John Mazzilli

The applicant sought $1,818.25 for chiropractic services following a motor vehicle accident.

The respondent denied the treatment plan, arguing the applicant had reached maximum medical recovery and the treatment was for unrelated issues.

The adjudicator found the applicant failed to meet her burden of proof, as she provided only case law and no contemporaneous corroborating evidence to support the treatment plan.

The applicant's request for $1,000 in costs due to the respondent exceeding page limits in its submissions was also dismissed, as the respondent's conduct was not found to be unreasonable, frivolous, vexatious, or in bad faith.

The application was dismissed.

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

The respondent denied treatment plans for chiropractic services, an attendant care assessment, and physiotherapy.

The Tribunal found the applicant was barred from proceeding on the chiropractic and attendant care claims because she failed to dispute the clear and unequivocal denials within the two-year limitation period under s. 56 of the Schedule, and declined to extend the time under s. 7 of the LAT Act.

The physiotherapy claim was dismissed as not reasonable and necessary, with the Tribunal finding the respondent's denial complied with s. 38(8).

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his pre-existing injuries from a prior accident were exacerbated, warranting removal from the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal excluded the applicant's late-filed medical evidence and accepted the respondent's medical assessment, finding no compelling evidence that the pre-existing conditions precluded recovery within the MIG.

The application for a $5,812.75 treatment plan and interest was dismissed as the applicant remained subject to the MIG limits.

The applicant sought accident benefits following a motor vehicle accident, which the respondent insurer denied on the basis that her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG due to physical injuries (lumbar sprain/strain) and psychological impairments (driving/passenger anxiety).

The Tribunal found that the applicant's physical injuries were uncomplicated soft tissue injuries that did not warrant removal from the MIG.

Furthermore, the Tribunal accepted the respondent's psychological assessment that the applicant's initial driving anxiety had dissipated over time.

As the applicant remained within the MIG and the limits were exhausted, the claims for further treatment plans and interest were dismissed.

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

The Tribunal found that the issue of whether the applicant's injuries fell outside the Minor Injury Guideline (MIG) was not properly before it, as it was omitted from the Case Conference Report and Order.

The Tribunal held that the respondent's denial notices for three chiropractic treatment plans complied with s. 38(8) of the Schedule.

However, the denial notice for a chronic pain assessment and a psychological assessment was deficient under s. 38(8) because it failed to provide clear reasons or specify the treatments being denied.

Consequently, the respondent was ordered to pay for the assessments pursuant to s. 38(11).

The claim for an award was dismissed.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, claiming catastrophic impairment, income replacement benefits, attendant care benefits, and various treatment plans.

The Licence Appeal Tribunal found that the applicant did not meet the threshold for catastrophic impairment under Criterion 7 (55% whole person impairment) or Criterion 8 (mental and behavioural disorders).

The Tribunal preferred the respondent's medical evidence, noting the applicant's pre-existing conditions and post-accident functioning, including international travel.

Claims for income replacement and attendant care benefits were dismissed as the applicant failed to prove a substantial inability to perform his pre-accident employment and the benefits had expired past the 260-week mark.

The application was dismissed in its entirety.

The applicant sought a determination that she sustained a catastrophic impairment under Criterion 8 (mental and behavioural disorders) following a 2018 motor vehicle accident.

The respondent insurer denied the claim, arguing her impairments were largely due to a pre-existing 2011 slip and fall injury.

The Tribunal applied the 'but for' test and found the accident was a necessary cause of her current impairments.

Preferring the applicant's expert evidence, the Tribunal concluded the applicant suffered marked (Class 4) impairments in three domains: social functioning, concentration, persistence and pace, and adaptation.

The applicant was deemed catastrophically impaired.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of multiple treatment and assessment plans for physiotherapy, psychological services, PRP injections, and chronic pain.

The applicant argued the denial notices were deficient under s. 38(8) of the Statutory Accident Benefits Schedule.

The Tribunal found that the respondent's denial notices complied with the Schedule, providing sufficient medical and other reasons.

Furthermore, the Tribunal determined that the disputed plans were not reasonable and necessary based on the medical evidence.

The applicant's claims for an award and interest were dismissed, and the respondent's request for costs was also denied.

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

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

The Tribunal found no compelling medical evidence that the applicant's physical soft tissue injuries or alleged psychological impairments warranted removal from the MIG.

The Tribunal preferred the respondent's psychological assessment over the applicant's, noting the applicant's assessor was not qualified to provide a psychological diagnosis.

The application was dismissed.

The applicant was struck by a reversing snow plow tractor (a backhoe with a snow plow attached) in a mall parking lot and sought statutory accident benefits.

The insurer denied benefits on the basis that the incident was not an 'accident' under the Schedule because the snow plow was not an 'automobile'.

