Sherilyn J. Pickering

The applicant requested a reconsideration of a previous Tribunal decision denying various statutory accident benefits, including attendant care benefits and multiple treatment plans.

The Tribunal found no material breach of procedural fairness.

However, it found an error of law in failing to determine if attendant care benefits were reasonable and necessary, though it ultimately concluded they were not.

The Tribunal also found an error of law and fact regarding three physiotherapy treatment plans, determining that the applicant was entitled to them because she had been removed from the Minor Injury Guideline and her treating neurologist had recommended the treatment.

The remainder of the reconsideration request was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied a treatment plan for home modifications.

The applicant argued the Tribunal breached procedural fairness and made errors of law and fact by misapprehending evidence related to causation and the characterization of his impairments.

The Adjudicator dismissed the request, finding that the original decision applied the correct legal test for causation and provided thorough reasons for the weight assigned to the evidence.

The Adjudicator concluded the applicant was attempting to re-litigate the weight of the evidence rather than demonstrating a reviewable error.

The defendant, His Majesty the King in Right of Ontario, moved for an order requiring the plaintiff’s accident benefits insurer to produce a file relating to a 2011 motor vehicle accident, arguing its relevance to a 2017 accident at issue in the present action.

The court found the moving party failed to establish either the relevance of the documents or that it would be unfair to proceed to trial without them, and dismissed the motion.

The court also awarded costs to the plaintiff.

The applicant requested a reconsideration of a decision finding she was not catastrophically impaired.

She argued the Tribunal breached procedural fairness by failing to assess two spheres of Criterion 8, and made errors of law and fact in assessing her visual and psychiatric impairments.

The Tribunal dismissed the request, finding no breach of procedural fairness as the statute did not require further analysis.

The Tribunal also found no errors of law or fact, noting that the applicant's experts failed to follow the AMA Guides' methodology for rating impairments.

The request for reconsideration was dismissed.

The applicant sought a reconsideration of a previous decision denying her entitlement to an attendant care benefit, various medical benefits, and cost of examination expenses.

She argued the Tribunal committed a material breach of procedural fairness and made errors of law in assessing the evidence.

The Tribunal dismissed the request, finding no breach of procedural fairness as the applicant had the opportunity to respond to arguments and failed to submit key evidence.

The Tribunal also found no errors of law, concluding the applicant was attempting to relitigate issues already decided.

The applicant, a minor, sought statutory accident benefits for psychological injuries arising from a motor vehicle accident involving her cousin.

The respondent insurer denied benefits, arguing the applicant was not an 'insured person' under the Schedule because cousins are not listed family members.

The Tribunal applied the modern approach to statutory interpretation and found that the applicant's mother had a de facto parent-child relationship with the cousin, making the applicant and the cousin 'sisters' for the purposes of the Schedule.

The Tribunal concluded the applicant is an insured person and eligible for benefits.

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

The insurer denied the benefits.

The Tribunal found the applicant was entitled to the psychological assessment and the October 2020 chiropractic treatment plan, as they were reasonable and necessary to address impairments resulting from the accident.

However, the Tribunal dismissed the claims for the 2022 chiropractic treatment plans due to insufficient evidence of their necessity and effectiveness.

The applicant was awarded interest on the overdue payments but denied an award under s. 10 of Reg. 664 as the insurer's actions were not unreasonable.

The applicant, who has pre-existing global developmental delay, autism spectrum disorder, and a seizure disorder, sought $3,528.83 for home modifications following a motor vehicle accident.

The applicant argued the accident worsened his seizures and aggressive behaviours, necessitating the modifications.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove on a balance of probabilities that the accident caused an exacerbation of his pre-existing impairments.

The adjudicator noted significant inconsistencies between the grandparents' subjective reports of worsened behaviour and contemporaneous pre-accident medical records, and preferred the respondent's medical evidence that the accident did not cause the reported deterioration.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits and various treatment plans for occupational therapy, physiotherapy, social work, and a psychological assessment.

The Licence Appeal Tribunal denied the claim for attendant care, finding the applicant failed to prove an ongoing need.

However, the Tribunal approved several of the treatment plans, either in whole or in part, finding them reasonable and necessary.

The Tribunal also granted an award under s. 10 of O. Reg. 664, ordering the respondent to pay $600 (15% of the denied occupational therapy benefits) because it unreasonably maintained its denial despite its own assessor recommending the treatment.

Preliminary motions regarding page limits and striking portions of the applicant's reply submissions were also addressed.

The applicant was involved in a motor vehicle accident and notified the insurer within seven days.

The insurer did not provide an accident benefits package, relying on a single confusing conversation where the applicant stated he was uninjured.

The applicant later submitted an application for benefits outside the standard 30-day window.

The Tribunal found that the insurer failed to discharge its obligation to provide the application forms under section 32(2) of the Schedule, meaning the 30-day clock never started.

The applicant was permitted to proceed with his claim.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found she was not catastrophically impaired and denied her claims for attendant care, treatment plans, housekeeping, and costs.

The applicant argued the Tribunal breached procedural fairness and made errors of fact and law in assessing various Whole Person Impairment (WPI) ratings, including those for upper extremity, mental status, diplopia, medications, and social functioning.

