Harry Adamidis

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

On the second day of the hearing, the applicant withdrew all substantive issues because her expert witnesses were unavailable, leaving only a preliminary issue regarding the limitation period for an income replacement benefit (IRB) claim and the respondent's request for costs.

The Tribunal found the IRB claim was statute-barred under s. 56 of the Schedule, as it was not disputed within two years and was not included in a tolling agreement between the parties.

The Tribunal also awarded $1,000 in costs to the respondent under Rule 19, finding the applicant acted unreasonably by failing to summons her experts and unnecessarily expending hearing time before withdrawing the application.

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

She argued the adjudicator erred in law by failing to consider the Whole Person Impairment (WPI) ratings for medication and her right wrist provided by an orthopedic surgeon.

The adjudicator acknowledged the error of omitting these ratings.

However, after recalculating the impairment using the correct method of combining Upper Extremity Impairment values, the adjudicator determined the applicant's total WPI was 49%.

As this remained below the 55% threshold required for catastrophic impairment, the error would not have changed the result, and the request for reconsideration was dismissed.

The applicant requested a reconsideration of a previous Licence Appeal Tribunal decision that denied her claims for an Income Replacement Benefit (IRB) and various treatment plans following a motor vehicle accident.

The applicant argued the Tribunal erred in law by requiring her to prove IRB entitlement after finding an accident occurred, and by not assessing whether the treatment plans were reasonable and necessary.

The Tribunal dismissed the reconsideration request, finding no error of law, as the applicant failed to meet her evidentiary burden for the IRB and the treatment plans were not incurred.

The respondent insurer requested a reconsideration of a Tribunal decision that awarded the applicant ongoing income replacement benefits (IRBs).

The insurer argued the Tribunal exceeded its jurisdiction and breached procedural fairness because only the quantum of the IRB, not ongoing entitlement, was in dispute.

The adjudicator dismissed the request, finding that the application, case conference report, and the parties' own submissions clearly indicated that ongoing entitlement was a live issue.

The adjudicator confirmed there was no error of law or breach of procedural fairness.

The applicant insurer sought repayment of income replacement benefits (IRBs) paid to the respondent, alleging wilful misrepresentation.

The respondent had submitted disability certificates claiming he was unable to work, but was later discovered to have been employed and earning a salary of $102,000 during the period he received IRBs.

The Tribunal found that the respondent's failure to disclose his employment income constituted wilful misrepresentation, exempting the insurer from the 12-month limitation period for seeking repayment.

The respondent was ordered to repay $23,285.70, representing the IRBs received while employed, plus interest.

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

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

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

The Tribunal found inconsistencies in the applicant's reported psychological symptoms and concluded the physical pain complaints were either pre-existing, resolved, or not causally linked to the accident.

The Tribunal held the injuries were minor and subject to the MIG limit.

As the remaining MIG funding was insufficient, the disputed treatment plans were not payable.

Claims for an award and interest were also dismissed.

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 statutory accident benefits following a motor vehicle accident.

The applicant's former counsel removed themselves from the record prior to the hearing.

The Tribunal provided the self-represented applicant with notice of the videoconference hearing and instructions on how to attend.

The applicant failed to appear at the hearing and did not respond to the Tribunal's attempts to contact her.

The adjudicator proceeded in the applicant's absence pursuant to Rule 3.7.1(a) of the Licence Appeal Tribunal Rules.

As the applicant filed no evidence and made no submissions, she failed to meet her burden of proof.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming catastrophic impairment.

At the hearing, the applicant did not appear, and her counsel made an oral request for an adjournment, citing newly discovered concerns about the applicant's capacity to instruct counsel.

The adjudicator denied the adjournment request, noting that counsel was retained by the applicant's mother acting as litigation guardian, making the capacity issues foreseeable, and that insufficient medical evidence was provided to support the request.

As the applicant filed no evidence and made no submissions to meet her burden of proof, the application was dismissed.

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 sought a determination that she sustained a catastrophic impairment under Criterion 7 of the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Tribunal assessed various Whole Person Impairment (WPI) ratings provided by multiple medical experts for physical and psychological impairments, including complex regional pain syndrome, sleep disturbances, and right upper extremity deficits.

The Tribunal rejected several of the applicant's expert ratings for failing to follow the AMA Guides' methodology and lacking objective medical evidence.

Ultimately, the Tribunal calculated a combined WPI rating of 50%, falling short of the 55% threshold required for a catastrophic impairment designation.

