Ontario Licence Appeal Tribunal

The applicant sought entitlement to statutory accident benefits for various treatment plans following a 2019 motor vehicle accident.

The Licence Appeal Tribunal found the applicant was entitled to a chiropractic treatment plan dated October 4, 2022, as the medical evidence supported it was reasonable and necessary to manage symptoms and improve functional capacity.

However, the Tribunal denied the remaining treatment plans, including a neurological assessment, a duplicate chiropractic plan, psychological services, and occupational therapy, finding insufficient medical evidence to establish they were reasonable and necessary.

Interest was awarded on the approved overdue benefits.

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.

A three-day videoconference hearing was scheduled, but the applicant failed to attend.

The Tribunal confirmed that the applicant had received proper notice of the hearing.

Proceeding in the applicant's absence pursuant to section 7(1) of the Statutory Powers Procedure Act, the Tribunal found that the applicant failed to present any evidence or submissions to meet their onus of proving entitlement to the disputed benefits.

The application was dismissed.

The applicant sought payment for unapproved portions of three treatment plans for psychological services and attendant care assessments, arguing a social worker should be paid at a psychologist's hourly rate.

The Tribunal found the applicant failed to prove the unapproved amounts, including additional administrative fees and the higher hourly rate, were reasonable and necessary.

The Tribunal also found the insurer's denial letters complied with s. 38(8) of the Schedule.

The application for benefits, interest, and an award under s. 10 of Reg. 664 was dismissed.

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) and she did not qualify for a non-earner benefit.

The Licence Appeal Tribunal found the applicant failed to prove her pre-existing psychological condition prevented maximal recovery within the MIG.

The Tribunal also dismissed the claim for a non-earner benefit, finding the medical evidence demonstrated the applicant continued to engage in her pre-accident activities and did not suffer a complete inability to carry on a normal life.

The application was dismissed.

The applicant, who sustained a catastrophic impairment in a 2015 motor vehicle accident, sought entitlement to tutoring support for her daughter, attendant care benefits, and home modifications.

The Tribunal dismissed the claim for tutoring support, finding no evidence that the daughter required a tutor.

While the Tribunal found the applicant's attendant care needs were $3,155.86 per month based on her psychological and cognitive impairments, it denied payment because the expenses had not been incurred.

The claim for home modifications was dismissed as the applicant failed to connect the proposed modifications to her accident-related impairments.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her psychological and physical injuries warranted removal from the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found insufficient medical evidence to corroborate the applicant's self-reported psychological impairments, noting she only visited a physician once post-accident.

The Tribunal concluded the applicant's injuries were predominantly minor and dismissed the claims for treatment plans outside the MIG limit.

The respondent's request for costs due to late submissions was also dismissed.

The appellant appealed the Registrar of Motor Vehicles' decision to suspend his Class A driver's licence under s. 47(1)(g) of the Highway Traffic Act.

The Registrar alleged the licence was obtained through dishonesty, relying on an OPP investigation into a bribery scheme involving commercial driver examiners.

The Tribunal found the OPP correspondence lacked persuasive evidence connecting the appellant to the scheme or demonstrating he was dishonest in the licencing process.

The Tribunal set aside the Registrar's decision, finding insufficient reason to suspend the licence.

The appellant requested a reconsideration of a Tribunal decision that confirmed the suspension of his Class A driver's licence.

The Tribunal dismissed the request because the appellant had not yet received written reasons for the decision, making it impossible to assess the merits of the reconsideration request under Rule 18.2.

The Tribunal also noted procedural deficiencies, including the failure to use the required form and the representative's failure to file a Declaration of Representative.

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.

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

The respondent denied income replacement benefits (IRBs), alleging the applicant wilfully misrepresented his pre-accident employment and income.

The Tribunal found no wilful misrepresentation, noting the applicant's language difficulties and reliance on his employer's cash payment and tax remittance practices.

The Tribunal awarded IRBs based on the applicant's CRA Notice of Assessment and medical evidence showing a substantial inability to perform his pre-accident heavy labour tasks.

