OLAT 2025

The appellant appealed Tarion's denial of her new home warranty claim regarding defects in the stone cladding of her home.

Although Tarion found the defects to be warranted, the claim was denied because the appellant refused to allow the builder access to the home to complete repairs during the 30-day post-conciliation repair period, insisting instead on her own method of repair.

The Licence Appeal Tribunal found that the builder's proposed repairs were reasonable and consistent with industry guidelines, and that the appellant's denial of access was unreasonable.

The appeal was dismissed and the builder's request for costs was denied.

The respondent insurer requested reconsideration of a Licence Appeal Tribunal decision that granted the applicant a 15% special award on dental services, chiropractic services, and prescription eyeglasses.

The Vice-Chair found the adjudicator committed a material breach of procedural fairness by failing to provide sufficient reasons for granting an award on the chiropractic services and eyeglasses.

However, the Vice-Chair upheld the award for the dental services, finding the adjudicator provided adequate reasons based on the insurer's unexplained eight-month delay in payment.

The reconsideration was granted in part, and the decision was varied to limit the 15% award solely to the dental services.

The applicant sought a determination that she sustained a catastrophic impairment under Criterion 7 of the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Tribunal assessed various Whole Person Impairment (WPI) ratings provided by multiple medical experts for physical and psychological impairments, including complex regional pain syndrome, sleep disturbances, and right upper extremity deficits.

The Tribunal rejected several of the applicant's expert ratings for failing to follow the AMA Guides' methodology and lacking objective medical evidence.

Ultimately, the Tribunal calculated a combined WPI rating of 50%, falling short of the 55% threshold required for a catastrophic impairment designation.

The application was dismissed.

The applicant sought entitlement to various statutory accident benefits following a motor vehicle accident, including chiropractic, massage therapy, occupational therapy, speech-language pathology, and assistive devices.

The Tribunal found that the accident exacerbated the applicant's pre-existing right hip osteoarthritis, necessitating a hip replacement.

The Tribunal approved a May 2022 treatment plan for chiropractic and massage therapy, as well as a long-handled tub scrubber, finding them reasonable and necessary.

The remaining treatment plans were denied due to a lack of compelling evidence demonstrating their necessity or because the expenses were incurred prior to the submission of a treatment plan.

The applicant sought statutory accident benefits following a motor vehicle accident, including funding for chiropractic services, a concussion assessment, a psychological assessment, and attendant care assessments.

The insurer denied the treatment plans.

The Tribunal found that the applicant failed to prove on a balance of probabilities that the disputed treatment plans were reasonable and necessary.

The medical evidence indicated the applicant's accident-related injuries were primarily soft tissue strains that had resolved, and her ongoing complaints were attributed to a subsequent fall at home.

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

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

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

The Tribunal found the applicant suffered from accident-related chronic pain with functional impairment, warranting removal from the MIG.

The Tribunal awarded the claimed medication expenses as reasonable and necessary for pain management and associated mental health challenges.

However, the claim for chiropractic services was denied due to insufficient evidence of reasonableness and necessity.

No interest was awarded.

The respondent insurer requested a reconsideration of a Tribunal decision that barred the applicant from proceeding with his application due to his failure to attend a properly scheduled s. 44 insurer's examination.

The respondent argued the Tribunal erred by failing to also address whether the applicant was barred for failing to dispute the denial of benefits within the two-year limitation period.

The Tribunal dismissed the request, finding that because the application was already barred under s. 55, the limitation period issue was moot and there was no error in declining to rule on it.

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

He notified the insurer of the accident the next day but denied injuries, and did not submit an intention to claim benefits until over six months later.

The insurer denied the claim based on late notice.

The Tribunal found that the applicant failed to comply with the seven-day notice requirement under section 32(1) of the Schedule and failed to provide a reasonable explanation for the delay.

Consequently, the application was dismissed as statute-barred under section 55(1)1.

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

The insurer denied benefits and argued the applicant was barred from proceeding because he failed to submit the OCF-1 application within the prescribed 30-day time limit.

The Tribunal found that the applicant provided a reasonable explanation for the delay, as the insurer's correspondence regarding the interplay between WSIB benefits and accident benefits was confusing.

Although the applicant was not barred from proceeding, the Tribunal closed the file as there were no substantive issues in dispute.

The applicant sought statutory accident benefits following a motor vehicle accident but was denied by the insurer.

The insurer raised a preliminary issue that the applicant was barred from proceeding under s. 55 of the Schedule for failing to attend requested insurer examinations (IEs) under s. 44.

The Tribunal found that the requested physiatry and psychological IEs were reasonably necessary and that the notice letters complied with the Schedule.