Applying the three-part test from Adams, the Tribunal found that the backhoe was not an automobile in ordinary parlance, was not defined as such in the insurance policy, and did not meet the enlarged definition in any relevant statute.

The application was dismissed.

The applicant sought a non-earner benefit following a motor vehicle accident.

The matter proceeded to a written hearing, but the applicant failed to file any written submissions or evidence.

The Tribunal proceeded in the applicant's absence pursuant to section 7(2) of the Statutory Powers Procedure Act.

The application was dismissed as the applicant failed to meet their burden of proof.

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

The respondent denied funding for various treatment and assessment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

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

The Tribunal found insufficient objective medical evidence to support chronic pain with a functional impairment, noting negative imaging and a section 44 assessment showing full range of motion.

The Tribunal also preferred the respondent's psychological assessment, which found the applicant exaggerated symptoms and did not meet the criteria for a psychological impairment.

The application was dismissed, and the applicant's request for an award was denied.

The applicant requested a reconsideration of a Tribunal decision that found she was not catastrophically impaired under criterion 8 of the AMA Guides.

The applicant argued the Tribunal breached procedural fairness by considering pre- and post-accident levels of function and erred in law by imposing a higher burden of proof for marked impairments in three domains.

The Tribunal dismissed the request, finding no error of law or fact and no breach of procedural fairness.

The Tribunal held that it properly applied the AMA Guides, appropriately weighed the medical evidence, and correctly placed less weight on an occupational therapy report that lacked an in-home assessment.

The applicant sought statutory accident benefits, claiming catastrophic impairment due to physical and psychological injuries from a 2015 motor vehicle accident.

The Tribunal found that the applicant failed to prove causation on a "but for" basis, noting that his psychological impairments were primarily caused by significant non-accident life stressors, including financial ruin and family breakdown.

The Tribunal also found the applicant did not meet the threshold for catastrophic impairment under Criterion 7 (Whole Person Impairment) or Criterion 8 (Mental and Behavioural Disorders).

Consequently, the claims for a neuro-psychological examination, attendant care benefits, and housekeeping and home maintenance benefits were dismissed.

The applicant insurer sought repayment of $16,400 in Income Replacement Benefits (IRB) paid to the respondent after she had returned to work.

The respondent argued the repayment notices were deficient under s. 52(2) of the Schedule.

The Tribunal found the notices were compliant given the information available to the insurer at the time, as the respondent had delayed providing her return-to-work dates and pay stubs.

The Tribunal ordered the respondent to repay the $16,400 overpayment plus interest.

The applicant sought entitlement to statutory accident benefits for social rehab counselling, physiotherapy, and occupational therapy following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the treatment plans were reasonable and necessary.

The Tribunal noted that the respondent had already paid the reasonable hourly rate for social work, the applicant had reached maximum medical recovery for physical injuries, and surveillance evidence contradicted the need for occupational therapy.

Claims for an award, interest, and costs were also dismissed.

The applicant sought statutory accident benefits 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) and the limits had been exhausted.

The applicant argued that pre-existing physical and psychological conditions warranted removal from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence that his pre-existing conditions precluded recovery within the MIG.

Relying on the respondent's section 44 assessors, the Tribunal concluded the applicant's injuries were predominantly minor.

The application was dismissed.

The applicant sought accident benefits following a motor vehicle accident, arguing for removal from the Minor Injury Guideline (MIG) due to chronic pain and psychological impairments.

The Tribunal found the medical evidence, including clinical notes from the family doctor and a sports medicine physician, supported soft tissue injuries rather than accident-related chronic pain with functional impairment.

The Tribunal preferred the respondent's psychological assessment over the applicant's, concluding there was no accident-related psychological diagnosis.

The applicant was found to remain within the MIG, and claims for a psychological assessment, an award, interest, and costs were dismissed.

The applicant sought entitlement to an income replacement benefit (IRB) and a physiotherapy treatment plan following a motor vehicle accident.

The respondent had terminated the IRB based on multidisciplinary assessments concluding the applicant did not suffer a substantial inability to perform the essential tasks of her pre-accident employment as a restaurant server.

The Tribunal found the applicant failed to provide supporting medical documentation to meet her onus for both the IRB and the treatment plan, relying instead on perceived deficiencies in the respondent's evidence.

The Tribunal accepted the respondent's medical evidence that the applicant's injuries were transient soft tissue injuries and that her psychological issues did not prevent her from working.

The application was dismissed in its entirety, including claims for interest and an award.

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

The respondent denied the benefits and scheduled multiple insurer's examinations under s. 44 of the Schedule.

The applicant failed to attend the examinations, arguing the notices were insufficient.

The Tribunal found the notices complied with the Schedule and that the applicant provided no valid reason for her non-attendance.

Consequently, the applicant was statute-barred from proceeding with the application under s. 55(1)2 of the Schedule, and the application was dismissed.