Daniela Corapi

The applicant requested a reconsideration of a Tribunal decision that found his application for income replacement benefits was statute-barred due to the expiry of the limitation period.

The applicant argued the adjudicator erred in law by applying the wrong test for a clear and unequivocal denial, made a factual error regarding his legal representation, and failed to consider arguments on discoverability, prematurity, and estoppel.

The adjudicator dismissed the request, finding no significant errors of law or fact, nor any violation of procedural fairness, that would warrant a reconsideration.

The applicant was involved in a rear-end motor vehicle accident and sought statutory accident benefits.

The respondent insurer denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG).

The applicant argued his injuries were not predominantly minor and that pre-existing conditions from a 2009 accident should remove him from the MIG.

The Tribunal found the applicant sustained predominantly minor soft-tissue injuries and failed to prove that pre-existing conditions prevented maximal recovery within the MIG limits.

The Tribunal also dismissed the claim for non-earner benefits, finding the applicant returned to work shortly after the accident and failed to establish a complete inability to carry on a normal life.

Finally, the Tribunal ordered the applicant to repay $6,105.00 in non-earner benefits that the respondent had paid in error, plus interest.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs) and treatment plans, which were denied by the respondent.

The applicant had pre-existing injuries from a workplace slip and fall but was improving and expected to return to work prior to the accident.

The adjudicator found that the motor vehicle accident exacerbated her pre-existing conditions, causing a substantial inability to perform the essential tasks of her employment.

The adjudicator ordered the respondent to pay IRBs, the disputed chiropractic treatment plan, and the chronic pain assessment, along with interest, but denied the applicant's request for a special award.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her physical and psychological injuries removed her from the Minor Injury Guideline (MIG).

The respondent denied the claims, relying on insurer's examinations that concluded the injuries were soft tissue in nature and fell within the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence to prove her injuries warranted treatment outside the MIG, noting that her chiropractic expert's methodology lacked proven reliability and her psychological expert relied heavily on self-reporting.

The application for benefits and interest was dismissed.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident.

The respondent insurer denied the IRBs in an Explanation of Benefits form in May 2016.

The applicant applied to the Licence Appeal Tribunal in February 2021, well past the two-year limitation period.

The Tribunal found that the respondent's denial was clear and unequivocal, validly triggering the limitation period.

The Tribunal declined to extend the limitation period under section 7 of the Licence Appeal Tribunal Act, finding no bona fide intention to appeal within the time limit, an extraordinary delay, prejudice to the respondent, and weak merits of the claim.

The application was dismissed as statute-barred.

The applicant filed an application with the Condominium Authority Tribunal which proceeded to mediation.

The applicant repeatedly failed to take the actions required to actively participate and move the matter forward to adjudication.

The Tribunal found the case to be abandoned and ordered it dismissed pursuant to Rule 32.3 of the CAT's Rules of Practice.

The applicant sought interest and a special award under Regulation 664, alleging that the respondent unreasonably delayed the payment of a $6,000 funeral benefit following the death of her son in a motor vehicle accident.

The respondent argued that the 30-day timeline for payment did not commence until the applicant provided confirmation that no WSIB claim had been filed, as the accident occurred during the course of employment.

The Tribunal found that the application was not complete until the WSIB confirmation was received, and the respondent paid the benefit within 30 days of that date.

The claims for interest and a special award were dismissed.

The applicant was injured in a motor vehicle accident and sought a medical benefit of $2,339.34 for chiropractic treatment under the Statutory Accident Benefits Schedule.

The respondent denied the treatment plan on the basis that it was not reasonable and necessary.

The applicant argued the treatment would mitigate chronic pain and increase the efficacy of psychological treatment for Somatic Symptom Disorder.

The Tribunal found that the applicant failed to provide objective evidence demonstrating that the proposed treatment would reasonably achieve its goals, noting that similar past treatments had not provided significant improvement.

The application was dismissed, and no interest was awarded.

The applicant sought payment of $503.90, representing the denied balance of a $2,200.00 psychological assessment proposed following a motor vehicle accident.

The respondent had partially approved the treatment plan based on a paper review by its psychological expert, who opined that the proposed cost was excessive and that the assessment could be completed for $1,696.10.

The Tribunal found that the applicant failed to discharge the onus of proving the full amount claimed was reasonable and necessary, as no particulars were provided to justify the maximum fee.

The application was dismissed, along with claims for interest and an award.

The applicant sought medical benefits for physiotherapy and psychological services following a motor vehicle accident.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained predominantly minor soft tissue injuries and failed to prove on a balance of probabilities that he suffered from chronic pain or psychological impairments that would remove him from the MIG.

As the applicant was subject to the $3,500 funding limit, the disputed treatment plans and claim for interest were denied.

The applicant was struck by a vehicle as a pedestrian and sought statutory accident benefits.

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

The Tribunal found that the applicant's psychological injuries, including depression and anxiety, removed her from the MIG.

The Tribunal ordered the respondent to pay for the disputed chiropractic treatment plans and a psychological assessment, finding them reasonable and necessary, along with interest on overdue payments.

Both parties' requests for costs were denied.

The applicant, who was catastrophically impaired in a motor vehicle accident, sought attendant care benefits of $6,000 per month.

The respondent conceded entitlement but disputed the quantum and whether past services provided by the applicant's sister were 'incurred' under the Schedule.

The Tribunal found the applicant required 24-hour basic supervisory care due to unpredictable cognitive and visual episodes, entitling her to $6,000 per month for most of the claimed period.

The Tribunal also found the sister provided services in a professional capacity, satisfying the incurred test.

The claim for a special award was dismissed as the insurer's delay was reasonable given accounting and documentation issues.

The applicant sought an award for unreasonably withheld or delayed income replacement benefits (IRBs).

Prior to the hearing, the respondent insurer reinstated and paid the disputed IRBs, and subsequently argued that the Licence Appeal Tribunal lacked jurisdiction to hear the claim for an award because there were no longer any substantive benefits in dispute.

The Tribunal held that it retains jurisdiction to determine if an applicant is entitled to an award even when the substantive benefits have been paid or reinstated prior to a hearing.

The Tribunal found that interpreting the legislation to allow an insurer to avoid an award by paying benefits on the eve of a hearing would create an absurd result and negate the purpose of the accident benefits scheme.