18 total
Application for accident benefits dismissed as statute-barred due to applicant's entitlement to WSIB benefits.
The applicant was involved in a motor vehicle accident while operating a commercial vehicle and sought statutory accident benefits.
The respondent denied benefits, arguing the applicant was in the course of employment and therefore required to pursue WSIB benefits under s. 61(1) of the Schedule.
The applicant claimed he was an independent contractor and that he elected to pursue a tort action under s. 30 of the WSIA, triggering the exception in s. 61(2).
The Tribunal drew an adverse inference against the applicant for failing to produce employment and WSIB records.
The Tribunal found the applicant had access to WSIB benefits and failed to prove a bona fide intention to pursue a tort claim, as a tort action was barred under s. 28(1) of the WSIA because both vehicles were Schedule 1 employers.
The application was dismissed as statute-barred.
Reconsideration request denied as the applicant failed to demonstrate material errors in the catastrophic impairment assessment.
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.
Request for reconsideration dismissed as the applicant improperly sought to re-weigh medical and surveillance evidence.
The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found she was not catastrophically impaired and denied a treatment plan for a catastrophic assessment.
The applicant argued the adjudicator erred in weighing the medical evidence, particularly regarding a pre-existing 2019 accident, and placed undue weight on surveillance evidence showing her speeding.
The Vice-Chair dismissed the request, finding the applicant was improperly attempting to re-weigh the evidence rather than identifying an error of law or fact.
The Tribunal also upheld the denial of the treatment plan balance, noting the applicant failed to explain why an amount greater than the statutory cap was reasonably required.
Catastrophic impairment designation denied; psychological and occupational therapy treatment plans approved as reasonable and necessary.
The applicant sought a determination of catastrophic impairment and entitlement to various medical, rehabilitation, and transportation benefits following a motor vehicle accident.
The Licence Appeal Tribunal found that the applicant did not sustain a catastrophic impairment under either Criterion 7 (55% Whole Person Impairment) or Criterion 8 (mental or behavioural disorder), preferring the respondent's medical evidence which indicated lower impairment ratings.
However, the Tribunal granted the applicant's claims for a psychological treatment plan and an occupational therapy assessment, finding them reasonable and necessary.
The claims for transportation expenses were dismissed for lack of evidence.
Reconsideration request dismissed; applicant failed to establish errors of law or fact regarding MIG limits.
The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found he remained within the Minor Injury Guideline (MIG) and was not entitled to disputed treatment plans.
The applicant argued the adjudicator erred in applying s. 18(2) of the Statutory Accident Benefits Schedule and in assessing his claim of chronic pain.
The Tribunal dismissed the reconsideration request, finding that the applicant failed to demonstrate an error of law or fact.
The Tribunal held that the applicant was attempting to re-litigate the weighing of medical evidence, which is not a valid ground for reconsideration under Rule 18.2.
Reconsideration granted and decision cancelled due to procedural unfairness in shortening the hearing schedule.
The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied catastrophic impairment and various benefits.
The applicant argued the Tribunal committed a material breach of procedural fairness by shortening the scheduled 12-day hearing to six days, which prevented one of their witnesses from testifying due to a scheduling conflict.
The Vice-Chair agreed, finding that the Tribunal failed to exercise its discretion in a procedurally fair manner and did not consider alternative options to accommodate the witness.
The reconsideration was granted and the original decision was cancelled.
Catastrophic impairment claim dismissed; applicant failed to prove marked psychological impairment caused by the accident.
The applicant sought a determination that she sustained a catastrophic impairment under Criterion 8 (mental or behavioural disorder) as a result of a motor vehicle accident, as well as payment for the unapproved balance of a catastrophic assessment treatment plan.
The respondent brought a preliminary motion arguing the claim was barred by res judicata due to a prior Tribunal decision denying non-earner benefits.
The adjudicator dismissed the motion, finding the prior decision did not rule on psychological impairments.
On the merits, the adjudicator found the applicant was not catastrophically impaired, preferring the respondent's psychiatric evidence that the applicant's impairments were pre-existing from a 2019 accident and that she had returned to her premorbid baseline.
Surveillance evidence and the applicant's ongoing activities, including attending college and travelling, contradicted claims of marked impairment.
The claim for the unapproved treatment plan balance was also dismissed as the applicant failed to justify costs exceeding the statutory maximums.
A driver who suffers a sudden seizure is not liable in negligence if they reasonably followed medical advice regarding their fitness to drive.
The plaintiffs brought a personal injury action against the estate of a deceased driver who caused a multi-vehicle collision after suffering a sudden seizure.
The defendant estate moved for summary judgment, arguing the collision was an inevitable accident caused by a sudden medical emergency.
The court found that the driver had followed all medical advice, complied with his medication regimen, and had no reason to anticipate the seizure.
Consequently, the court granted the motion for summary judgment and dismissed the action, holding that the driver met the standard of reasonable care.
Application for accident benefits dismissed; applicant failed to prove injuries warranted removal from the Minor Injury Guideline.
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 $3,500 Minor Injury Guideline (MIG) limit.
The applicant argued for removal from the MIG based on pre-existing physical and psychological impairments, accident-related psychological impairment, and chronic pain.
The Tribunal found the applicant failed to provide compelling medical evidence that his pre-existing conditions would prevent maximal medical recovery within the MIG.
The Tribunal also found insufficient evidence that the applicant suffered from accident-related psychological impairment or chronic pain with functional impairment.
The application was dismissed, and the applicant was found not entitled to the disputed treatment plans, interest, or an award.
