OLAT 2025

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs).

The respondent deemed the applicant eligible for IRBs but failed to pay them for nearly two years, ignoring multiple inquiries from the applicant.

The Licence Appeal Tribunal found that the respondent's failure to pay the benefits, despite having the necessary documentation and an accountant's report supporting entitlement, constituted an unreasonable delay.

The Tribunal ordered the respondent to pay a special award under s. 10 of Regulation 664 equal to 50% of the IRBs claimed during the period of delay, plus interest.

The applicant sought a non-earner benefit and a determination that their injuries fell outside the Minor Injury Guideline following a motor vehicle accident.

The Tribunal found that the applicant was statute-barred from pursuing the non-earner benefit because they failed to dispute the insurer's clear and unequivocal denial within the two-year limitation period.

The Tribunal also held that it lacked jurisdiction to make a standalone determination regarding the Minor Injury Guideline in the absence of an underlying dispute for medical or rehabilitation benefits.

The application was dismissed.

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

The respondent denied the benefit, relying on insurer's examinations.

The Tribunal found the applicant met the test for an IRB, preferring the evidence of the applicant's treating physicians and the respondent's own kinesiologist, who found the applicant demonstrated functional limitations below the physical demands of his pre-accident job as a café supervisor.

The Tribunal rejected the respondent's other experts, noting inconsistencies in their reasoning.

The applicant was awarded the IRB with interest, but his claim for an award for unreasonable delay was dismissed due to lack of evidence.

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 Tribunal found that the applicant's injuries were predominantly minor and subject to the $3,500 MIG limit, as the applicant failed to provide compelling medical evidence of a psychological condition or other injuries warranting removal from the MIG.

Consequently, the claim for a $2,200 psychological assessment was dismissed.

The Tribunal also dismissed the claim for a non-earner benefit, finding the applicant failed to establish a complete inability to carry on a normal life.

Claims for an award and interest were also 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).

The applicant argued for removal from the MIG based on a pre-existing low back condition, psychological impairments, chronic pain, and a concussion.

The Tribunal found the applicant failed to meet the burden of proof for removal from the MIG, preferring the respondent's section 44 assessments over the applicant's evidence, which lacked corroboration from the family doctor's clinical notes.

As the applicant remained within the MIG, the disputed treatment plans were not considered, and claims for interest and a special award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a psychological assessment and physiotherapy services outside the Minor Injury Guideline (MIG).

The respondent denied the benefits, arguing the applicant's injuries were minor.

The Tribunal found that the applicant failed to demonstrate psychological or physical impairments warranting removal from the MIG, preferring the respondent's insurer's examinations which were consistent with the family physician's clinical notes.

As the injuries were deemed minor and the MIG limit was exhausted, the proposed treatment plans and claim for interest were dismissed.

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

The Tribunal found that the applicant's injuries fell within the Minor Injury Guideline (MIG), as he failed to establish a pre-existing condition or chronic pain with functional impairment that would warrant removal.

The Tribunal also dismissed the claim for an income replacement benefit, finding the applicant did not meet his onus to establish a substantial inability to perform the essential tasks of his employment, and the respondent properly relied on an Insurer Examination to discontinue the benefit.

The applicant sought accident benefits following a motor vehicle accident, which the respondent insurer denied on the basis that her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG due to physical injuries (lumbar sprain/strain) and psychological impairments (driving/passenger anxiety).

The Tribunal found that the applicant's physical injuries were uncomplicated soft tissue injuries that did not warrant removal from the MIG.

Furthermore, the Tribunal accepted the respondent's psychological assessment that the applicant's initial driving anxiety had dissipated over time.

As the applicant remained within the MIG and the limits were exhausted, the claims for further treatment plans and interest were dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied an extension of time to pursue claims for income replacement benefits and various treatment plans, and denied entitlement to attendant care benefits and other medical benefits.

The Vice-Chair found that the Tribunal had correctly applied the Manuel factors in refusing the extension of time and had not breached procedural fairness.

The Vice-Chair also upheld the Tribunal's findings that the applicant failed to meet his burden of proving the requested attendant care benefits and treatment plans were reasonable and necessary.

The request for reconsideration was denied.

The applicant sought statutory accident benefits for psychological injuries sustained after witnessing a police cruiser strike hydro wires, which subsequently killed her husband.

The respondent denied the claim on the basis that the applicant was not an 'insured person' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal found that the applicant was merely a bystander and was not 'involved in' the accident, as she was not struck by the vehicle and her psychological impairments stemmed from grief rather than a fear for her own safety.

