation's decision to deny their claims for 34 construction defects in their new home.

While Tarion agreed the defects were covered under warranty, it denied the claims because the appellants failed to provide the builder reasonable access to the home to complete repairs during the post-conciliation repair period.

The Licence Appeal Tribunal found that the appellants' demands—including three-hour repair windows, criminal background checks for workers, and refusal of hotel accommodations—were unreasonable and interfered with the builder's statutory right to mitigate damages.

The appeal was dismissed and the claims were denied.

The applicant was injured in a motor vehicle accident in June 2017 but did not submit an application for accident benefits (OCF-1) until May 2021.

The respondent denied benefits on the basis of the delay.

The Tribunal found that the applicant failed to notify the respondent within the 7-day time limit prescribed by s. 32(1) of the Schedule and failed to provide a reasonable explanation for the 1,418-day delay under s. 34.

The application for accident benefits was therefore time-barred and dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

She failed to submit her OCF-1 application within the 30-day time limit prescribed by the Schedule, submitting it nearly two years later.

The respondent argued she was statute-barred from proceeding.

The Tribunal found the applicant had a reasonable explanation for the delay, citing her psychological and cognitive impairments, her mistaken belief that a previous law firm had submitted the form, and confusion caused by the respondent's partial approval of a treatment plan.

The Tribunal concluded the applicant could proceed with her application to a substantive hearing.

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

The insurer raised a preliminary issue that the applicant was barred from proceeding because he failed to dispute the denial of benefits within the two-year limitation period under s. 56 of the Schedule.

The Tribunal found that the insurer failed to prove how the denial letters for the medical benefits were delivered, meaning the limitation period had not started for those claims.

However, the Tribunal found that a valid denial for Non-Earner Benefits was properly delivered to the applicant's legal representative, and the applicant failed to dispute it within two years or establish grounds for an extension under s. 7 of the LAT Act.

The applicant was permitted to proceed with the medical benefits claims but barred from pursuing the Non-Earner Benefits.

The applicant sought removal from the Minor Injury Guideline (MIG) and payment for a psychological assessment and a functional abilities evaluation following a motor vehicle accident.

The applicant argued that psychological impairments and chronic pain warranted removal from the MIG.

The Tribunal found that the applicant failed to provide sufficient evidence of a psychological impairment or chronic pain syndrome, preferring the respondent's section 44 insurer examination reports which concluded the applicant suffered only minor sprains and strains.

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

The applicant was involved in a motor vehicle accident and submitted an Application for Accident Benefits (OCF-1) over two years after receiving the forms from the insurer.

The insurer denied the application as being outside the 30-day statutory deadline.

The Licence Appeal Tribunal held a preliminary issue hearing to determine if the applicant was statute-barred from proceeding.

The Tribunal found that the applicant failed to provide a credible or reasonable explanation for the delay, rejecting arguments related to the COVID-19 pandemic, a misunderstanding of available benefits, and a delayed fibromyalgia diagnosis.

The application was dismissed as statute-barred.

The applicant was injured in a motor vehicle accident during the course of her employment and applied for statutory accident benefits.

The insurer denied benefits, arguing the applicant was required to claim WSIB benefits and that her election to pursue a tort claim under s. 61(2) of the Schedule was made primarily to obtain accident benefits.

The Tribunal found that the applicant failed to demonstrate a bona fide intention to pursue a tort action, noting her significant delay in issuing a Statement of Claim until after the limitation period expired.

Consequently, the Tribunal held the applicant was statute-barred under s. 61 of the Schedule and dismissed the application.

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

The respondent denied the benefit on the basis that the applicant had returned to his pre-accident employment as a seasonal window cleaner for four months before a regular seasonal layoff.

The Tribunal found the respondent's denial notice complied with the Schedule.

On the merits, the Tribunal held the applicant failed to prove he suffered a substantial inability to perform his essential work tasks within the first 104 weeks, or a complete inability to engage in suitable employment thereafter.

The application was dismissed.

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

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that he was not entitled to an income replacement benefit (IRB) due to failing to submit a disability certificate and continuing to work.

The Tribunal found the applicant failed to prove his physical or psychological injuries warranted removal from the MIG.

The Tribunal also dismissed the IRB claim because the applicant did not submit the required disability certificate and failed to establish any substantial inability to perform his employment tasks or any actual income loss.