Ontario Licence Appeal Tribunal

The applicant sought various statutory accident benefits following a 2008 motor vehicle accident.

The respondent raised a preliminary issue that the applicant was barred from proceeding with her claims for attendant care and housekeeping benefits due to her failure to attend insurer's examinations.

The adjudicator found the applicant failed to comply with her obligation to attend the examinations but exercised discretion to permit the application to proceed, subject to the condition that the claims be restricted to the period ending on the date of the decision.

On the substantive issues, the adjudicator dismissed the applicant's claims for attendant care, housekeeping, and other medical and rehabilitation benefits, finding she had not demonstrated the expenses were incurred or reasonable and necessary.

The respondent's claim for repayment of non-earner benefits was also dismissed.

The applicant insurer sought repayment of $16,400 in Income Replacement Benefits (IRB) paid to the respondent after she had returned to work.

The respondent argued the repayment notices were deficient under s. 52(2) of the Schedule.

The Tribunal found the notices were compliant given the information available to the insurer at the time, as the respondent had delayed providing her return-to-work dates and pay stubs.

The Tribunal ordered the respondent to repay the $16,400 overpayment plus interest.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to various treatment plans and assessments outside the Minor Injury Guideline (MIG) due to chronic pain and psychological impairment.

The Licence Appeal Tribunal found that the applicant's physical injuries were soft tissue in nature and did not result in functional impairment consistent with chronic pain syndrome.

The Tribunal also preferred the respondent's psychological assessment, which found no evidence of psychological impairment, over the applicant's assessment.

Consequently, the applicant was not removed from the MIG, and the claims for disputed treatment plans, interest, and a section 10 award were dismissed.

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

The respondent denied the benefits, and the applicant applied to the Licence Appeal Tribunal.

The matter was scheduled for a written hearing.

The applicant failed to file any submissions or evidence by the deadline and did not properly request an adjournment.

As the applicant bore the onus of proving entitlement to the disputed benefits and removal from the Minor Injury Guideline, the Tribunal dismissed the application pursuant to section 7(2) of the Statutory Powers Procedure Act.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically a treatment plan for physiotherapy services totaling $3,875.12.

The Licence Appeal Tribunal found that the applicant failed to demonstrate the treatment was reasonable and necessary, noting a significant gap in medical evidence between the accident and the proposed plan.

The claims for the treatment plan, 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, and the applicant applied to the Licence Appeal Tribunal.

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

As the applicant bore the onus of proving entitlement to the benefits and removal from the Minor Injury Guideline, the Tribunal found the applicant failed to meet this burden.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits, which the respondent denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG due to chronic pain, a psychological impairment, and pre-existing injuries from a prior accident.

The Tribunal found insufficient medical evidence to support a diagnosis of chronic pain or an accident-related psychological impairment.

Furthermore, the applicant failed to prove that any pre-existing injuries precluded her recovery within the MIG.

The application was dismissed, and no benefits or interest were awarded.

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

After the applicant's representative withdrew, the applicant failed to file any written submissions or evidence for the scheduled written hearing.

The Licence Appeal Tribunal proceeded with the hearing pursuant to s. 7(2) of the Statutory Powers Procedure Act.

The Tribunal found that the applicant failed to meet his evidentiary burden to prove entitlement to the claimed benefits, removal from the Minor Injury Guideline, or an award.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit and several treatment plans for physical and psychological rehabilitation and assessments.

The Licence Appeal Tribunal dismissed the application, finding that the applicant did not suffer a substantial inability to perform the essential tasks of his pre-accident employment.

The Tribunal preferred the evidence of the respondent's insurer's examination assessors, who concluded the applicant sustained minor soft tissue injuries and a temporary adjustment disorder, over the applicant's evidence.

All disputed treatment plans were deemed not reasonable and necessary.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline (MIG).

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

As the applicant bore the onus of proving entitlement to the claimed benefits and removal from the MIG, the Tribunal dismissed the application in its entirety.

The applicant was injured in a bicycle accident in April 2023 but did not submit an Application for Accident Benefits (OCF-1) to the respondent insurer until January 2025.

The respondent argued the applicant was barred from proceeding due to the delay.

The Tribunal found that the applicant failed to comply with the seven-day notice requirement under section 32 of the Schedule and did not provide a reasonable explanation for the delay.