The application for benefits was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming for physiotherapy and psychological services.

The respondent denied the benefits.

The Tribunal found that the applicant had reached maximum medical recovery for her soft-tissue injuries and failed to prove the physiotherapy treatments were reasonable and necessary.

The Tribunal also found the applicant failed to demonstrate the proposed hourly rate for psychological services was reasonable.

The claims for benefits, interest, and an award for unreasonable delay were 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 she failed to properly elect an income replacement benefit (IRB) before commencing the application.

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor, as she failed to provide sufficient medical evidence of a psychological impairment or chronic pain with functional impairment to warrant removal from the MIG.

Consequently, the disputed treatment plans were not payable.

Furthermore, the Tribunal held that the applicant was not entitled to an IRB because she failed to submit an OCF-10 election form prior to filing the application, a defect that could not be cured retroactively.

The application was dismissed.

The applicant insurer sought repayment of $39,942.85 in income replacement benefits (IRB) paid to the respondent, alleging the respondent wilfully misrepresented his pre-accident income on his 2018 tax return.

The Tribunal found that while the respondent's reported income was not in accordance with the facts due to his cash-based business practices, the misrepresentation was not wilful.

The insurer failed to prove the respondent fabricated his income with a conscious wrong or evil purpose to falsely qualify for IRB.

The application for repayment was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, various treatment plans for physiotherapy and psychological services, and medication expenses.

The Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, noting inconsistencies in her self-reporting and evidence of pre-existing conditions.

The Tribunal also found that the proposed treatment plans and medication expenses were not reasonable and necessary as a result of the accident.

The application was dismissed in its entirety, with no interest or award granted.

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

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

The Tribunal found that the applicant did not suffer from chronic pain or a psychological condition that would warrant removal from the MIG.

However, the Tribunal determined that one of the insurer's denial notices failed to comply with the requirements of s. 38(8) of the Schedule.

As a result, the treatment plan associated with the defective notice was deemed payable.

The remaining treatment plans were denied, and no award for unreasonable delay was granted.

The applicant sought entitlement to multiple treatment plans for chiropractic, occupational therapy, social rehabilitation counselling, speech-language pathology, and vision services following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that the majority of the disputed treatment plans were reasonable and necessary, relying heavily on insurer examination reports and surveillance evidence showing the applicant's functional independence.

The Tribunal granted entitlement only for the incurred cost of a mattress.

The applicant's claim for a special award under section 10 of Regulation 664 was dismissed, as the insurer's reliance on medical assessments and partial approvals did not constitute unreasonable conduct.

The applicant sought post-104-week income replacement benefits (IRB) following a 2018 motor vehicle accident.

The applicant was involved in a second accident in 2019.

The Tribunal found that the applicant's primary reason for his inability to work was a concussion and related symptoms, which were caused by the 2019 accident, not the 2018 accident.

The applicant failed to prove on a balance of probabilities that the injuries from the 2018 accident caused a complete inability to engage in any employment for which he is reasonably suited by education, training, or experience.

The application for IRB and interest was dismissed.

The applicant's husband died from a cardiac arrest following a snowmobile accident where he sustained a fractured tibia.

The respondent denied death and funeral benefits, arguing the death was caused by a pre-existing heart condition rather than the accident.

The Tribunal applied the purpose and causation tests, preferring the applicant's expert medical evidence that the tibial fracture caused a deep vein thrombosis and fatal pulmonary embolism.

The Tribunal found the death was directly caused by the accident and ordered the respondent to pay the $25,000 death benefit and $6,000 funeral benefit, plus interest.

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

The matter was scheduled for a written hearing, but the applicant failed to file written submissions or any further correspondence by the deadline.

The respondent requested the application be dismissed as abandoned.

The adjudicator proceeded with the hearing under s. 7(2) of the Statutory Powers Procedure Act and dismissed the application, finding the applicant failed to meet her burden of demonstrating entitlement to the disputed treatment plans, an award, or interest.

The applicant was injured in a motor vehicle accident and sought income replacement benefits.

The insurer designated him as catastrophically impaired but disputed the quantum of the benefit, arguing he was self-employed and entitled to $185.00 per week.

The applicant argued he was an employee entitled to $400.00 per week.

The Tribunal applied the Sagaz test and found that the applicant was an employee, as his hours and duties were controlled by the employer, he wore a company uniform, and he did not operate his own business.

The Tribunal ordered the insurer to pay income replacement benefits of $400.00 per week from October 20, 2020, ongoing, plus interest.