Patrick Baker

The applicant sought Income Replacement Benefits (IRBs) following a motor vehicle accident.

The parties disputed the weekly quantum, with the applicant claiming $989.08 based on employment income, and the respondent calculating $80.77 based on self-employment income.

The Tribunal found that the applicant reported her income to the CRA as self-employment income, and therefore her IRBs must be calculated on that basis.

The Tribunal ordered the respondent to pay $80.77 per week plus interest, but denied the applicant's request for a special award, finding the respondent's withholding of payment was not unreasonable given the inaccurate account of self-employment.

The applicant sought an income replacement benefit (IRB) and funding for psychological treatment following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove a substantial inability to perform the essential tasks of his employment, as he provided no job description or details of his essential tasks.

The Tribunal also denied the psychological treatment plans, concluding they were not reasonable and necessary because they duplicated OHIP-funded psychiatric services the applicant was already receiving.

The applicant fell from the roof of his fifth wheel trailer while inspecting and cleaning it in preparation for a trip.

He sought statutory accident benefits from the respondent, who denied the claim on the basis that the incident was not an 'accident' under s. 3(1) of the Schedule.

The Licence Appeal Tribunal found that while the trailer met the definition of an automobile and the activity satisfied the purpose test, the incident failed the causation test.

The fall was caused by a loss of footing, an intervening act, and was not directly caused by the use or operation of the trailer.

The application was dismissed.

The applicant sought statutory accident benefits, including an income replacement benefit (IRB) and medical benefits for physiotherapy and psychotherapy, after allegedly being struck by a reversing vehicle.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove she was employed at the time of the accident or that she suffered a substantial inability to perform the essential tasks of her employment.

The Tribunal also denied the treatment plans, preferring the respondent's section 44 assessments which found no objective musculoskeletal or psychological impairments, and noting a lack of contemporaneous complaints in the applicant's medical records.

The applicant sought reconsideration of a decision denying entitlement to a $2,165 medical and rehabilitation benefit for physiotherapy.

The applicant argued the Tribunal violated procedural fairness by failing to provide reasons regarding Dr. Wilderman's evidence.

The adjudicator dismissed the request, noting that while all evidence must be reviewed, an adjudicator is not required to refer to every piece of evidence in the decision, and the original reasons for denying the claim were clear.

The applicant sought accident benefits following a 2012 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 based on chronic pain, psychological impairments, and a pre-existing condition.

The Tribunal found the applicant failed to provide sufficient medical evidence to warrant removal from the MIG, noting the injuries were predominantly soft tissue and there was no objective evidence of chronic pain or psychological impairment attributable to the accident.

Consequently, the disputed treatment plans for a psychological examination and catastrophic assessments were deemed not reasonable and necessary.

The application was dismissed.

The applicant filed a Request for Reconsideration of a Tribunal decision that denied her claim for post-104 week income replacement benefits (IRBs).

The applicant argued that the adjudicator made significant errors of law and fact by misapprehending the evidence regarding her volunteer work, wedding planning activities, and medical limitations, and that the decision violated procedural fairness.

The Tribunal dismissed the request, finding that the adjudicator had properly weighed the evidence, including the applicant's post-accident activities and the medical reports.

The Tribunal concluded that the applicant failed to demonstrate a complete inability to engage in any employment for which she was reasonably suited by education, training, or experience, and that no error was made that would have led to a different result.

The applicant sought a medical and rehabilitation benefit of $2,165.00 for physiotherapy treatment following a 2014 motor vehicle accident.

The respondent denied the benefit.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that her ongoing shoulder and back pain were caused by the accident, noting potential work-related causes and a pre-existing cyst.

The Tribunal also found the treatment was not reasonable and necessary as maximum medical recovery had likely been reached.

The application was dismissed, with no interest or award payable.

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

The respondent insurer denied a treatment plan for a chronic pain assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant sought to be removed from the MIG based on a diagnosis of chronic pain syndrome provided by a chiropractor.

The Licence Appeal Tribunal found that a chiropractor is not qualified to diagnose chronic pain syndrome.

As the applicant provided no other medical evidence, she failed to prove she should be removed from the MIG.

The application for the chronic pain assessment and interest was dismissed.

The applicant requested a reconsideration of a decision denying him non-earner benefits.

The applicant argued the Tribunal made errors of law and fact regarding the assessment of his pre-accident activities as a paramedic candidate, his psychological impairments, and his post-accident restrictions.

The Adjudicator dismissed the request, finding that the Tribunal carefully weighed the evidence and made no errors of law or fact that would warrant reconsideration.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found his claims fell within the Minor Injury Guidelines (MIG) and denied further medical benefits.

