Ontario Licence Appeal Tribunal

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

The respondent denied treatment plans for physiotherapy, assistive devices, and a chronic pain assessment.

The Tribunal found the applicant failed to establish the reasonableness and necessity of the physiotherapy and assistive devices plans due to a lack of supporting evidence and submissions.

However, the Tribunal approved the chronic pain assessment plan, finding sufficient evidence of consistent pain and functional limitations to warrant further investigation.

Interest was awarded on the overdue payment for the assessment.

The applicant sought payment for three physiotherapy treatment plans following a motor vehicle accident.

The adjudicator found that the applicant failed to prove the treatments were reasonable and necessary, noting that the applicant's own family physician recorded that physiotherapy was not helping, and neither the applicant's nor the respondent's medical assessors recommended ongoing physiotherapy.

The applicant also argued entitlement based on the insurer's failure to provide timely notice under section 38(8) of the Schedule.

The adjudicator agreed the insurer was non-compliant but dismissed the claim because the applicant provided no evidence that the expenses were actually incurred during the period of non-compliance.

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 she failed to attend scheduled Insurer Examinations (IEs).

The Tribunal found the applicant did not prove her injuries warranted removal from the MIG.

Furthermore, the applicant failed to establish entitlement to an Income Replacement Benefit (IRB) and was barred from proceeding with the IRB claim due to her unexcused failure to attend properly scheduled IEs.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically a $3,861.20 physiotherapy treatment plan.

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

The applicant argued the respondent's denial notice violated s. 38(8) of the Schedule.

The Tribunal found the denial notice was compliant, as referencing the MIG is a valid medical reason for denial.

The applicant failed to provide substantive evidence to warrant removal from the MIG.

The application was dismissed.

The appellants brought a motion to extend the document exchange deadline in their appeal of a Tarion Warranty Corporation decision.

The respondent consented to the extension but requested that documents unrelated to new expert reports be exchanged immediately and that the hearing be adjourned for 60 days.

The Tribunal granted the extension for all documents to be exchanged on the same date, finding that the issues were interrelated and piecemeal disclosure was inappropriate.

The Tribunal also granted a 30-day adjournment of the hearing to allow the respondent sufficient time to review the new expert reports.

The applicant insurer sought repayment of $4,336.81 in income replacement benefits (IRBs) paid to the respondent, alleging he returned to work without notifying them.

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

The Tribunal found the applicant's initial notices for $1,697.09 were valid and timely, but a subsequent notice for the higher amount was issued beyond the 12-month limitation period without proof of wilful misrepresentation or fraud.

The Tribunal ordered the respondent to repay $1,697.09 plus interest, and denied the respondent's request for costs.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his psychological injuries and pre-existing conditions warranted treatment outside the Minor Injury Guideline (MIG).

The respondent denied the benefits, arguing the injuries were minor.

The Tribunal found that the applicant's pre-existing back pain and anxiety did not preclude his recovery within the MIG.

Furthermore, the Tribunal preferred the respondent's psychological assessment, finding the applicant's anxiety and depression were primarily related to personal stressors rather than the accident.

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

The appellant appealed the 45-day impoundment of his jointly-owned motor vehicle, which was impounded after he was caught driving with a suspended licence.

He argued the impoundment would cause exceptional hardship.

The Tribunal found that the exceptional hardship ground under s. 50.2(3)(d) of the Highway Traffic Act was unavailable because a vehicle owned by the appellant's co-owner (his wife) had previously been impounded under s. 55.1.

The Tribunal interpreted 'same owner' in s. 50.2(4) to apply to both co-owners to prevent circumvention of the Act's public safety purposes.

The appeal was dismissed and the impoundment confirmed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found that he was barred from proceeding with a claim for income replacement benefits due to the expiry of the two-year limitation period.

The applicant argued that the Tribunal breached procedural fairness and made errors of law and fact in applying case law regarding clear and unequivocal denials and the extension of time.

The adjudicator dismissed the request, finding that the applicant was attempting to re-litigate the original decision and failed to establish any material breach of procedural fairness or errors of law or fact that would warrant a reconsideration under Rule 18.2.

The applicant was injured in a motor vehicle accident and sought $7,738.72 for a chiropractic treatment plan.

The respondent insurer denied the plan based on insurer's examinations which concluded the applicant had reached maximum medical recovery.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to provide contemporaneous medical evidence or address the goals of the treatment to prove it was reasonable and necessary.

The Tribunal also found the insurer's denial was compliant with the Schedule and denied claims for interest and an award.

The appellant appealed the impoundment of his vehicle under the Highway Traffic Act after he lent it to a co-worker whose licence was suspended.

The Licence Appeal Tribunal dismissed the appeal, finding that the appellant failed to exercise due diligence because he did not ask to examine the driver's licence or verify its validity.

The Tribunal also found that the impoundment would not cause exceptional hardship, as the appellant had access to three other household vehicles, as well as taxis, ride-sharing, and rental vehicles.