Application for catastrophic impairment and accident benefits dismissed after applicant's expert recanted findings during cross-examination.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a catastrophic impairment and was entitled to post-104 income replacement benefits, attendant care, and various medical benefits.
The Licence Appeal Tribunal dismissed the application.
The Tribunal gave no weight to the applicant's key expert psychiatrist, who recanted his findings during cross-examination when confronted with evidence of the applicant's actual functional capabilities, including international travel and childcare.
Consequently, the applicant failed to prove she met the criteria for catastrophic impairment or that she suffered a complete inability to engage in suitable employment.
As the non-catastrophic benefit limits were exhausted, all claims were dismissed.
Application for accident benefits dismissed as barred by res judicata; new evidence did not warrant waiver.
In a previous decision, the Tribunal determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and that MIG limits were exhausted.
The applicant subsequently submitted new treatment plans and filed a second application seeking removal from the MIG.
The respondent raised res judicata as a preliminary issue.
The Tribunal found that the four preconditions for res judicata were met and that the new medical evidence submitted did not establish a material change in circumstances to warrant waiving the doctrine.
The application was dismissed.
Appeal dismissed; Adjudicator did not err by ignoring financial documents the appellant failed to enter into evidence.
The appellant appealed a Licence Appeal Tribunal decision denying his claim for income replacement benefits following a motor vehicle accident.
The appellant argued the Adjudicator breached procedural fairness and erred in law by failing to consider financial documents contained in his voluminous document brief.
The Divisional Court dismissed the appeal, finding no breach of procedural fairness or error of law, as the appellant had failed to enter the documents into evidence despite multiple directions and opportunities from the Adjudicator to do so.
The court also upheld the denial of an award for unreasonably withheld payments.
Applicant removed from MIG due to chronic pain but denied non-earner benefit.
The applicant sought statutory accident benefits following a single-vehicle accident.
The Tribunal found the applicant was not entitled to a non-earner benefit, as she failed to demonstrate a complete inability to carry on a normal life, noting her pre-existing conditions and lack of evidence showing a significant post-accident functional decline.
However, the Tribunal removed the applicant from the Minor Injury Guideline (MIG), finding she met the criteria for chronic pain and suffered an exacerbation of prior psychological impairments.
The Tribunal awarded $2,460.00 for a psychological assessment but denied a $3,805.69 claim for physiotherapy because the treatment plan was not submitted into evidence.
Applicant removed from Minor Injury Guideline due to pre-existing hardware issue; most treatment plans denied.
The respondent denied certain treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant was not subject to the MIG due to a pre-existing medical condition involving a loose screw in a surgically implanted plate in his arm, which was exacerbated by the accident and prevented recovery within the MIG limits.
The Tribunal awarded the outstanding $200 for a partially approved physiotherapy plan but denied the remaining treatment plans for physical rehabilitation and psychological services, finding insufficient evidence that they were reasonable and necessary.
Applicant entitled to chronic pain assessment and interest; claims for psychological assessment and special award dismissed.
The applicant sought statutory accident benefits following a motor vehicle accident, including chiropractic treatment, a psychological assessment, a chronic pain assessment, a special award, and interest.
The adjudicator found no jurisdiction over the chiropractic treatment plans as they had already been approved by the respondent and the dispute arose from improper invoicing.
The claim for the remaining cost of a psychological assessment was dismissed because the applicant failed to prove that fees exceeding the guideline rate were reasonable.
However, the adjudicator granted the cost of a chronic pain assessment, finding it necessary to explore the applicant's pain complaints and rejecting the respondent's medical examination report.
The claim for a special award for unreasonable delay was dismissed, but interest was awarded on the approved chronic pain assessment.
Treatment plans deemed not reasonable and necessary, but insurer liable for expenses incurred during defective notice period.
The applicant sought medical benefits for chiropractic, massage, acupuncture, and shockwave therapy following a motor vehicle accident.
The adjudicator found that the applicant failed to prove the proposed treatment plans were reasonable and necessary, as her family physician had not recommended such facility-based treatments and the insurer's examination concluded they would not be beneficial.
However, the adjudicator found that the insurer's initial denials of the treatment plans were defective under s. 38(8) of the Statutory Accident Benefits Schedule for failing to provide medical reasons.
Consequently, the insurer was ordered to pay for any expenses incurred during the period of non-compliance, along with interest.
Application for accident benefits dismissed; applicant failed to prove injuries fell outside the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming her injuries fell outside the Minor Injury Guideline (MIG) due to a pre-existing medical condition, chronic pain, psychological impairments, and physical limitations.
The Tribunal found that the applicant failed to provide sufficient medical evidence from specialists to prove she could not attain maximal recovery within the MIG or that she developed chronic pain syndrome or a psychological impairment.
Relying on the respondent's specialist assessments, the Tribunal concluded the applicant's injuries remained within the MIG.
As the $3,500 limit was exhausted, the disputed treatment plans, interest, and an award were denied.
Insured must repay overpaid IRBs due to undisclosed return to work and maternity benefits.
The applicant insurer sought repayment of Income Replacement Benefits (IRBs) paid to the respondent, alleging she failed to disclose her return to work and receipt of maternity benefits.
The Tribunal found that the respondent did not independently inform the insurer of her maternity income or return to work, which constituted an assertion not in accordance with the facts.
The Tribunal ordered the respondent to repay $14,317.80 in overpaid IRBs, plus $250.56 in interest, for a total of $14,568.36.