The applicant argued the Tribunal made significant errors of law and fact, specifically regarding the mandatory payment provisions under s. 38(11) of the Statutory Accident Benefits Schedule and the consideration of a psychological assessment.

The adjudicator found no significant errors of law or fact that would have changed the outcome, noting that the proposed treatment plans were not reasonable and necessary.

The request for reconsideration was dismissed.

Both parties requested reconsideration of a previous Tribunal decision regarding statutory accident benefits.

The respondent argued the Tribunal erred in awarding psychological services and an award for a functional impairment assessment, and breached procedural fairness by deeming the assessment incurred under s. 3(8) without notice.

The applicant argued the Tribunal erred by requiring attendant care services to be incurred.

The Tribunal upheld the respondent's request in part, finding a breach of procedural fairness regarding the s. 3(8) deeming provision, and struck that portion of the decision.

The applicant's request was dismissed in full.

The applicant sought statutory accident benefits for two chiropractic treatment plans following a rear-end motor vehicle accident.

The insurer denied the plans.

At the Licence Appeal Tribunal, the adjudicator found that the applicant failed to prove the treatments were reasonable and necessary.

The medical evidence, including clinical notes and records, did not support an ongoing physical impairment requiring the proposed treatment.

The adjudicator accepted the insurer's orthopaedic assessment that the applicant's soft tissue injuries had resolved.

The application was dismissed.

The applicant sought income replacement benefits (IRBs) following a 2014 motor vehicle accident.

The Tribunal found the applicant met the test for a pre-104 week IRB, as her physical and psychological impairments caused a substantial inability to perform the essential tasks of her pre-accident employment as an educational assistant.

However, the claim for a post-104 week IRB was dismissed.

The Tribunal concluded the applicant did not suffer a complete inability to engage in any employment for which she was reasonably suited, noting her volunteer work in a retail setting, her training as a wedding planner, and medical evidence indicating improvement in her condition.

Claims for a special award were dismissed, but interest was awarded on overdue pre-104 week benefits.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision.

The respondent denied a chiropractic treatment plan on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been reached.

The applicant argued that pre-existing disc bulges and chronic back pain prevented maximal recovery within the MIG limits.

The Tribunal found that the applicant failed to provide compelling medical evidence of a pre-existing condition that would remove her from the MIG.

As the injuries were predominantly minor, the treatment plan was not payable, and claims for interest and a special award were dismissed.

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

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

The applicant argued that physical and psychological impairments, as well as chronic pain, removed him from the MIG.

The Tribunal found that the applicant failed to provide persuasive medical evidence to show his injuries fell outside the MIG, noting a lack of accident-related complaints to his family physician and failure to meet the AMA Guides criteria for chronic pain.

As the $3,500 MIG limit was already exhausted, the claims for additional medical benefits and an award for unreasonably withheld payments were dismissed.

The applicant requested a reconsideration of a decision dismissing his application for medical benefits, arguing the adjudicator failed to consider evidence and applied an incorrect test.

The Tribunal found that the applicant was attempting to re-litigate failed arguments and re-weigh the evidence, which is not the purpose of a reconsideration.

The Tribunal concluded there was no significant error of law or fact.

The respondent's request for costs was also dismissed, as the reconsideration request was not found to be frivolous or vexatious.

The applicant was involved in a motor vehicle accident and claimed non-earner benefits.

The respondent paid benefits for a period before terminating them based on insurer's examinations.

The applicant applied to the Licence Appeal Tribunal to dispute the denial.

The Tribunal applied the Heath test and found that the applicant had not suffered a complete inability to carry on a normal life, as he remained independent with personal care, could drive, and complete most household chores.

The application for non-earner benefits, interest, and a Regulation 664 award was dismissed.

The applicant sought income replacement benefits following a motor vehicle accident.

The insurer brought a preliminary motion to preclude the appeal on the basis that the applicant failed to submit a Disability Certificate (OCF-3) within 104 weeks of the accident, as required by section 36 of the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant failed to meet the strict requirements of section 36 and that the omission was not merely a technical breach.

The Tribunal also denied the applicant's request for relief from forfeiture under section 129 of the Insurance Act, finding the applicant's conduct unreasonable and noting the prejudice to the insurer.

The motion was granted and the appeal was precluded from proceeding.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found their injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed to have new evidence consisting of clinical notes from a doctor advising time off work due to neck pain.

The Associate Chair denied the request for reconsideration because the applicant failed to provide the actual evidence or submissions explaining why the records could not have been obtained prior to the hearing or how they would have changed the decision.