Jeffrey Shapiro

The applicant sought a Non-Earner Benefit (NEB) and various medical benefits following a motor vehicle accident.

The Tribunal found that while the applicant's life was affected by the accident, she did not suffer a 'complete inability to carry on a normal life' as she continued to engage in substantially all of her pre-accident caregiving activities, albeit with some restrictions and assistance.

The Tribunal approved two physiotherapy treatment plans and an orthopaedic assessment as reasonable and necessary, but denied a third physiotherapy plan, a psychotherapy plan, and a claim for a special award.

Interest was awarded on the approved incurred expenses.

The applicant was catastrophically impaired in a motor vehicle accident and received a non-earner benefit (NEB) from the respondent insurer.

The insurer denied further payment of the NEB in October 2016.

The applicant appealed the denial to the Licence Appeal Tribunal in November 2018, beyond the two-year limitation period under section 56 of the Statutory Accident Benefits Schedule.

The insurer brought a motion to dismiss the appeal as time-barred.

The Tribunal found that the insurer had properly sent the denial notice by mail and fax.

Applying the four-part test under section 7 of the Licence Appeal Tribunal Act, the Tribunal declined to extend the limitation period, finding no bona fide intention to appeal within the period and no valid reason for the delay.

The application for the NEB was dismissed as time-barred.

The insurer sought reconsideration of a decision ordering it to pay a $1,500 special award on two files for unreasonably withholding or delaying payment of attendant care benefits.

The insurer argued that the previous reconsideration decision did not explicitly order payment and that it was simply following the Tribunal's procedure to determine the final quantum.

The Vice-Chair dismissed the request, finding that the previous decision had settled a minimum amount due, which the insurer accepted and failed to pay for 10 months.

The Tribunal held that in the context of consumer protection legislation, it was unreasonable for the insurer to delay paying the undisputed minimum amount while litigating a minor remaining difference.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and medical benefits.

The insurer initially placed the applicant in the Minor Injury Guideline (MIG) and denied post-104 IRBs.

The Tribunal found the applicant suffered a complete inability to engage in any employment for which she was reasonably suited due to severe depression and psychological issues arising from the accident, entitling her to post-104 IRBs.

The Tribunal also awarded a 30% special award under s. 10 of O. Reg. 664 on the medical treatment plans, finding the insurer unreasonably delayed approval and improperly relied on an assessor's legal conclusion regarding the MIG, but denied an award on the IRBs.

The applicant sought a Non-Earner Benefit (NEB) following a motor vehicle accident.

The respondent insurer denied the claim, relying on independent medical examinations which concluded the applicant did not suffer a complete inability to carry on a normal life.

The Tribunal dismissed the application, finding the applicant's testimony unreliable due to numerous inconsistencies regarding her marital status, gym attendance, prior accidents, and work history.

The Tribunal accepted the respondent's unrefuted medical evidence and noted the applicant's failure to provide corroborating evidence for her claims.

The applicant sought statutory accident benefits, including an income replacement benefit (IRB) and medical benefits, following an ebike collision.

The Licence Appeal Tribunal dismissed the application, finding the applicant's evidence regarding her pre-accident income and inability to work lacked credibility and was contradicted by surveillance evidence showing her working and riding her ebike.

The Tribunal concluded the applicant suffered predominantly minor injuries subject to the $3,500 treatment cap, which had been exhausted, and that the requested treatment plans were not reasonable or necessary.

The applicant sought a non-earner benefit following a motor vehicle accident, which the respondent insurer denied.

The applicant filed an appeal with the Licence Appeal Tribunal more than two years after the denial.

The respondent raised a preliminary issue that the claim was statute-barred under section 56 of the Statutory Accident Benefits Schedule.

The applicant requested an extension of time under section 7 of the Licence Appeal Tribunal Act.

The Tribunal found the application was filed at least two months late and the applicant failed to provide sufficient evidence or argument to satisfy the four-part test for an extension of time.

The claim for the non-earner benefit was dismissed as statute-barred.

Aviva sought reconsideration of a Licence Appeal Tribunal decision regarding P.R.'s entitlement to an income replacement benefit (IRB) following a motor vehicle accident.

Aviva argued the Tribunal made factual errors in finding P.R. was entitled to ongoing IRB and calculation errors regarding the quantum and overpayment.

The Vice-Chair dismissed the request regarding ongoing entitlement, finding no significant errors of fact that would change the result.

However, the Vice-Chair granted the request in part to correct calculation errors, adjusting the weekly IRB rate to $400 and reducing the overpayment amount owed to Aviva from $7,885.31 to $7,193.31.

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

The matter was scheduled for a four-day hearing, but the applicant failed to appear.

As the applicant bore the onus to prove entitlement and called no evidence, the application was dismissed.

The respondent's request for costs was also denied, as the unrepresented applicant's failure to appear did not meet the high standard of unreasonable, frivolous, vexatious, or bad faith conduct under Rule 19.

The insurer sought reconsideration of a Tribunal decision awarding the insured attendant care benefits.

The insurer argued that the Tribunal erred in law by awarding benefits at a flat rate of $25 per hour rather than applying the mandatory maximum hourly rates set out in the Attendant Care Hourly Rate Guideline and the Form 1 Assessment of Attendant Care Needs.

The Vice-Chair agreed, finding that the Guideline rates are mandatory for services actually rendered and cannot be used merely as a calculation tool to establish a total monthly cap.

The reconsideration was granted in part, and the matter was remanded to the original adjudicator for a hearing limited to determining the proper quantum of the benefit based on the hours previously found to have been incurred.

