OLAT 2025

The applicant, a minor with pre-existing autism spectrum disorder, sought statutory accident benefits after being left alone on a school bus.

The respondent denied the claims for attendant care benefits and occupational therapy services, arguing the applicant's ongoing needs were related to his pre-existing condition rather than the incident.

The Tribunal applied the 'but for' test for causation and found that the applicant failed to prove on a balance of probabilities that his current impairments were caused by the incident, noting a lack of recent medical evidence supporting an ongoing accident-related impairment.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits, chiropractic treatment, and psychological services.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the proposed treatments and attendant care were reasonable and necessary.

The Tribunal also found no basis for an award for unreasonable delay or interest, as no benefits were overdue.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of multiple treatment and assessment plans for physiotherapy, psychological services, PRP injections, and chronic pain.

The applicant argued the denial notices were deficient under s. 38(8) of the Statutory Accident Benefits Schedule.

The Tribunal found that the respondent's denial notices complied with the Schedule, providing sufficient medical and other reasons.

Furthermore, the Tribunal determined that the disputed plans were not reasonable and necessary based on the medical evidence.

The applicant's claims for an award and interest were dismissed, and the respondent's request for costs was also denied.

The applicant sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Tribunal first denied the applicant's request for a sealing order and anonymity, finding the applicant failed to meet the high threshold established in Sherman Estate.

On the merits, the Tribunal found the applicant was entitled to a gym membership, once-weekly personal training, a progress report, and a physiatry assessment, as these were reasonable and necessary to address his ongoing physical and psychological impairments.

The Tribunal denied the remaining claims for 90-minute psychological sessions and occupational therapy assessments.

The applicant's claim for a section 10 award for unreasonable withholding of benefits was also dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for massage therapy, botox injections, and acupuncture.

The respondent insurer denied the treatment plans.

The Tribunal found that the applicant established the massage therapy was reasonable and necessary to treat ongoing chronic neck and back pain, supported by clinical records.

However, the applicant failed to provide sufficient medical evidence or submissions demonstrating that the botox injections and acupuncture were reasonable and necessary.

The Tribunal ordered the respondent to pay for the massage therapy with interest, but dismissed the claims for botox and acupuncture.

The applicant sought entitlement to statutory accident benefits for physiotherapy, massage, and assistive devices following a 2019 motor vehicle accident.

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

The Tribunal noted a lack of contemporaneous medical evidence supporting the treatment plans and found that the applicant relied on outdated records that did not endorse the specific goods or services claimed.

As no benefits were payable, the claim for interest was also dismissed.

The applicant sought payment for various treatment and assessment plans following a motor vehicle accident, including a chronic pain assessment, attendant care assessment, neuropsychological assessment, physiotherapy, chiropractic, and massage therapy.

The respondent denied the benefits.

The Tribunal dismissed the application, finding that the applicant failed to meet the burden of proving the plans were reasonable and necessary.

The Tribunal noted a lack of supporting medical evidence, found the chronic pain assessment to be duplicative of existing treatment, and concluded that no interest was payable as no benefits were overdue.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically funding for a neuropsychological catastrophic assessment, a neurocognitive catastrophic assessment, and document support expenses.

The adjudicator found that the neuropsychological assessment was reasonable and necessary because the medical evidence raised a question regarding whether the applicant's impairments stemmed from the accident, entitling the applicant to an expert opinion on the issue.

However, the adjudicator denied funding for the neurocognitive assessment, finding it would overlap with the neuropsychological assessment, and denied the document support expenses for lack of supporting evidence.

The applicant was awarded $2,260.00 for the neuropsychological assessment and HST.

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

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

The applicant failed to attend the scheduled examinations and provided no reasonable explanation for his non-attendance.

The Tribunal held that the applicant was barred from proceeding with his claims for attendant care benefits and vestibular physiotherapy.

The Tribunal further dismissed the claim for an occupational therapy treatment plan, finding the applicant failed to prove it was reasonable and necessary.

Claims for interest and a special award were also dismissed.

The applicant, a self-employed food delivery driver, sought an income replacement benefit (IRB) following a motor vehicle accident.

The insurer suspended benefits due to the applicant's failure to provide proof of income and file his 2016 tax return, calculating his IRB quantum at $0.00 pursuant to s. 4(5) of the Statutory Accident Benefits Schedule.

The Tribunal found that while s. 4(5) excludes unreported income from IRB calculations, it does not negate the $185.00 weekly minimum under s. 7(2)1ii.

The Tribunal held the applicant was entitled to the minimum IRB for the period after he complied with the insurer's information requests until he no longer met the medical test.