The applicant sought accident benefits for psychological injuries allegedly sustained as a result of her spouse's involvement in a motor vehicle accident four years prior.

The respondent denied the claim, arguing the applicant was not an 'insured person' under section 3(1) of the Statutory Accident Benefits Schedule and had failed to apply within the prescribed timelines.

The Tribunal found that the applicant failed to provide evidence linking her psychological impairments to the accident, as her medical records did not mention the accident and instead noted unrelated anxiety.

Consequently, the Tribunal concluded the applicant was not an 'insured person' and dismissed the claim, finding it unnecessary to address the limitation period issue.

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

The issues in dispute included entitlement to the balance of a treatment plan for a catastrophic impairment assessment, interest on previously denied but subsequently approved treatment plans, and a special award under s. 10 of Reg. 664.

The Tribunal found that the catastrophic assessment fees were subject to the $2,000 funding cap per assessment under s. 25(5)(a) of the Schedule, and that separate fees for file reviews and overall summaries were not payable.

The Tribunal awarded interest on the three treatment plans that the insurer approved after the applicant was deemed catastrophically impaired, calculating interest from the date of the application to the date of settlement.

The claim for a special award was dismissed, as the insurer's initial denials were based on medical evidence and statutory provisions, and its behaviour was not unreasonable.

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 that a recent MRI finding of a disc bulge and a referral for spine surgery warranted removal from the MIG, explaining that a lack of OHIP coverage delayed his medical evidence.

The Tribunal found that the applicant failed to establish causation linking the disc bulge to the accident.

Consequently, the applicant's injuries were deemed predominantly minor, and the claims for a chiropractic treatment plan and interest were dismissed.

The applicant sought entitlement to various medical assessments and interest on income replacement benefits (IRBs) following a motor vehicle accident.

The Licence Appeal Tribunal found the proposed psychological and chronic pain assessments were reasonable and necessary, and not reasonably available through OHIP, ordering them payable with interest.

However, the orthopaedic assessment was denied as available through OHIP, and the physiatry assessment was denied as duplicative.

The Tribunal also denied the claim for interest on IRBs, finding the insurer's delay in payment was justified by the applicant's failure to provide reasonably requested documentation under section 33 of the Schedule.

A claim for a bad faith award under section 10 was dismissed.

The appellant appealed the 90-day impoundment of her vehicle under the Highway Traffic Act after it was driven by an individual with a suspended licence.

The Tribunal granted an extension of time to file the appeal but ultimately dismissed the appeal on its merits.

The Tribunal found the appellant failed to establish that the vehicle was stolen or that she exercised due diligence, noting she took no steps to prevent the driver from accessing her keys despite a previous similar incident.

The Tribunal also held that the appellant was precluded from claiming exceptional hardship because the vehicle had been previously impounded.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied entitlement to two physiotherapy treatment plans, an orthopedic assessment, and an award.

The adjudicator granted the reconsideration in part, finding an error of fact regarding the January 12, 2024 physiotherapy treatment plan because the initial decision overlooked material clinical notes and records supporting the plan.

The applicant was found entitled to this plan plus interest.

The reconsideration requests for the other treatment plans and the award were dismissed, as the applicant had not provided submissions on them at the initial hearing or failed to establish an error.

The respondent's request for costs was denied because the reconsideration request was partially successful and not frivolous.

The applicant sought a determination that he sustained a catastrophic impairment under Criterion 8 of the Schedule following a 2017 motor vehicle accident.

The Tribunal found that while the applicant suffered from accident-related mental and behavioural disorders, he did not sustain a marked impairment in the spheres of activities of daily living or social functioning.

The Tribunal preferred the evidence of the respondent's assessors, noting the applicant maintained independence in personal care and continued to have meaningful social interactions with family and friends.

The claims for unapproved balances of assessment plans, interest, and an award were also dismissed.

The applicant was involved in a motor vehicle accident but did not notify her insurer of her intention to apply for statutory accident benefits until 15 months later.

The insurer denied the claim based on non-compliance with the seven-day notice period under s. 32(1) of the Schedule.

The Tribunal found that the applicant provided a reasonable explanation for the delay under s. 34, noting her significant pre- and post-accident medical conditions, cognitive struggles, and genuine ignorance of her entitlement to benefits.

The Tribunal concluded that the hardship to the applicant outweighed any prejudice to the insurer, allowing the application to proceed.

The appellant appealed the Registrar of Motor Vehicles' decision to suspend his Class G driver's licence for medical reasons, specifically cognitive impairment.

The suspension was based on an unsolicited Medical Condition Report from the appellant's treating neurologist, who diagnosed mild cognitive impairment and recommended an on-road functional driving assessment.

The Licence Appeal Tribunal found that the appellant suffers from a cognitive impairment that is likely to significantly interfere with his ability to drive safely.

Applying the Canadian Council of Motor Transport Administrators Medical Standards for Drivers, the Tribunal confirmed the suspension until the appellant completes the recommended functional driving assessment.