The insurer sought reconsideration of a Tribunal decision awarding the insured attendant care benefits at a flat rate of $25 per hour.

The insurer argued that the adjudicator made a significant error of law by failing to apply the mandatory maximum hourly rates set out in the Attendant Care Hourly Rate Guideline and the Form 1 Assessment of Attendant Care Needs.

The Vice-Chair agreed, finding that the Guideline rates are mandatory for services actually rendered and cannot be used merely as a calculation tool to establish a total monthly cap.

The reconsideration was granted in part, and the matter was remanded to the original adjudicator to determine the proper quantum of benefits based on the hours previously found to have been incurred, applying the correct Guideline rates.

The applicant sought reconsideration of a Tribunal order denying his motion to reinstate a previously withdrawn application.

The underlying dispute concerned the billing rate for a psychotherapist under a treatment plan that had been approved for psychologist services.

The Vice-Chair dismissed the reconsideration request, finding no error in the original decision because the treatment plan as submitted had been fully settled, and the new dispute regarding psychotherapist rates was not ripe for adjudication as it had never been submitted to the insurer for processing.

The insurer sought reconsideration of a Licence Appeal Tribunal decision that found the applicant entitled to payment for Lidocaine intravenous injections and a dietician assessment following a motor vehicle accident.

The insurer argued the Tribunal made significant errors of law and fact by misapprehending the 'reasonable and necessary' standard and improperly shifting the burden of proof.

The Vice-Chair dismissed the reconsideration request, finding that the original adjudicator properly considered the evidence, applied the correct legal standards, and made reasonable factual findings based on the medical evidence presented.

The applicant, a pedestrian struck by a vehicle, applied for statutory accident benefits including an income replacement benefit (IRB), physiotherapy, massage therapy, and dental services.

The insurer denied the benefits.

The Tribunal found that the applicant did not establish a substantial inability to perform the essential tasks of his pre-accident employment, relying on the objective medical evidence of the insurer's physiatrist.

The Tribunal also found the requested physiotherapy and massage therapy were not reasonable and necessary, and the massage therapy was incurred without an approved treatment plan.

The dental claim was withdrawn by the applicant.

The application was dismissed.

The applicant, a pedestrian who sustained catastrophic injuries when struck by a vehicle, sought retroactive attendant care benefits from the date of the accident in 2007 until she formally applied in 2015.

The respondent insurer had denied coverage in a related tort action for years before finally admitting it insured the vehicle.

The Tribunal found that it was initially impossible, and later impractical, for the applicant to submit her application earlier due to the insurer's non-coverage position and failure to notify her of her rights.

The Tribunal awarded retroactive attendant care benefits of $6,000 per month with interest accruing from the date of her hospital discharge in 2007.

The applicant sought reconsideration of a Licence Appeal Tribunal decision that denied funding for catastrophic impairment assessments.

The applicant argued the Tribunal applied the wrong legal test and improperly weighed evidence.

The Vice-Chair dismissed the request, finding that the applicant improperly attempted to introduce new evidence and that the original adjudicator correctly applied the test of whether further investigation was reasonable and necessary.

The request for reconsideration was denied.

The applicant sought a determination that he was catastrophically impaired under section 3(2)(f) of the Statutory Accident Benefits Schedule due to mental or behavioural disorders following two motor vehicle accidents.

The applicant had significant pre-existing impairments from a 2002 workplace fall, including chronic pain and depression.

The adjudicator found that while the applicant suffered from a pain disorder and depression, his functional limitations were overstated and did not meet the threshold for a marked (Class 4) impairment.

Furthermore, applying the material contribution test, the adjudicator concluded that the applicant's current level of impairment was not materially caused by the motor vehicle accidents, as his condition was essentially the same as before the accidents.

The application for catastrophic impairment was dismissed.

However, the applicant was awarded $1,500 in costs due to the respondent's unreasonable conduct in delaying the closing submissions.

The respondent insurer sought reconsideration of a case conference order denying its request for the production of photographs taken by the applicant after a slip and fall incident.

The insurer argued the adjudicator erred by refusing to order production of a relevant document.

The Vice-Chair denied the reconsideration request, finding that the insurer failed to demonstrate how the photographs were relevant or material to determining whether the incident constituted an accident under the Statutory Accident Benefits Schedule.

The applicant was injured in a motor vehicle accident and sought an income replacement benefit (IRB) after initially returning to work but claiming he could not continue due to accident-related back pain.

The insurer denied the benefit, arguing the applicant lacked credibility and was terminated from his employment for other reasons.

The adjudicator found the applicant's testimony regarding his medical history and prior injuries to be highly inconsistent and lacking credibility.

Relying on the respondent's orthopedic expert who found no objective impairment, the adjudicator concluded the applicant did not suffer a substantial inability to perform his employment and dismissed the appeal.

The applicant was injured in a motor vehicle accident in the United States and incurred significant hospital expenses.

The respondent insurer paid the hospital up to the $50,000 policy limit for non-catastrophic medical and rehabilitation benefits.

The applicant sought payment of the remaining hospital bill balance, chiropractic services, and an income replacement benefit (IRB).

The adjudicator dismissed the claims for medical expenses, finding that while the expenses were reasonable and necessary, the policy limits had been exhausted.

The adjudicator also dismissed the claim for an IRB, relying on surveillance evidence that showed the applicant working as a truck driver shortly after the accident, contradicting his testimony.

The respondent's request for costs due to the applicant's failure to attend case conferences was denied, as the high standard for awarding costs was not met.