The application was dismissed.

The applicant requested a reconsideration of a previous Licence Appeal Tribunal decision that denied her entitlement to a neurological assessment, a chronic pain assessment, a second treatment plan for physiotherapy, and assistive devices.

The applicant argued that the adjudicator made errors of fact and law and sought to introduce new evidence.

The Tribunal found that the applicant failed to establish any errors of fact or law, and that the new evidence did not meet the threshold for admission under Rule 18.2(c).

The request for reconsideration was dismissed.

The applicant sought statutory accident benefits for physiotherapy, in-home yoga therapy, assistive devices, and handrails following a motor vehicle accident.

The insurer denied the benefits.

The Tribunal found that the applicant's accident-related physical injuries had largely resolved and that her ongoing pain was due to non-accident-related conditions such as arthritis and fibromyalgia.

The Tribunal also found insufficient evidence to link her balance issues and need for assistive devices to the accident.

The application was dismissed in its entirety.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including an income replacement benefit (IRB), attendant care benefits, and payment for treatment plans.

The respondent stopped paying the IRB based on an accounting report that deducted speculative Canada Pension Plan Disability (CPP-D) amounts.

The Tribunal found that vacation pay and pre-accident earnings should be included in the IRB calculation, and that speculative CPP-D amounts could not be deducted, entitling the applicant to an ongoing IRB.

The Tribunal denied the claim for attendant care benefits because the applicant failed to prove the expenses were incurred.

The Tribunal approved an in-home occupational therapy assessment as reasonable and necessary, but denied a small balance for physiotherapy services that exceeded the maximum hourly rate.

Claims for a special award and costs were dismissed, but interest was awarded on overdue benefits.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, chiropractic services, and various expenses.

The adjudicator first determined that the applicant was barred from proceeding on the issue of catastrophic impairment because he failed to attend a properly noticed insurer's examination.

On the merits, the adjudicator dismissed the claim for a non-earner benefit, finding that the applicant's post-accident functional abilities demonstrated he did not suffer a complete inability to carry on a normal life.

The claims for chiropractic services and out-of-pocket expenses were also dismissed, as the applicant failed to prove they were reasonable and necessary to treat an accident-related injury, with evidence showing his pain was likely a continuation of pre-existing chronic pain.

Claims for interest and a special award were consequently denied.

The applicant sought statutory accident benefits following an incident where she was assaulted by her husband while driving, causing her to veer off the road and mount a curb.

The Tribunal found that the incident met the definition of an "accident" under s. 3(1) of the Schedule, as the operation of the vehicle was the dominant feature causing her psychological injuries, which exacerbated pre-existing conditions.

Consequently, the applicant's injuries were removed from the Minor Injury Guideline.

However, the applicant's claims for an income replacement benefit, various treatment plans, attendant care benefits, and a special award were dismissed because she failed to provide sufficient medical evidence or establish that the expenses were reasonable, necessary, and incurred.

The applicant sought a determination that she sustained a catastrophic impairment and was entitled to attendant care benefits following a motor vehicle accident.

The Tribunal found that the applicant did not sustain a catastrophic impairment, as her psychological and physical impairments did not meet the threshold of three or more marked impairments under Criterion 8.

The Tribunal also denied the claim for attendant care benefits, finding that the applicant failed to prove her spouse suffered an economic loss to provide the care, and therefore the expenses were not incurred.

Claims for interest and a special award were also dismissed.

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 sought a determination that she sustained a catastrophic impairment under Criterion 8 (mental and behavioural disorders) following a motor vehicle accident.

The Tribunal found that while the applicant sustained a mild neurocognitive disorder and a specific phobia as a result of the accident, her impairments in activities of daily living, social functioning, and concentration, persistence and pace were only moderate (Class 3).

Although the applicant demonstrated a marked impairment (Class 4) in adaptation, the Tribunal concluded this was caused by severe pre-existing psychological limitations rather than the accident.

The application was dismissed.

The applicant requested a reconsideration of a Tribunal decision that dismissed her application for failing to attend insurer's examinations (IEs).

The applicant argued the adjudicator made errors of fact and law regarding her attendance and the consent forms required for the IEs.

The Tribunal found no errors of law or fact, noting that the applicant was attempting to re-litigate issues already decided and that her disagreements with the adjudicator's analysis did not meet the high threshold for reconsideration.

The request for reconsideration was dismissed.