Ontario Licence Appeal Tribunal

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 applicant sought entitlement to statutory accident benefits for various physiotherapy, chiropractic, and psychological treatment plans following a motor vehicle accident.

The adjudicator found that the applicant failed to meet her burden of proving the treatment plans were reasonable and necessary.

The adjudicator relied on section 44 insurer examination reports which concluded the applicant had reached maximum medical recovery and lacked objective evidence of ongoing accident-related pathology.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for two physiotherapy treatment plans.

The Tribunal found the December 2023 treatment plan for $1,828.10 was reasonable and necessary based on the recommendations of the applicant's family physician and an orthopaedic surgeon.

However, the Tribunal denied the remaining $117.07 from a July 2023 treatment plan because neither party provided submissions regarding the disputed amount.

The application was granted in part, with interest payable on overdue benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and an attendant care assessment.

The insurer denied the benefits.

The Tribunal found that the applicant failed to prove the treatments were reasonable and necessary, noting that the injuries were primarily soft tissue and the applicant's hand injury was from a subsequent fall.

The Tribunal also found no evidence supporting the need for an attendant care assessment.

The claims for an award and interest 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).

The applicant argued for removal from the MIG on the basis of chronic pain with functional impairment.

The Tribunal found the applicant failed to provide sufficient objective medical evidence to establish chronic pain with a functional limitation, noting the applicant's own expert did not diagnose chronic pain.

As the applicant was held to the MIG and the disputed treatment plans exceeded the remaining limits, the application was dismissed.

The applicant, who suffered catastrophic psychological injuries after a vehicle struck and killed her friend while they were walking, sought various statutory accident benefits.

The Licence Appeal Tribunal found the applicant was entitled to treatment plans for nutritional counselling (including produce boxes), drum lessons, and OCF-18 completion fees, but denied the enhanced hourly rate for a psychotherapist.

The Tribunal also granted a section 10 award of $2,585.20 against the respondent for egregiously proceeding with an in-home attendant care assessment despite the applicant's explicit refusal to consent.

The appellant appealed the 45-day impoundment of her motor vehicle after her son was caught driving it with a suspended licence.

The appellant argued the vehicle was stolen at the time of the impoundment.

The Tribunal found that the appellant had explicitly forbidden her son from driving the vehicle and had lent it only to her daughter-in-law.

The son took the vehicle without permission following an argument.

The Tribunal concluded the vehicle was stolen within the meaning of the Highway Traffic Act and ordered the Registrar to release it.

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

The insurer denied funding for occupational therapy, physiatry, and neuropsychological assessments, as well as an accountant's report and transportation expenses.

The Licence Appeal Tribunal found that the applicant failed to attend properly scheduled insurer's examinations without a reasonable excuse, barring her from disputing entitlement to the medical assessments.

The claim for the accountant's report was dismissed because the applicant was previously barred from claiming income replacement benefits.

The transportation expenses were denied for failing to address the 50-kilometre deductible.

The application was dismissed in its entirety.

The applicant sought outstanding balances for attendant care benefits following a motor vehicle accident.

The respondent had partially approved the invoices using a ratio method because the invoices lacked the required particulars to substantiate the services provided.

The Tribunal found that the applicant failed to demonstrate she incurred the full balance of the invoices and upheld the respondent's use of the ratio method.

The application for outstanding benefits, interest, and an award was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident involving a school bus.

The Tribunal found that while the applicant's physical injuries fell within the Minor Injury Guideline (MIG), she was entitled to be removed from the MIG due to a psychological impairment, specifically post-traumatic stress disorder.

The applicant's claim for a non-earner benefit was dismissed as she failed to demonstrate a complete inability to carry on a normal life, with evidence showing no significant difference in her pre- and post-accident activities.

The Tribunal approved a treatment plan for psychological services but denied other plans for chiropractic and orthopaedic assessments due to a lack of supporting evidence.

A claim for a special award under Regulation 664 was 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 claimed she suffered from chronic pain, but provided only emergency room records from the day of the accident showing a normal X-ray.

The Tribunal found the applicant failed to meet her burden of proving chronic pain with functional impairment to warrant removal from the MIG.

As the applicant remained within the MIG, the disputed treatment plans were not considered, and the application was dismissed.

