OLAT 2025

The applicant insurer sought repayment of $16,400 in Income Replacement Benefits (IRB) paid to the respondent after she had returned to work.

The respondent argued the repayment notices were deficient under s. 52(2) of the Schedule.

The Tribunal found the notices were compliant given the information available to the insurer at the time, as the respondent had delayed providing her return-to-work dates and pay stubs.

The Tribunal ordered the respondent to repay the $16,400 overpayment plus interest.

The applicant sought statutory accident benefits following a slip and fall in a restaurant parking lot, which was previously determined to be an accident under the Schedule.

The Tribunal found the applicant was entitled to income replacement benefits for a closed period until he returned to work.

Claims for attendant care benefits were dismissed as the applicant failed to prove the expenses were incurred.

The Tribunal awarded funding for an attendant care assessment, physiotherapy, and partial occupational therapy, finding them reasonable and necessary.

The applicant's request for a special award under s. 10 of O. Reg. 664 was denied, as the insurer's initial denial based on the definition of an accident was not unreasonable.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically a treatment plan for physiotherapy services totaling $3,875.12.

The Licence Appeal Tribunal found that the applicant failed to demonstrate the treatment was reasonable and necessary, noting a significant gap in medical evidence between the accident and the proposed plan.

The claims for the treatment plan, interest, and an award for unreasonable delay were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit and several treatment plans for physical and psychological rehabilitation and assessments.

The Licence Appeal Tribunal dismissed the application, finding that the applicant did not suffer a substantial inability to perform the essential tasks of his pre-accident employment.

The Tribunal preferred the evidence of the respondent's insurer's examination assessors, who concluded the applicant sustained minor soft tissue injuries and a temporary adjustment disorder, over the applicant's evidence.

All disputed treatment plans were deemed not reasonable and necessary.

The applicant sought medical benefits for occupational therapy (a SPECT scan) and optometric services following a motor vehicle accident, along with interest and a special award.

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

The medical evidence, including normal MRI results and a lack of referrals, did not support the need for a SPECT scan or functional assessment.

The claims for interest and a special award were consequently dismissed.

The applicant requested a reconsideration of a Tribunal decision that found he remained within the Minor Injury Guideline (MIG) and was not entitled to an income replacement benefit (IRB) or other disputed benefits following a motor vehicle accident.

The applicant argued the adjudicator erred in assessing the medical evidence, including requiring contemporaneous records for psychological impairments, and misapplied the test for IRB entitlement.

The Tribunal dismissed the request, finding the adjudicator properly weighed the evidence, including the reliability of the psychological assessment, and correctly focused the IRB analysis on the essential tasks of the applicant's pre-accident employment.

No errors of law or fact were established under Rule 18.2(b).

The applicant sought payment for four treatment plans, arguing the respondent insurer failed to provide sufficient medical reasons in its denial notices as required by s. 38(8) of the Statutory Accident Benefits Schedule.

The Tribunal found that the respondent's denial letters were compliant, as they clearly relied on and excerpted independent medical examination reports that directly addressed the requested treatments.

Because the notices were compliant, the applicant was not entitled to the treatment plans under s. 38(11).

The application was dismissed, and claims for interest and an award were denied.

The applicant sought statutory accident benefits after falling in a parking lot while loading groceries into her vehicle.

The insurer denied the claim on the basis that the incident was a slip and fall, not an 'accident' under the Schedule.

The applicant filed an appeal with the Tribunal more than two years after receiving the denial letter by registered mail.

The Tribunal found the denial letter was valid and triggered the limitation period.

The Tribunal declined to extend the limitation period under section 7 of the LAT Act, finding the applicant failed to establish a bona fide intention to appeal or provide medical evidence supporting the merits of her claim.

The application was dismissed as statute-barred.

The applicant was a pedestrian struck by a vehicle and sought statutory accident benefits.

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

The Licence Appeal Tribunal found that the applicant sustained a concussion, removing him from the MIG.

However, the Tribunal dismissed the claims for attendant care benefits, occupational therapy, and a psychological assessment, finding them not reasonable and necessary given the applicant's return to work and independence in self-care.

The Tribunal approved treatment plans for physiotherapy and chiropractic services, noting they provided temporary pain relief and improved range of motion.

The claim for a special award was dismissed, but interest was awarded on the approved treatment plans.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits, which the respondent denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG due to chronic pain, a psychological impairment, and pre-existing injuries from a prior accident.

The Tribunal found insufficient medical evidence to support a diagnosis of chronic pain or an accident-related psychological impairment.

Furthermore, the applicant failed to prove that any pre-existing injuries precluded her recovery within the MIG.

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

The applicant was injured in a bicycle accident in April 2023 but did not submit an Application for Accident Benefits (OCF-1) to the respondent insurer until January 2025.

