Cezary Paluch

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) after the respondent terminated them.

The Tribunal found that the applicant suffered from chronic pain and psychological impairments caused by the accident, rendering her substantially unable to perform the essential tasks of her pre-accident employment as a general labourer.

The Tribunal ordered the respondent to pay the IRBs and interest on overdue amounts.

The applicant's claim for a special award under Regulation 664 was dismissed, as the respondent's initial denial of treatment plans was not unreasonable given the medical evidence available at the time.

The respondent insurer brought a motion to validate the late service of addendum medical reports.

The reports were due on January 12, 2018, but were served by email on the evening of January 15, 2018, making them two days late under the Tribunal's rules.

The adjudicator granted the motion, finding that the delay was minor, the respondent kept the applicant informed, and there was no prejudice to the applicant.

The adjudicator noted that excluding the reports would be disproportionate and unfair.

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

The Tribunal applied the AMA Guides and the three-step test from Pastore.

While finding the applicant suffered a psychological impairment caused by the accident, the Tribunal concluded she did not suffer a marked (Class 4) impairment in any of the four functional domains.

The Tribunal preferred the respondent's multidisciplinary medical evidence over the applicant's experts, noting credibility concerns and the applicant's failure on performance validity tests.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought Income Replacement Benefits (IRBs).

The insurer suspended and later terminated the benefits, arguing the applicant failed to provide requested financial documentation under s. 33 of the Schedule and no longer met the disability test.

The Tribunal found that the applicant breached s. 33 without a reasonable explanation, disentitling her to benefits for the period of non-compliance.

Furthermore, the Tribunal held that the applicant failed to prove on a balance of probabilities that she suffered a substantial inability to perform the essential tasks of her employment as a restaurant owner, relying on the insurer's multidisciplinary assessments.

The application and request for costs were dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits for physical rehabilitation and acupuncture services, which the respondent insurer denied.

The Licence Appeal Tribunal found that the applicant's physical and psychological impairments were caused by the accident.

The Tribunal placed limited weight on the insurer's medical examination reports due to methodological flaws and incomplete record reviews.

The Tribunal concluded that the proposed treatment plans were reasonable and necessary to address the applicant's persistent pain and psychological distress.

The applicant was awarded the claimed medical benefits and interest, while the respondent's request for costs was denied.

The applicant sought accident benefits for psychological counselling after a previous application was dismissed on the basis that their injuries fell within the Minor Injury Guideline (MIG).

The respondent insurer brought a motion to dismiss the new application, arguing it was barred by res judicata.

The Tribunal dismissed the motion as premature, noting that the specific claim for psychological services was not part of the first application, the determination of whether injuries fall within the MIG is not static, and the matter had not yet proceeded to a case conference to identify the issues and exchange disclosure.

The applicant sought costs after the respondent conceded catastrophic impairment less than two weeks before the scheduled hearing.

The applicant argued the respondent acted unreasonably, frivolously, and in bad faith by delaying the concession and failing to produce two medical reports.

The Tribunal dismissed the motion, finding the respondent acted reasonably in relying on its medical evidence and noting the applicant's low medical/rehabilitation expenses.

The Tribunal also found no breach of disclosure orders, as the applicant could have obtained the reports directly from his own service providers.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the 104-week mark, at which point the respondent terminated them.

The applicant applied to the Licence Appeal Tribunal for ongoing benefits, arguing he suffered a complete inability to engage in any suitable employment due to physical and psychological impairments.

The Tribunal dismissed the application, finding the applicant's medical evidence failed to address the more stringent post-104 week test and lacked specific diagnoses.

The Tribunal accepted the respondent's expert evidence that the applicant could return to work and had alternative vocational options.

The respondent brought a motion to dismiss the applicant's application for statutory accident benefits due to the applicant's failure to comply with a production order and missed deadlines for filing submissions.

The adjudicator denied the request for dismissal, finding that the statutory requirements for dismissal without a hearing were not met and proper notice was not given.

However, as a remedy for the non-compliance, the adjudicator ordered that the applicant could not rely on the unproduced medical records and allowed the respondent to file supplementary submissions.

The applicant brought a motion to amend their witness list and request summonses for two witnesses, Christopher Lun and Douglas Young, ahead of an upcoming hearing.

The Tribunal allowed the applicant to replace one witness and add a psychologist on consent.

The Tribunal ordered that a summons be issued for Mr. Lun, the respondent's adjuster, upon the applicant complying with Rule 8.2.

However, the Tribunal refused to add Mr. Young, the adjuster's manager, as a witness, finding the applicant failed to provide sufficient evidence that he was a necessary or relevant witness regarding the issue of a special award.