The applicant sought an income replacement benefit and funding for a physiotherapy treatment plan following a motor vehicle accident.

The respondent raised a preliminary issue that the applicant was barred from proceeding for failing to attend insurer's examinations.

The Tribunal found the respondent's notices of examination were non-compliant with the Schedule, allowing the hearing to proceed.

On the substantive issues, the Tribunal dismissed the application, finding the applicant failed to prove a substantial inability to perform the essential tasks of her employment due to inconsistencies in her evidence regarding her return to work.

The Tribunal also denied the treatment plan as the applicant failed to provide goals or corroborating medical evidence to establish it was reasonable and necessary.

The applicant sought accident benefits following a motor vehicle accident, which the respondent 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 a pre-existing traumatic brain injury and chronic pain with functional impairment.

The Tribunal found that the applicant failed to establish that her pre-existing condition prevented maximal recovery within the MIG, noting medical evidence that she had reached maximum medical recovery.

The Tribunal also found insufficient evidence of chronic pain or functional impairment, as the applicant had resumed driving and work duties.

Consequently, the applicant was held to be subject to the MIG, and her claims for physiotherapy treatment plans and interest were dismissed.

The applicant sought a non-earner benefit (NEB), interest, and an award under s. 10 of Reg. 664 following a motor vehicle accident.

The Tribunal found that the applicant suffered a complete inability to carry on a normal life, as her injuries continuously prevented her from engaging in pre-accident childcare and housekeeping activities.

The Tribunal preferred the evidence of the applicant's physiatrist over the insurer's section 44 assessors.

The applicant was awarded the NEB and interest, but the claim for a section 10 award was dismissed as the insurer's conduct did not rise to the level of being unreasonable.

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 applicant sought removal from the MIG based on chronic pain and psychological injury, specifically PTSD.

The Tribunal found that the applicant failed to establish chronic pain with a functional impairment, noting she had returned to her daily activities, including driving.

The Tribunal also preferred the respondent's psychological assessment, finding the applicant's psychological symptoms were clinically associated sequelae of her minor soft tissue injuries.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to chiropractic treatments, an in-home assessment, and in-home treatments.

The Licence Appeal Tribunal dismissed the application, finding that the applicant had achieved maximal recovery and functional range of motion.

The Tribunal preferred the respondent's insurer's examinations, noting the applicant had returned to full-time employment as a nurse and was able to participate in activities such as hiking, cycling, and yoga.

As no benefits were payable, the claim for interest was also dismissed.

The respondent insurer requested a reconsideration of a Tribunal decision that awarded the applicant $25,280.00 for a catastrophic assessment treatment plan.

The respondent argued the Tribunal failed to apply the $2,000.00 statutory limit per assessment under s. 25(5) of the Schedule and improperly awarded separate fees for duplicative assessments and a file review.

The Tribunal found it had erred by not addressing these key arguments in the original decision.

The reconsideration was granted in part, and the applicant's entitlement to the treatment plan was reduced to $17,176.00.

The appellant appealed the 45-day impoundment of her motor vehicle, which was seized when another individual was caught driving it with a suspended licence.

The appellant argued the impoundment would cause exceptional hardship regarding her employment and childcare transportation needs.

The Licence Appeal Tribunal dismissed the appeal, finding the appellant failed to demonstrate that no alternative transportation was available, as she had access to a rental vehicle, rides from co-workers, public transit options, and assistance from family members.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, which the respondent insurer denied.

The applicant applied to the Licence Appeal Tribunal, arguing that his injuries, including a head laceration and ongoing pain complaints, warranted removal from the Minor Injury Guideline (MIG) due to chronic pain.

The Tribunal found that the applicant's injuries were predominantly minor and that he had not established a diagnosis of chronic pain with functional impairment.

As the applicant was subject to the $3,500 MIG limit, the Tribunal did not assess the reasonableness and necessity of the proposed treatment plans.

The 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 on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued for removal from the MIG due to chronic pain and psychological impairments.

The Tribunal found that the applicant failed to establish a functional impairment related to chronic pain and preferred the respondent's psychological assessment over the applicant's pre-screening report.

The Tribunal concluded the injuries were minor, and since the MIG limit was exhausted, the disputed treatment plans were not payable.