Harry Adamidis

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her entitlement to six physiotherapy treatment plans and an occupational therapy assessment.

The applicant argued the adjudicator made errors of fact and law in weighing the medical evidence and in finding that section 38(8) of the Schedule did not apply because an OCF-1 was not in evidence.

The Tribunal dismissed the request, finding that the applicant was attempting to re-litigate the case and introduce new evidence without explaining why it was not previously available.

The Tribunal concluded there were no errors of fact or law in the original decision's weighing of the medical reports or its findings on the treatment plans.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision regarding her entitlement to attendant care benefits.

She argued the Tribunal made errors of law by finding it lacked jurisdiction to determine the rate for attendant care, by applying the ratio method to calculate payments, and by breaching procedural fairness through inadequate reasons.

The adjudicator dismissed the request, finding no errors of law or breaches of procedural fairness, as the original decision correctly applied the statutory scheme and provided sufficient reasons for its findings.

The respondent insurer requested a reconsideration of a Tribunal decision that found the applicant entitled to a treatment plan for 108 sessions of physiotherapy.

The respondent argued the Tribunal made an error of fact by failing to address the excessive number of sessions proposed.

The adjudicator dismissed the request, finding that the original decision had considered the medical evidence, including a recommendation from the applicant's family doctor specifically supporting the 108-session plan, and that no error of fact was established.

The applicant sought a determination that she sustained a catastrophic impairment under Criterion 8 of the Statutory Accident Benefits Schedule due to psychological impairments following a motor vehicle accident.

The Tribunal assessed her functioning in four areas: activities of daily living, social functioning, concentration, persistence and pace, and adaptation.

While the Tribunal found marked impairments in activities of daily living and adaptation, it found only moderate impairments in social functioning and concentration, persistence and pace.

As the applicant did not demonstrate three marked impairments or one extreme impairment, she was found not to be catastrophically impaired.

Consequently, her claims for attendant care, housekeeping benefits, and various treatment plans were dismissed.

The Tribunal also declined to order an award for unreasonable delay.

The applicant sought death benefits under the Statutory Accident Benefits Schedule following the death of her partner in a motor vehicle accident.

The insurer denied the claim on the basis that the applicant did not meet the definition of 'spouse' under the Insurance Act, as the couple maintained separate households and did not live together in the same dwelling.

The Tribunal agreed with the insurer, finding that the broader definition of spouse under the Family Law Act does not apply to accident benefits.

The application for death benefits for the applicant and her daughters was dismissed.

The applicant sought attendant care benefits, an award, and interest following a motor vehicle accident.

The Tribunal found the applicant entitled to $942.19 per month in attendant care benefits based on the occupational therapist's assessment of her needs for exercise supervision, bathing, and equipment maintenance.

The Tribunal dismissed the claims for incurred attendant care shortfalls, interest, and a section 10 award, finding the insurer's reliance on the ratio method and its own assessments was reasonable.

The applicant sought payment for various prescription medications following a 2014 motor vehicle accident.

The respondent insurer had paid 50% of the claimed amounts and denied the remainder.

The Tribunal found that the applicant failed to establish on a balance of probabilities that the disputed medications, including those for pain and substance dependence, were reasonable and necessary as a result of the accident.

The application for accident benefits and interest was dismissed.

The applicant insurer sought repayment of $85,181.38 in income replacement benefits (IRBs) paid to the respondent following a 2010 motor vehicle accident.

The insurer alleged the respondent engaged in willful misrepresentation by working post-accident while denying employment to assessors.

The Tribunal found it had jurisdiction to hear the dispute and concluded the respondent willfully misrepresented his employment status.

As the respondent failed to provide evidence to calculate the exact quantum of repayment, the Tribunal ordered the full amount of $85,181.38 to be repaid, plus interest.

The applicant sought various statutory accident benefits following a motor vehicle accident, including six treatment plans for physiotherapy, an orthopaedic assessment, an occupational therapy assessment, and a psychological assessment.

The Tribunal found that the insurer's denials complied with the medical reasons requirement under s. 38(8) of the Schedule.

On the merits, the Tribunal dismissed the claims for physiotherapy, finding that the applicant's pain was attributable to a somatic symptom disorder rather than a physical impairment, and physiotherapy was not a reasonable treatment for a psychological condition.

The occupational therapy assessment was also denied for lack of evidence linking it to attendant care needs.

However, the Tribunal granted the orthopaedic assessment, as it was reasonable for the applicant to investigate her pain prior to her psychological diagnosis, and the psychological assessment, as it was necessary and not duplicative.

Claims for an award were dismissed, but interest was awarded on the approved plans.

The applicant requested a reconsideration of a decision finding her injuries were predominantly minor under the Minor Injury Guideline (MIG).