As the applicant failed to attend without a reasonable explanation, her application was dismissed.

However, the Tribunal awarded the applicant $500 in costs due to the insurer's unreasonable conduct in delaying the production of an occupational therapy report.

The applicant sought various statutory accident benefits, including treatment plans and attendant care benefits, following a motor vehicle accident.

At the start of the videoconference hearing, both parties requested to convert the proceeding to a written hearing as they were unprepared to proceed.

The adjudicator denied the request, noting the file's age and proper notice, and ordered a brief recess for preparation.

Following the recess, the parties advised that they had settled all issues in dispute, resulting in the closure of the Tribunal's file.

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

The matter was scheduled for a 7-day videoconference hearing.

The applicant, who was self-represented after her counsel withdrew, failed to attend the hearing despite receiving proper notice.

The Tribunal proceeded in her absence pursuant to section 7(3) of the Statutory Powers Procedure Act.

As the applicant tendered no evidence and made no submissions, she failed to meet her burden of proof.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a catastrophic impairment due to a mental or behavioural disorder under Criterion 8 of the Schedule.

The Tribunal assessed the applicant's functioning across four spheres: activities of daily living, social functioning, concentration, persistence and pace (CPP), and adaptation.

While the Tribunal found a marked impairment in CPP, it concluded the applicant only sustained moderate impairments in the other three spheres.

As the applicant did not demonstrate a marked impairment in three or more spheres, or an extreme impairment in one, the application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline and seeking income replacement benefits and physiotherapy costs.

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

Proceeding under the Statutory Powers Procedure Act, the Tribunal found the applicant failed to meet her evidentiary burden to demonstrate entitlement to the claimed benefits.

The application was dismissed.

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

The respondent denied benefits and requested the applicant attend Insurer's Examinations (IEs).

The applicant failed to attend multiple scheduled IEs, citing unavailability and transportation issues.

The Tribunal found the applicant failed to provide a reasonable explanation for her non-attendance.

Consequently, the applicant is barred under section 55(1) of the Schedule from proceeding to a hearing, and the application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a massage chair, physiotherapy, and medical marijuana.

The Licence Appeal Tribunal denied the claim for the massage chair, finding insufficient medical evidence that it was reasonable and necessary.

The Tribunal partially approved the physiotherapy plan, relying on the strong recommendation of the applicant's treating family physician.

The Tribunal also approved the plan for medical marijuana, noting the family physician's support for its use in treating the applicant's chronic pain syndrome.

Claims for a special award under s. 10 of Reg. 664 were dismissed, but interest on overdue benefits was granted.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and funding for physiotherapy and a physiatry assessment.

The insurer had suspended IRBs due to the applicant's failure to attend section 44 examinations.

The Tribunal found that the applicant did not suffer a substantial inability to perform the essential tasks of her pre-accident employment, relying on functional abilities evaluations and the applicant's return to work as a cashier.

The Tribunal also dismissed the claim for physiotherapy as not reasonable and necessary, and declined to order a special award, finding the insurer did not unreasonably withhold benefits.

The insurer agreed to fund the physiatry assessment, and the Tribunal ordered interest on that overdue payment.

The applicant sought entitlement to a psychological assessment treatment plan and an award for unreasonable delay following a motor vehicle accident.

The adjudicator dismissed the application, finding the applicant failed to prove the assessment was reasonable and necessary.

The adjudicator preferred the objective testing and comprehensive assessments of the respondent's psychological experts over the applicant's pre-screening report and treating records, which lacked contemporaneous psychological complaints.

The adjudicator also found the respondent's denial letter complied with the notice requirements under s. 38(8) of the Schedule.

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

The insurer denied funding for a psychological assessment and psychological treatment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that the applicant failed to attend scheduled insurer's examinations (IEs).

The Tribunal found the applicant was not barred from proceeding because the insurer's notices requiring the IEs failed to provide sufficient medical reasons under s. 44(5) of the Schedule.

The Tribunal also removed the applicant from the MIG based on psychological diagnoses and ordered the insurer to pay for the disputed treatment plans because its denial letters failed to comply with the medical reasons requirement under s. 38(8).

The claim for a special award was dismissed.

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

The Licence Appeal Tribunal found the applicant was barred from receiving income replacement benefits because she was driving with a suspended licence at the time of the accident, which constitutes driving without a valid licence under s. 31(1)(a)(ii) of the Schedule.

Consequently, the insurer was entitled to repayment of $9,483.76 in previously paid benefits.

The Tribunal also dismissed the applicant's claims for various medical and rehabilitation benefits, finding she failed to prove the proposed treatments were reasonable and necessary.