Cezary Paluch

The applicant was involved in a motor vehicle accident and failed to apply for statutory accident benefits within the prescribed timelines, waiting approximately 11 months.

The applicant argued the delay was reasonable because he thought his injuries would resolve, he did not know he could apply for benefits from his own insurer since he was driving his uncle's car, and the insurance agent was allegedly negligent.

The Tribunal applied the Horvath factors and found the applicant's explanations unreasonable, noting that ignorance of the law is not a reasonable explanation and there was no evidence the injuries prevented him from applying.

The application was dismissed as statute-barred under section 55(1)1 of the Schedule.

The applicant sought a determination that she sustained a catastrophic impairment due to a mental or behavioural disorder following an ATV accident.

The central issue was whether she suffered a marked impairment in the domain of adaptation.

The Tribunal found that the applicant's psychological impairments, including autism spectrum disorder and depression, were pre-existing and not caused by the accident under the 'but for' test.

Furthermore, the Tribunal preferred the respondent's psychiatric evidence, concluding that the applicant's level of function was compatible with a mild impairment rather than a marked one.

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

The applicant, a first responder, sought statutory accident benefits for psychological impairments sustained after attending the aftermath of the Toronto van attack.

The insurer denied the claim on the basis that the applicant was not involved in an 'accident' as defined in section 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant did not meet the purpose or causation tests.

The van was being used as a weapon, not for its ordinary and well-known activities, and the applicant's use of the fire truck did not directly cause his impairments.

The application was dismissed.

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

After the applicant's counsel was removed from the record due to an inability to communicate with the applicant, the applicant failed to attend the scheduled videoconference hearing despite receiving notice.

The Licence Appeal Tribunal found that the applicant had abandoned the application pursuant to Rule 3.4 of the Tribunal's Rules of Practice and Procedure and dismissed the claim.

The applicant, an Uber driver, was injured in a motor vehicle accident and claimed entitlement to post-104 week income replacement benefits (IRBs).

The insurer terminated IRBs on the basis that the applicant could return to suitable employment.

The Tribunal found that the applicant suffered a complete inability to engage in any employment for which he was reasonably suited by education, training, or experience, due to the synergistic impact of his physical injuries and psychological impairments, including chronic pain and depression.

The Tribunal ordered ongoing IRBs at $200 per week plus interest, but dismissed the applicant's claims for a special award and costs, finding the insurer's conduct was not unreasonable or in bad faith.

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

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

The Tribunal found that the applicant suffered from chronic pain syndrome and related psychological impairments, removing him from the MIG.

The Tribunal preferred the evidence of the applicant's chronic pain specialist over the insurer's physiatrist, who failed to address the psychological components of the pain.

The Tribunal also found the insurer failed to comply with the procedural requirements of section 38 of the Schedule by responding to the treatment plan almost a year late.

The applicant was awarded the cost of the assessment and interest.

The applicant sought $12,580.00 for a multidisciplinary chronic pain program following a 2015 motor vehicle accident.

The respondent denied the treatment plan, arguing the applicant's current pain complaints were not accident-related and she had reached maximum medical recovery.

The Tribunal found the proposed program lacked specificity and the applicant failed to prove it was reasonable and necessary.

The Tribunal also noted inconsistencies in the applicant's reporting of her injuries and preferred the respondent's medical evidence, which concluded the applicant had achieved maximum medical improvement.

The application was dismissed.

The applicant sought various medical and assessment benefits following a motor vehicle accident, arguing her chronic pain and psychological impairments warranted removal from the Minor Injury Guideline (MIG).

The Tribunal preferred the evidence of the respondent's assessors, finding the applicant's injuries were predominantly minor and did not cause sufficient functional impairment to justify removal from the MIG.

The Tribunal noted the applicant's experts failed to account for subsequent motor vehicle accidents and relied heavily on self-reporting without objective testing.

As the applicant's injuries fell within the MIG and the $3,500 limit had been exhausted, the disputed treatment plans were not payable.

Claims for an award and interest were also dismissed.

During a hearing to determine if the applicant was catastrophically impaired, the respondent objected to the applicant's expert witness testifying to matters beyond her original report, specifically a late-served rebuttal report.

The Tribunal ruled that the expert could testify to all relevant matters, including the new report.

The Tribunal found that under the Statutory Powers Procedure Act, it has broad discretion to admit relevant evidence, and the probative value of the testimony outweighed any prejudice to the respondent, which could be cured by allowing cross-examination and reply evidence.

The applicant was injured in a motorcycle accident and subsequently settled her statutory accident benefits claim with the respondent insurer for $50,000.

Years later, she applied for a catastrophic impairment determination, which the insurer denied on the basis of the prior full and final settlement.

At a preliminary issue hearing, the applicant argued she lacked capacity and was under duress when she signed the settlement.

The Tribunal found the settlement was valid, the cooling-off period had expired, and the applicant failed to establish mental incapacity or duress.

The application was dismissed as statute-barred.

The applicant sought a special award under s. 10 of O. Reg. 664, alleging the respondent unreasonably delayed paying a settlement amount of $5,786.83 to two medical clinics.

The respondent argued the Tribunal lacked jurisdiction because the payment obligation arose from a private settlement agreement, not an entitlement under the Statutory Accident Benefits Schedule.

The Tribunal agreed it lacked jurisdiction, finding the dispute was contractual.

In the alternative, the Tribunal found the respondent's conduct did not meet the high threshold for a special award, as the delay resulted from a miscommunication regarding the submission of invoices through HCAI, rather than excessive or stubborn behaviour.