Claims for a vision assessment and a recliner chair were dismissed for lack of contemporaneous medical evidence.

A claim for a special award was also dismissed.

The applicant sought a non-earner benefit following a motor vehicle accident.

The applicant argued that the insurer failed to provide a compliant notice under section 36(4) of the Schedule, and therefore the benefit was payable under section 36(6).

The Tribunal found that the insurer's denial letter was issued under section 36(7) following an insurer's examination, and the Schedule provides no remedy for non-compliance with section 36(7).

The Tribunal further found that the applicant failed to meet the substantive test for a non-earner benefit, as no evidence was provided to compare pre- and post-accident activities.

The application was dismissed, and the respondent's request for costs was denied.

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

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

The applicant applied to the Licence Appeal Tribunal, claiming chronic pain and psychological impairments warranted removal from the MIG.

The Tribunal found the applicant failed to meet his burden of proof, noting a lack of medical evidence supporting chronic pain with functional impairment or a psychological condition.

As the applicant remained within the MIG, the disputed psychological assessment was not payable.

The application was dismissed.

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 requested a reconsideration of a Licence Appeal Tribunal decision that found he was not catastrophically impaired following a motor vehicle accident.

The applicant argued that the panel erred in its assessment of medical evidence from several experts and improperly applied the AMA Guides for impairment ratings under Criteria 6, 7, and 8.

The Vice-Chair dismissed the request, finding that the applicant was attempting to re-litigate the panel's factual findings and re-weigh the evidence.

The Vice-Chair concluded that the applicant failed to demonstrate any material errors of law or fact, or breaches of procedural fairness, that would have likely changed the outcome of the original decision.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found he was subject to the Minor Injury Guideline (MIG) and dismissed his claims for a chiropractic treatment plan, an award, and interest.

The applicant argued the Tribunal failed to address his argument under s. 38(11) of the Schedule regarding a defective notice of examination, and that it erred in its assessment of his chronic pain evidence.

The Vice-Chair acknowledged the Tribunal erred by not explicitly addressing the s. 38(11) argument, but found this error would not have changed the outcome because s. 38(11) is not triggered by a breach of s. 44(5).

The Vice-Chair dismissed the remaining grounds, finding the applicant was improperly attempting to re-litigate the Tribunal's weighing of the medical evidence.

The request for reconsideration was dismissed.

The appellant appealed the 45-day impoundment of their commercial motor vehicle under the Highway Traffic Act.

The vehicle was impounded because the driver was operating it while subject to an ignition interlock condition.

The Licence Appeal Tribunal dismissed the appeal, finding that the appellant failed to exercise due diligence by relying solely on the driver's verbal assurance of being properly licensed without verifying the licence status.

The Tribunal also found no exceptional hardship, as the appellant had access to alternative transportation for personal needs and a second company vehicle was available for business use.

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

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

The applicant argued for removal from the MIG based on chronic pain and a psychological impairment.

The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain with functional impairment or a psychological condition, noting significant gaps in medical treatment and a lack of corroborating evidence in the family physician's records.

The Tribunal concluded the injuries were predominantly minor, dismissing the application for the disputed treatment plans and an award.

The applicant requested reconsideration of a Licence Appeal Tribunal decision that found he was not catastrophically impaired and dismissed his claims for an income replacement benefit (IRB) and other benefits following a motor vehicle accident.

The applicant argued the Tribunal erred in its causation analysis and failed to address his argument for IRB entitlement under s. 36(6) of the Statutory Accident Benefits Schedule.

The Vice-Chair dismissed the causation arguments, finding no error in the Tribunal's application of the 'but for' test.

However, the Vice-Chair granted the reconsideration request in part, finding the Tribunal erred by failing to explicitly consider the applicant's s. 36(6) argument regarding the insurer's alleged failure to provide a compliant denial.

A written re-hearing was ordered solely to determine the applicant's entitlement to an IRB under s. 36(6), along with related claims for an award and interest.

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.