The respondent argued the applicant was barred from proceeding due to the delay.

The Tribunal found that the applicant failed to comply with the seven-day notice requirement under section 32 of the Schedule and did not provide a reasonable explanation for the delay.

Ignorance of the law and a subjective belief that injuries would resolve through OHIP care were not accepted as reasonable explanations.

The application was dismissed as statute-barred.

The applicant sought various statutory accident benefits following a 2008 motor vehicle accident.

The respondent raised a preliminary issue that the applicant was barred from proceeding with her claims for attendant care and housekeeping benefits due to her failure to attend insurer's examinations.

The adjudicator found the applicant failed to comply with her obligation to attend the examinations but exercised discretion to permit the application to proceed, subject to the condition that the claims be restricted to the period ending on the date of the decision.

On the substantive issues, the adjudicator dismissed the applicant's claims for attendant care, housekeeping, and other medical and rehabilitation benefits, finding she had not demonstrated the expenses were incurred or reasonable and necessary.

The respondent's claim for repayment of non-earner benefits was also dismissed.

The appellant appealed the 45-day impoundment of her motor vehicle under section 50.2 of the Highway Traffic Act on the grounds of exceptional hardship.

The vehicle was impounded after the driver was caught driving with a suspended licence.

The Tribunal found that the appellant failed to establish that there were no reasonable alternatives to the impounded vehicle for attending her medical appointments and work.

As the appellant had access to transit, ride-sharing, and assistance from friends and family, the appeal was dismissed and the impoundment was confirmed.

The appellant appealed the 45-day impoundment of his motor vehicle under section 50.2 of the Highway Traffic Act, which occurred after his son's friend was caught driving it with a suspended licence.

The appellant argued the impoundment would cause exceptional financial hardship to himself and possible loss of employment for his son.

The Licence Appeal Tribunal dismissed the appeal, finding the appellant failed to establish that no alternative to the impounded vehicle was available, as he had access to another vehicle and there was no evidence his son could not find alternative transportation.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident, claiming she sustained a catastrophic impairment.

The Licence Appeal Tribunal evaluated her impairments under Criterion 7 (Whole Person Impairment) and Criterion 8 (mental and behavioural disorders) of the Schedule.

The Tribunal rejected several of the applicant's expert ratings due to methodological flaws and inconsistencies with surveillance footage, which showed the applicant performing strenuous tasks like shovelling snow and shopping independently.

The Tribunal concluded the applicant did not meet the threshold for catastrophic impairment and dismissed her claims for attendant care, treatment plans, and a special award.

The respondent insurer requested a reconsideration of a preliminary issue decision which found that the applicant was an 'insured person' under the Schedule because she and the catastrophically injured person were sisters.

The respondent argued the Tribunal erred in fact and law, asserting the evidence supported a finding that they were cousins.

The Tribunal dismissed the request, finding that the respondent improperly attempted to re-weigh evidence and raise new case law that was not presented at the initial hearing.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision regarding her entitlement to statutory accident benefits following a motor vehicle accident.

The adjudicator granted the request in part, finding a factual error in the original decision which had limited income replacement benefits to date rather than ongoing, as the issue of entitlement was not in dispute.

The adjudicator varied the decision to award income replacement benefits to date and ongoing.

However, the adjudicator dismissed the reconsideration request regarding three disputed treatment plans, finding that the applicant was attempting to re-litigate the issue and had failed to demonstrate any error of law or fact.

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).

The Licence Appeal Tribunal found that the applicant failed to meet her burden to demonstrate that her injuries warranted removal from the MIG, noting her submissions were not tied to the medical evidence.

As the applicant was subject to the $3,500 MIG limit, the Tribunal dismissed the claim for a $12,912.72 multi-disciplinary assessment and denied interest.

The appellant appealed the impoundment of a motor vehicle registered to her deceased partner.

The vehicle was impounded after being driven by someone with a suspended licence.

The respondent brought a preliminary motion arguing the appellant lacked standing to appeal.

The Tribunal found that under the Highway Traffic Act, only the registered owner of the vehicle has standing to appeal an impoundment.

As the appellant was not the registered owner and had not yet obtained authority to administer the deceased's estate, she lacked standing.

The appeal was dismissed.

Both the applicant and the respondent requested reconsideration of a Tribunal decision regarding entitlement to income replacement benefits (IRBs).

The respondent argued the Tribunal erred in finding the applicant was not barred from proceeding despite missing an insurer's examination, and erred in awarding pre-104-week IRBs.

The applicant argued the Tribunal erred in denying post-104-week IRBs.

The Vice-Chair dismissed both requests, finding neither party met the high threshold of demonstrating an error of law or fact that would likely have changed the result, and that both parties were improperly attempting to re-litigate the original decision.