She sought to introduce a new MRI report obtained after the hearing, arguing it showed a pre-existing condition worsened by the accident.

The Tribunal dismissed the request, finding the applicant failed to explain why the MRI could not have been obtained before the hearing.

Furthermore, the Tribunal noted the new evidence did not address whether the pre-existing condition would prevent maximal recovery, as required by s. 18(2) of the Schedule, and therefore would not have affected the result.

The applicant was involved in a motor vehicle accident and received an Income Replacement Benefit (IRB).

The respondent insurer sought repayment of $101,571.44, alleging the applicant willfully misrepresented his functional abilities and receipt of collateral disability benefits.

The Tribunal found no willful misrepresentation regarding functional abilities or CPP disability benefits, but found the applicant willfully misrepresented his receipt of $43,400 in disability income from RBC Insurance.

The Tribunal ordered the applicant to repay $27,000 of the IRB, representing the overlapping period, plus interest.

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

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

The Tribunal found that the applicant's injuries were predominantly minor, preferring the insurer's medical examinations which showed the applicant's pain did not significantly impede his function and that he had returned to physical work.

As the applicant remained within the MIG and the disputed plans exceeded the $3,500 limit, the application for the treatment plans and interest was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including a determination of catastrophic impairment and a chiropractic assessment.

The insurer raised preliminary issues regarding the applicant's failure to attend insurer examinations and the expiry of the limitation period.

The Tribunal found that the applicant failed to submit to the insurer examinations without a reasonable explanation and was therefore barred from proceeding with the catastrophic impairment issue.

The Tribunal also found that the applicant failed to dispute the denial of the chiropractic assessment within the two-year limitation period.

The application was dismissed.

The respondent insurer brought a motion to bar the applicant from proceeding with her application for statutory accident benefits under s. 55(1)2 of the Schedule.

The applicant had attended an initial psychiatric insurer's examination but left before it was completed, citing discomfort with the assessor.

The applicant subsequently refused to attend rescheduled examinations with different assessors, arguing they were too intrusive.

The Tribunal found that the insurer was entitled to a complete examination and that the applicant failed to provide a reasonable explanation for her non-attendance.

The motion was granted and the application was barred from proceeding.

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

The respondent denied a treatment plan for psychological services and requested an insurer's examination (IE).

The applicant failed to attend the IE, arguing the respondent's notice was void ab initio for failing to provide medical reasons for the denial under s. 38(8) of the Schedule.

The Tribunal found the respondent's notice complied with the Schedule by citing a lack of compelling evidence that the impairment was outside the Minor Injury Guideline.

As the applicant provided no reasonable explanation for failing to attend the IE, the Tribunal held she was barred from proceeding with the application under s. 55(1)2 of the Schedule.

The applicant sought statutory accident benefits, including an income replacement benefit (IRB) and a medical benefit for physiotherapy, following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove she suffered a substantial inability to perform the essential tasks of her employment, as she continued to work part-time and insurer's examinations found no substantial impairment.

The Tribunal also denied the physiotherapy treatment plan, preferring the insurer's medical evidence which found no musculoskeletal injuries prior to an intervening second accident.

Claims for interest and a special award were consequently dismissed.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including a neurological assessment, a chronic pain assessment, physiotherapy, and assistive devices.

The Licence Appeal Tribunal found that the neurological and chronic pain assessments were duplicative of previous OHIP-funded assessments and therefore not reasonable and necessary.

The Tribunal granted entitlement to one physiotherapy treatment plan based on the recommendations of neurologists who diagnosed radicular pain, preferring their evidence over the respondent's physiatrist.

The claims for a second physiotherapy plan and assistive devices were dismissed for lack of supporting evidence.

Interest was awarded on the overdue physiotherapy benefits.

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

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

The applicant claimed her chronic low back pain and an annular tear revealed on an MRI removed her from the MIG.

The Tribunal found insufficient evidence to connect the annular tear to the accident, noting a significant delay in reporting back pain.

The application was dismissed, and the applicant was found not entitled to the disputed treatment plans or interest.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit, treatment plans for physiotherapy and a psychological assessment, and interest.

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 failed to establish chronic pain or a psychological impairment that would warrant removal from the MIG, preferring the respondent's psychological assessment over the applicant's.

As the injuries were predominantly minor and the applicant provided insufficient evidence regarding pre- and post-accident activities, the claims for the non-earner benefit and treatment plans beyond the MIG limit were dismissed.

The applicant sought $789.39 for physiotherapy and an assistive vacuum following a motor vehicle accident, along with an award for unreasonable delay and interest.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to submit the required treatment and assessment plan under s. 38(2) of the Schedule and provided no evidentiary basis for the claimed expenses.

Claims for an award and interest were also dismissed as there were no overdue benefits and insufficient evidence of unreasonable conduct by the insurer.