The motion was dismissed.

The applicant sought statutory accident benefits for lost educational expenses after a motor vehicle accident prevented her from continuing her college program.

She claimed $15,153.00, primarily related to OSAP grants that were converted to loans when she withdrew.

The Licence Appeal Tribunal found that the applicant met the criteria for being unable to continue her program due to her injuries.

However, the Tribunal held that lost educational expenses are confined to expenses incurred before the accident for the specific term in which she was enrolled.

The Tribunal denied the claims for tuition, internet, telephone, and food, but awarded $862.69 for room and board (rent) incurred for January 2019 prior to the accident, plus interest.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) for nearly four years before the insurer terminated them based on insurer's examinations.

The applicant sought ongoing IRBs, arguing she suffered a complete inability to engage in suitable employment due to severe physical and psychological impairments, including chronic pain syndrome and PTSD.

The Tribunal found that the applicant met the post-104 week disability test, preferring the evidence of her treating practitioners and experts over the insurer's assessors, who failed to consider her psychological impairments.

The Tribunal ordered the insurer to pay IRBs of $400 per week from the date of termination, plus interest.

However, the Tribunal dismissed the applicant's claim for an award under O. Reg. 664, finding the insurer's reliance on its medical assessments was not unreasonable or immoderate.

The applicant sought to dispute the denial of income replacement benefits and two treatment plans following a motor vehicle accident.

The respondent raised a preliminary issue that the application was statute-barred under s. 56 of the Statutory Accident Benefits Schedule because it was filed more than two years after the clear and unequivocal denials.

The Tribunal found that the denials were proper and that the application was filed late.

The Tribunal also held that it did not have jurisdiction under s. 7 of the Licence Appeal Tribunal Act to extend the limitation period in the Schedule, as the Schedule is a regulation, not an Act.

Even if it had jurisdiction, the Tribunal found that the justice of the case did not warrant an extension based on the Manuel factors.

The application was dismissed as statute-barred.

The applicant was involved in two motor vehicle accidents and sought statutory accident benefits, including non-earner benefits and medical benefits.

The respondent terminated the non-earner benefits and denied several treatment plans.

The Tribunal found that the respondent breached the Statutory Accident Benefits Schedule by failing to provide proper notice when terminating the non-earner benefits, entitling the applicant to payment for the disputed period.

The Tribunal also found that the applicant's pre-existing lupus was aggravated by the accident, satisfying the causation test.

The physiotherapy treatment plans were deemed reasonable and necessary, but the claims for orthopaedic and psychological assessments were dismissed because they were incurred before the treatment plans were submitted.

The applicant's request for a special award was denied.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that granted the applicant entitlement to two treatment plans.

The respondent argued that the Tribunal breached procedural fairness by relying on the applicant's affidavit evidence after the respondent had waived cross-examination under the mistaken belief that the affidavit was being withdrawn.

The Adjudicator agreed that a significant error of fact and breach of procedural fairness occurred, as the Tribunal had relied heavily on the untested affidavit in its original decision.

The reconsideration was granted, the original decision was cancelled, and a rehearing on written submissions without the affidavit was ordered.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits, medical and rehabilitation benefits, and interest.

The Licence Appeal Tribunal dismissed the claim for attendant care benefits, finding the applicant failed to prove the expenses were incurred.

The Tribunal granted the cost of a mattress as an assistive device, finding it reasonable and necessary to address the applicant's sleep disturbance.

The Tribunal also awarded $924.24 for occupational therapy services because the insurer's denial letter failed to provide sufficient medical and other reasons as required by s. 38(8) of the Schedule.

The remaining claims for occupational therapy and chiropractic services were dismissed as not reasonable and necessary.

The Tribunal drew an adverse inference against the applicant for failing to comply with a production order regarding her pre-accident medical records.

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

The respondent denied a treatment plan for physiotherapy 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 she should be removed from the MIG due to pre-existing conditions, chronic pain, and psychological impairment.

The Tribunal found insufficient evidence of a documented pre-existing condition that would prevent maximal recovery.

Furthermore, the Tribunal preferred the respondent's multi-disciplinary independent medical examinations, which concluded the applicant's physical and psychological injuries were predominantly minor and did not cause significant functional impairment.

The application was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found her injuries fell within the Minor Injury Guideline.

The applicant argued the Tribunal erred in its weighing of the medical evidence, specifically regarding the reports of Dr. Nathanson, Dr. Oshidari, and Dr. Wilderman.

The adjudicator dismissed the request, finding that the Tribunal properly exercised its discretion in weighing the evidence, including giving limited weight to diagnoses of chronic pain and severe PTSD that lacked sufficient foundation or were outside the assessors' scope of expertise.

The reconsideration was dismissed.

The applicant sought accident benefits following a motor vehicle accident, disputing the insurer's determination that his injuries fell within the Minor Injury Guideline (MIG) and the termination of his income replacement benefits (IRBs).

The Tribunal found that the applicant's physical injuries, including left shoulder bursitis, were minor and not caused by the accident.

The Tribunal rejected the applicant's claim of chronic pain syndrome, giving little weight to his medical expert's report due to a lack of analysis and missing medical history.

The Tribunal also drew an adverse inference from the applicant's failure to produce relevant employment and medical records.

Consequently, the Tribunal held that the applicant's injuries were subject to the MIG limit, which had been exhausted, and that he failed to prove entitlement to IRBs.