The respondent brought a motion to dismiss the applicant's claim for statutory accident benefits after the applicant filed their written submissions late.

The applicant had requested an extension due to a power outage, which the Tribunal granted without requiring a formal notice of motion, leading to confusion for the respondent.

The adjudicator dismissed the motion to dismiss the claim, finding that the applicant should not bear the burden of the Tribunal's administrative oversight and that dismissing the claim for a one-day delay would be unfair.

The adjudicator adjusted the hearing schedule to allow the respondent to file supplementary submissions and address costs.

The applicant, a 31-year-old homemaker and mother, suffered serious physical and psychological injuries in a motor vehicle accident.

She applied for non-earner benefits, which the respondent insurer terminated.

The Tribunal applied the Heath test to determine if the applicant suffered a complete inability to carry on a normal life.

Finding the applicant and her treating practitioners credible, and placing limited weight on the insurer's assessors, the Tribunal concluded that the applicant's pain and psychological impairments continuously prevented her from engaging in substantially all of her pre-accident activities, particularly caregiving and homemaking.

The Tribunal ordered the respondent to pay the non-earner benefits and interest on overdue amounts.

The applicant brought a motion to vary a case conference order to add a newly denied treatment plan for chronic pain as an issue in dispute for an upcoming hearing.

The respondent opposed, arguing a separate application was required.

The Adjudicator granted the motion, finding that adding the issue would save time and resources, avoid unnecessary case conferences, and ensure a fair and expeditious resolution, as the new issue involved the same parties and accident.

The applicant in a statutory accident benefits dispute sought production of statistics regarding the number of reports completed by the respondent insurer's medical assessors over the past three years and the amounts paid for them.

The applicant argued this information was necessary to assess the experts' impartiality.

The adjudicator denied the request, finding that the information was not relevant to the substantive issues in dispute and was not necessary for a full and satisfactory understanding of the issues under the Tribunal's Rules of Practice.

The adjudicator noted that the appropriate forum to challenge an expert's objectivity is during cross-examination at the hearing.

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

She initially elected to receive a non-earner benefit (NEB) but later sought to re-elect an income replacement benefit (IRB).

The Licence Appeal Tribunal held a preliminary hearing to determine if she could re-elect.

The Tribunal found that under section 35(3) of the Statutory Accident Benefits Schedule, an election of benefits is final unless the insured has sustained catastrophic injuries, which the applicant had not.

The Tribunal rejected the applicant's arguments that her election was invalid or that promissory estoppel applied due to alleged erroneous advice from an adjuster.

The respondent's request for costs was denied as the applicant's conduct was not unreasonable, frivolous, vexatious, or in bad faith.

The applicant sought medical and rehabilitation benefits for chronic pain treatment and physiotherapy following a motor vehicle accident.

The respondent insurer denied the treatment plans on the basis that the applicant had reached maximum medical improvement.

The Licence Appeal Tribunal found that the applicant's medical evidence lacked precision and failed to link the proposed treatments to the accident or demonstrate how they would improve his function.

Relying on the respondent's medical assessors, who concluded the applicant's injuries had resolved, the Tribunal held the treatment plans were not reasonable and necessary.

The claim for a chronic pain assessment was also dismissed because the applicant failed to submit the required Treatment and Assessment Plan (OCF-18).

The application was dismissed in its entirety.

The applicant brought a motion seeking corrections to a case conference order, restriction of the respondent's addendum medical reports, permission to cross-examine the respondent's experts, an adjournment of the hearing, and costs.

The adjudicator allowed the addendum reports but granted the applicant the right to cross-examine the authors.

The adjudicator also granted the adjournment on consent to allow for a pending catastrophic impairment examination, permitted re-examination of the applicant, denied the production of adjuster notes, and dismissed the claim for costs.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident.

The insurer raised a preliminary issue that the applicant failed to apply for the benefit within 104 weeks of the accident.

The Tribunal found that the applicant did submit a completed disability certificate within the 104-week period, satisfying the application requirement.

However, on the substantive issue, the Tribunal dismissed the claim because the applicant failed to provide sufficient medical evidence demonstrating a substantial inability to perform the essential tasks of his employment during the first 104 weeks, which is a prerequisite for claiming post-104 week IRBs.

The applicant sought statutory accident benefits for attendant care provided by her husband, a medical doctor, following a motor vehicle accident.

The insurer denied the benefits on the basis that the expenses were not 'incurred' under section 3(7)(e) of the Schedule.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the services were provided as claimed, there was no legal obligation to pay, and the husband did not sustain an economic loss or provide the services in the ordinary course of his profession.

The Tribunal also denied the cost of an examination and held it lacked jurisdiction to grant equitable relief such as estoppel.