Craig Mazerolle

The applicant sought medical benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) limit, which had been exhausted.

The applicant claimed removal from the MIG based on psychological impairments and chronic pain.

The Tribunal found insufficient evidence of a psychological impairment or chronic pain, noting the applicant's post-accident life and functional capacity remained largely unchanged.

The Tribunal concluded the injuries were minor and fell within the MIG.

Claims for an award and costs were also dismissed.

The applicant sought reconsideration of a Licence Appeal Tribunal decision that found her subject to the Minor Injury Guideline (MIG) and denied several disputed medical benefits.

The applicant argued the Tribunal erred in its application of s. 38 of the Statutory Accident Benefits Schedule, violated procedural fairness by admitting expert reports without cross-examination, and incorrectly assessed her physical and psychological impairments.

The adjudicator dismissed the request for reconsideration in full, finding no significant errors of law or fact, and concluding that the admission of the expert reports was an appropriate exercise of the Tribunal's procedural powers.

The adjudicator also affirmed that the applicant's injuries, including TMJ dysfunction and psychological distress, were properly classified as minor injuries or clinically associated sequelae.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and funding for chiropractic services and a chronic pain assessment.

The Licence Appeal Tribunal dismissed the claim for a non-earner benefit, finding that surveillance evidence and inconsistencies in the applicant's self-reporting undermined her claim of a complete inability to carry on a normal life.

However, the Tribunal granted the medical benefits, concluding that the applicant suffered from an accident-related pain condition and that the proposed treatments were reasonable and necessary to address her physical and psychological impairments.

The respondent's request for costs was denied.

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

The respondent insurer raised a limitation defence, arguing the applicant failed to challenge the denial of these benefits within the two-year limitation period under s. 56 of the Statutory Accident Benefits Schedule.

Applying the Court of Appeal's decision in Tomec, the adjudicator found that the limitation period for the housekeeping benefit and post-104-week attendant care benefit did not commence until the applicant was deemed catastrophically impaired, as she could not have discovered her entitlement before that designation.

However, the claim for attendant care services incurred prior to the 104-week mark was statute-barred, as it was clearly denied and not pursued within two years.

The applicant's request for costs was dismissed.

The parties both sought reconsideration of a previous Licence Appeal Tribunal decision regarding statutory accident benefits following a motor vehicle accident.

The respondent sought to overturn the award of an income replacement benefit based on newly obtained medical records and a CPP-D denial letter.

The adjudicator dismissed the respondent's request, finding the new records did not alter the conclusion that the applicant suffered serious cognitive and psychological impairments.

The applicant sought reconsideration to approve previously denied treatment plans, providing two of the three missing plans.

The adjudicator granted the applicant's request in part, approving the physiotherapy plan and portions of the psychological services plan, but upheld the denial of the psychological assessment as that plan was still not provided.

The applicant sought medical benefits for chiropractic services following a motor vehicle accident.

The respondent insurer denied the treatment plans, arguing the applicant's pain presentation was inconsistent and his physical injuries no longer required facility-based therapy.

The Tribunal found the applicant's self-reported pain and improvements credible, supported by psychological assessments indicating he was not feigning symptoms.

The Tribunal ordered the respondent to pay for the disputed medical benefits, excluding services incurred prior to the submission of the treatment plan, along with interest.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits from her insurer under the Statutory Accident Benefits Schedule.

The insurer denied several treatment plans, including physiotherapy, psychological and neurological assessments, and a chronic pain program.

The Licence Appeal Tribunal found that the applicant continued to suffer from significant accident-related pain and granted entitlement to the physiotherapy, neurological assessment, disability certificate, chronic pain assessment, chronic pain program, and a portion of the shockwave therapy.

Claims for further psychological assessment and treatment were denied as duplicative or unnecessary given previously approved funding.

The Tribunal declined to order a special award or costs, finding the insurer's adjusting of the file was reasonable.

The applicant sought statutory accident benefits, including an income replacement benefit and medical treatment, following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's physical injuries were predominantly minor and that she failed to prove a psychological impairment or that a pre-existing condition prevented her maximal recovery.

The Tribunal also dismissed the claim for an income replacement benefit, as the applicant had continued to work post-accident and did not demonstrate a substantial inability to perform the essential tasks of her employment.

The applicant sought medical benefits following a motor vehicle accident, arguing her physical and psychological injuries, including TMJ disorder and driving anxiety, warranted removal from the Minor Injury Guideline (MIG).

The Tribunal found the applicant's injuries were predominantly minor and subject to the $3,500 MIG limit.

The Tribunal also rejected the argument that the insurer's failure to comply with the section 38(8) timeline permanently barred it from relying on the MIG.

The insurer was ordered to pay the remaining $465.97 under the MIG limit for incurred physiotherapy, but the claims for TMJ and psychological assessments, as well as a claim for an award, were dismissed.