Ignorance of the law and a subjective belief that injuries would resolve through OHIP care were not accepted as reasonable explanations.

The application was dismissed as statute-barred.

The applicant sought payment for four treatment plans, arguing the respondent insurer failed to provide sufficient medical reasons in its denial notices as required by s. 38(8) of the Statutory Accident Benefits Schedule.

The Tribunal found that the respondent's denial letters were compliant, as they clearly relied on and excerpted independent medical examination reports that directly addressed the requested treatments.

Because the notices were compliant, the applicant was not entitled to the treatment plans under s. 38(11).

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

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic and psychological treatment.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the chiropractic treatment was reasonable and necessary, noting a lack of supporting clinical notes and a subsequent unrelated ankle injury.

The Tribunal also denied the claim for an enhanced hourly rate for psychological services, as the applicant did not demonstrate the psychotherapist had training or experience akin to a psychologist to justify the higher rate.

The appellants appealed a Notice of Proposal issued by the Registrar to refuse the renewal of the licence of Sunrise Barrie and to revoke the licences of Sunrise Patterson and Sunrise Homes.

The Registrar argued the appellants were ineligible due to past financial misconduct and receiverships of associated corporations.

The Tribunal found that Sunrise Patterson and Sunrise Homes could not reasonably be expected to be financially responsible and directed the Registrar to carry out the proposal to revoke their licences.

However, the Tribunal found that Sunrise Barrie, having been taken over by an equity partner that stabilized its finances and brought it into compliance, could reasonably be expected to be financially responsible.

The Tribunal directed the Registrar to renew Sunrise Barrie's licence subject to conditions.

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

The Licence Appeal Tribunal found that the applicant failed to prove the psychotherapist services warranted an hourly rate above the prescribed minimum in the FSRA Professional Services Guidelines.

The Tribunal also found insufficient evidence to support the claims for progress reports, brokerage services, and service planning.

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

The applicant sought statutory accident benefits after falling in a parking lot while loading groceries into her vehicle.

The insurer denied the claim on the basis that the incident was a slip and fall, not an 'accident' under the Schedule.

The applicant filed an appeal with the Tribunal more than two years after receiving the denial letter by registered mail.

The Tribunal found the denial letter was valid and triggered the limitation period.

The Tribunal declined to extend the limitation period under section 7 of the LAT Act, finding the applicant failed to establish a bona fide intention to appeal or provide medical evidence supporting the merits of her claim.

The application was dismissed as statute-barred.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing her injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain.

The Licence Appeal Tribunal found the applicant failed to meet her burden of proof, noting the medical evidence conflated injuries from the subject accident with a subsequent accident and did not engage with the AMA Guides criteria for chronic pain.

As the applicant remained subject to the MIG and the monetary limits were exhausted, the disputed treatment plans for neurological and chronic pain assessments were denied.

Claims for interest and a section 10 award were also dismissed.

The applicant sought entitlement to a non-earner benefit, multiple treatment plans for physiotherapy and assessments, and an award under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent did not participate in the written hearing.

The Tribunal found that the applicant failed to meet his burden of proving entitlement to the non-earner benefit and the treatment plans, noting a lack of contemporaneous medical evidence.

The Tribunal also found that the respondent's denial notices complied with section 38(8) of the Schedule.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a slip and fall in a restaurant parking lot, which was previously determined to be an accident under the Schedule.

The Tribunal found the applicant was entitled to income replacement benefits for a closed period until he returned to work.

Claims for attendant care benefits were dismissed as the applicant failed to prove the expenses were incurred.

The Tribunal awarded funding for an attendant care assessment, physiotherapy, and partial occupational therapy, finding them reasonable and necessary.

The applicant's request for a special award under s. 10 of O. Reg. 664 was denied, as the insurer's initial denial based on the definition of an accident was not unreasonable.

The applicant sought statutory accident benefits after being assaulted and carjacked while backing her vehicle out of a parking space.

The respondent denied benefits on the basis that the incident did not meet the definition of an 'accident' under s. 3(1) of the Schedule.

The Tribunal found that while the incident met the purpose test, it failed the causation test.

The physical assault by the third party was an intervening act that severed the chain of causation, and the use or operation of the vehicle was not the direct cause of the applicant's impairments.

The application was dismissed.