The Adjudicator dismissed the request, finding no material breach of procedural fairness as the applicant had ample opportunity to present her case during the 11-day hearing.

Furthermore, the Adjudicator concluded that no errors of fact or law were made that would have resulted in a different outcome.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for an occupational therapy device, specifically the repair of a heated car seat, costing $927.60.

The respondent denied the treatment plan, relying on an insurer's examination that concluded the device was not reasonable and necessary.

The Tribunal found that the applicant met her burden of proving the device was reasonable and necessary to manage her chronic pain while driving in winter months, supported by her occupational therapist's report.

The Tribunal ordered the respondent to pay for the treatment plan with interest, but declined to order a special award as there was no evidence of unreasonable delay or ill intention.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including attendant care benefits and various treatment plans for occupational therapy, physiotherapy, optometry, social work, and medical assessments.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline and the expenses were not reasonable and necessary.

The Licence Appeal Tribunal dismissed the application, finding that the attendant care benefits were not incurred and the applicant failed to prove on a balance of probabilities that the proposed treatment plans were reasonable and necessary for her accident-related injuries.

Claims for interest and an award were also dismissed.

The applicant sought statutory accident benefits following a 2019 motor vehicle accident, claiming entitlement to attendant care benefits, various treatment plans, and a special award.

The Licence Appeal Tribunal dismissed the majority of the claims, finding that the applicant failed to prove the expenses were reasonable and necessary or incurred.

The Tribunal preferred the respondent's insurer examination reports, which found the applicant independent in her activities of daily living and lacking neurological impairment.

However, the Tribunal granted the applicant's claim for a driving assessment due to undisputed vehicular anxiety, along with applicable interest.

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

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

The Tribunal found the applicant demonstrated she suffered from chronic pain with functional impairment, warranting removal from the MIG, based on a chronic pain assessment and consistent reporting of ongoing pain and withdrawal from activities.

The Tribunal ordered the respondent to pay the $2,195.01 treatment plan plus interest, finding it reasonable and necessary.

However, the Tribunal denied the applicant's request for a special award, concluding the insurer's reliance on its medical examination report, while ultimately unpersuasive, was not unreasonable.

The applicant requested a reconsideration of a preliminary issue decision which found his claim for Income Replacement Benefits (IRBs) was statute-barred.

The applicant argued the adjudicator erred in finding the insurer's denial letter was clear and unequivocal, and in refusing to extend the limitation period under section 7 of the Licence Appeal Tribunal Act.

The Tribunal dismissed the request, finding the applicant was attempting to relitigate the initial decision and failed to establish any errors of law or fact that would have changed the outcome.

The Tribunal also rejected the applicant's attempt to introduce an undated resignation letter as new evidence.

The applicant sought a determination that she was catastrophically impaired under Criterions 7 and 8 of the Statutory Accident Benefits Schedule following a 2017 motor vehicle accident, along with payment for disputed treatment and assessment plans.

The Tribunal found that the applicant's expert on visual impairment failed to follow the AMA Guides' testing methods, resulting in the rejection of the 24% WPI rating for diplopia.

The Tribunal also adjusted the applicant's psychological impairment ratings, finding them inconsistent with her demonstrated functional abilities.

Consequently, the applicant did not meet the threshold for catastrophic impairment under either criterion.

The claims for psychological services and catastrophic impairment assessments were dismissed for lack of evidence demonstrating they were reasonable and necessary.

The respondent's request for costs due to the applicant's late withdrawal of Criterion 4 was also dismissed.

The applicant, a pedestrian struck by a vehicle, sought a medical benefit for an occupational therapy treatment plan.

The respondent denied the plan but failed to provide medical reasons in its denial notices, violating section 38(8) of the Statutory Accident Benefits Schedule.

The Tribunal found the non-compliant denials engaged section 38(11), entitling the applicant to the incurred goods and services plus interest.

The applicant's claim for an award under section 10 of Regulation 664 was dismissed as the respondent's conduct was not excessive or imprudent.

The applicant sought various statutory accident benefits following a 2018 motor vehicle accident, including attendant care benefits, post-104 income replacement benefits, and several treatment plans.

The Tribunal dismissed the claims for attendant care and income replacement benefits, finding the applicant was independent with personal care and did not suffer a complete inability to engage in suitable employment.

The Tribunal granted the treatment plans for a SPECT scan and occupational therapy, finding them reasonable and necessary to address the applicant's traumatic brain injury and ongoing impairments.

Claims for other assessments, physiotherapy, speech-language therapy, and a special award were dismissed.

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

The respondent denied various benefits, including non-earner benefits and several treatment plans, and raised a preliminary issue that the applicant was barred from proceeding due to non-attendance at an insurer's examination.

The Tribunal found the applicant was not statute-barred because the missed examination had been rescheduled.

On the merits, the Tribunal awarded non-earner benefits for a closed period, finding the applicant's pain practically prevented her from engaging in her nursing studies and pre-accident activities until she successfully resumed a full course load.

The Tribunal also partially approved several treatment plans for physiotherapy, chiropractic, massage, and occupational therapy assessments, while denying others for lack of evidence.

Interest was awarded on overdue payments, but the claim for a special award was dismissed.