The applicant's claim for a special award under s. 10 of Regulation 664 was dismissed as no submissions were made on the issue.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs), physiotherapy, psychological treatments, and medication expenses.

The Tribunal found the applicant was disentitled to pre-104 week IRBs due to non-compliance with section 33 of the Schedule for failing to provide self-employment financial records, and did not meet the test for post-104 week IRBs.

The Tribunal approved the physiotherapy treatment plans as reasonable and necessary, but dismissed the claims for the unapproved portions of the psychological treatment plans and the medication expenses.

The claim for an award under section 10 of Regulation 664 was dismissed as the insurer's denials were reasonably informed by independent medical examinations.

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.

The Tribunal scheduled a written hearing, but the applicant failed to file any written submissions.

Pursuant to section 7(2) of the Statutory Powers Procedure Act, the Tribunal proceeded without the applicant's participation.

The application was dismissed as the applicant failed to meet his evidentiary burden.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, claiming catastrophic impairment, income replacement benefits, attendant care benefits, and various treatment plans.

The Licence Appeal Tribunal found that the applicant did not meet the threshold for catastrophic impairment under Criterion 7 (55% whole person impairment) or Criterion 8 (mental and behavioural disorders).

The Tribunal preferred the respondent's medical evidence, noting the applicant's pre-existing conditions and post-accident functioning, including international travel.

Claims for income replacement and attendant care benefits were dismissed as the applicant failed to prove a substantial inability to perform his pre-accident employment and the benefits had expired past the 260-week mark.

The application was dismissed in its entirety.

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

The respondent denied the claims.

The Tribunal considered procedural issues regarding late expert reports and submissions, ultimately admitting them to ensure procedural fairness.

On the merits, the Tribunal found the applicant was not entitled to the disputed physiotherapy, assistive devices, personal training, or psychological therapy, as she failed to prove they were reasonable and necessary, or they were barred by the Schedule's timing provisions.

However, the Tribunal granted entitlement to a $2,200 psychological assessment, finding it was submitted within the five-year limitation period and supported by medical evidence.

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

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG due to a psychological condition, specifically insomnia and anxiety.

The Tribunal found that the applicant's psychological symptoms did not amount to a condition justifying removal from the MIG, noting inconsistencies in his reporting to his family physician and accepting the respondent's psychological assessment.

As the MIG limit was exhausted, the application for treatment plans and an award was dismissed.

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

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG due to chronic pain syndrome.

The adjudicator found that the applicant failed to establish chronic pain with functional impairment, preferring the respondent's s. 44 assessment over the applicant's s. 25 assessment, which relied heavily on uncorroborated self-reporting.

Consequently, the applicant remained in the MIG, and most disputed treatment plans were not payable.

However, a psychological assessment plan was deemed payable under s. 38(11) of the Schedule because the respondent's explanation of benefits failed to provide proper medical or other reasons for denial.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to an income replacement benefit (IRB), various treatment plans, and removal from the Minor Injury Guideline (MIG) due to psychological impairments.

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor and subject to the $3,500 MIG limit, as the psychological evidence relied entirely on self-reporting and lacked objective clinical support.

The Tribunal also dismissed the claim for an IRB, finding the applicant failed to prove a substantial inability to perform the essential tasks of his employment as a real estate agent.

All claims, including requests for interest and an award, were dismissed.

The applicant was injured in a motor vehicle accident and sought $3,000.22 for a physiotherapy treatment plan under the Statutory Accident Benefits Schedule.

The insurer denied the benefit.

The Licence Appeal Tribunal found the treatment plan reasonable and necessary to assist in relieving the applicant's chronic pain, preferring the evidence of the applicant's treating family doctor and physiotherapist over the insurer's paper review.

The Tribunal ordered the insurer to pay the treatment plan amount plus interest.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit, an attendant care assessment, and chiropractic services.

The Licence Appeal Tribunal dismissed the claims for the non-earner benefit and the attendant care assessment, finding the applicant failed to provide sufficient medical evidence or a detailed comparison of pre- and post-accident activities to establish a complete inability to carry on a normal life.

However, the Tribunal granted the treatment plans for chiropractic services, concluding that the medical evidence supported the necessity of physical therapy for the applicant's accident-exacerbated bilateral shoulder and knee impairments.

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 that the applicant failed to establish psychological impairments or chronic pain with functional impairment sufficient to warrant removal from the MIG.

The Tribunal also dismissed the claim for a non-earner benefit, finding the applicant did not meet the high threshold of demonstrating a complete inability to carry on a normal life.

Claims for treatment plans, interest, and an award for unreasonable delay were also dismissed.