The applicant sought a $10,000 death benefit following the death of her son, who was struck by a car.

The issue was whether the son, who had a developmental delay and lived independently in a subsidized apartment, was 'principally dependent' on the applicant for financial support or care under the Statutory Accident Benefits Schedule.

The Tribunal found that the son was largely independent, covering most of his expenses through social assistance and employment, and navigating the community with support from various sources.

The application for a death benefit was dismissed.

The applicant was struck by a vehicle as a pedestrian and sought income replacement and medical benefits.

The Tribunal found the applicant was entitled to ongoing income replacement benefits beyond the 104-week mark, as his accident-related psychological and cognitive impairments rendered him completely unable to engage in any employment for which he was reasonably suited.

The claims for medical benefits were dismissed because the applicant failed to provide the required treatment plans (OCF-18s) to establish that the treatments were reasonable and necessary.

The applicant sought reconsideration of a Tribunal decision that denied her attendant care benefits, barred her from proceeding with disputed treatment plans due to non-attendance at insurer's examinations, and limited her income replacement benefits.

The adjudicator dismissed the applicant's request for reconsideration, finding no significant errors of law or fact in the original decision.

However, upon further review, the adjudicator found that he had erred in law by reversing the burden of proof when awarding income replacement benefits for a brief period after the 104-week mark.

Consequently, the adjudicator revoked the award of income replacement benefits from March 16, 2017 to June 3, 2017.

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

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered an accident-related psychological impairment, removing her from the MIG.

The Tribunal further held that the proposed physiotherapy treatment plans were reasonable and necessary for her recovery, and awarded the disputed benefits along with interest.

The applicant was involved in a motor vehicle accident and applied for statutory accident benefits approximately two years later, well beyond the required timelines.

The respondent denied the benefits due to the delay.

The applicant argued she had a reasonable explanation for the delay, citing psychological impairment and reliance on her former legal counsel.

The Tribunal found that neither explanation was objectively reasonable, noting the applicant's ability to complete other significant tasks during the delay period and her failure to follow up with her counsel.

The application for benefits was dismissed, and the applicant's request for costs was denied.

The applicant was struck by a minivan while crossing the street and sought statutory accident benefits, including non-earner benefits, attendant care, housekeeping, and medical benefits for assistive devices.

The Tribunal dismissed the claims for non-earner and attendant care benefits, finding the applicant failed to provide sufficient evidence of her pre- and post-accident activities or that attendant care expenses were incurred.

The claim for a mattress topper was statute-barred as it was purchased before a treatment plan was submitted.

However, the Tribunal found the anti-fatigue mat was reasonable and necessary, and ordered the respondent to pay for it.

The applicant requested that the adjudicator recuse himself and void his previous decision dismissing the applicant's motion to strike the respondent's preliminary issue, alleging a reasonable apprehension of bias.

The adjudicator applied the test for reasonable apprehension of bias and found that the applicant failed to meet the high threshold required to overcome the presumption of impartiality.

The request for recusal was refused and the previous decision was confirmed.

The applicant was injured in a rear-end motor vehicle accident and sought medical and attendant care benefits from the respondent insurer.

The adjudicator denied the claim for attendant care benefits, finding the applicant failed to incur the expenses.

However, the adjudicator granted entitlement to four physiotherapy treatment plans, a psychological treatment plan, a functional impairment assessment, and a chronic pain assessment, finding them reasonable and necessary.

The adjudicator also awarded a 20% special award under Regulation 664 regarding the functional impairment assessment, concluding the insurer unreasonably withheld approval by relying on an assessor's unconvincing change of opinion.

The applicant brought a motion to strike a preliminary issue raised by the respondent regarding her alleged non-attendance at insurer's examinations.

The applicant argued the preliminary issue lacked a foundational basis and the examinations were non-compliant with the Schedule and privacy legislation.

The adjudicator dismissed the motion, finding that the respondent provided sufficient information about the preliminary issue and that the applicant's arguments were best heard at the preliminary issue hearing itself.

The adjudicator also declined to award costs to the applicant.

The applicant sought medical benefits for physiotherapy and assessments following a rear-end collision.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 financial cap had been reached.

The Tribunal found that the applicant failed to prove his injuries, including alleged chronic pain and psychological impairments, fell outside the MIG.

The Tribunal also found insufficient evidence that the applicant's pre-existing conditions prevented maximal recovery under the MIG.

The application was dismissed.

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

The respondent denied certain assessments, arguing they fell under the Minor Injury Guideline.

The respondent raised a preliminary issue that the applicant's challenge was barred by the two-year limitation period under section 56 of the Schedule.

The Tribunal found that the respondent's denial letters were equivocal and contingent on further medical examinations, meaning the limitation period did not begin until the applicant received the final assessment reports.

The Tribunal allowed the application to proceed and denied the respondent's request for costs.