John Mazzilli

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her entitlement to pre- and post-104-week income replacement benefits.

The applicant argued that the Tribunal erred in law and fact, and committed a material breach of procedural fairness, regarding the sufficiency of the insurer's notice of determination, the onus of proof, and the review of medical documents by an expert.

The adjudicator dismissed the request, finding that the notice complied with the Statutory Accident Benefits Schedule, the onus of proof correctly remained on the applicant, and the medical expert had properly considered the functional abilities evaluation report.

The reconsideration threshold under Rule 18.2 was not met.

The applicant sought statutory accident benefits following a motor vehicle accident but failed to attend the scheduled videoconference hearing.

The applicant also failed to attend previous case conferences and did not provide any evidence or submissions.

The adjudicator proceeded in the applicant's absence, dismissed the application for lack of evidence, and ordered the applicant to pay $750 in costs to the respondent for their unreasonable conduct and failure to participate in the Tribunal's processes.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit, removal from the Minor Injury Guideline (MIG), and funding for chiropractic and psychological treatment plans.

The Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, preferring the respondent's multidisciplinary medical assessments over the applicant's evidence.

The Tribunal also concluded that the applicant failed to establish a psychological impairment warranting removal from the MIG.

As the applicant remained subject to the MIG and the limits were exhausted, the disputed treatment plans were not payable, and the application was dismissed.

The applicant sought a determination of catastrophic impairment and entitlement to various treatment plans following a motor vehicle accident.

The Tribunal found that the applicant did not meet the 55% whole person impairment threshold under either Criterion 6 (physical) or Criterion 7 (combined physical and psychological), assessing his physical impairment at 37% and combined impairment at 43%.

The Tribunal denied the claim for outstanding catastrophic impairment assessments, finding them duplicative.

However, the Tribunal granted the cost of a NuStep cross trainer, finding it reasonable and necessary for the applicant's rehabilitation.

The Tribunal also granted the cost of a neurovisual assessment because the insurer's denial notice failed to comply with the requirements of s. 38(8) of the Schedule.

The applicant's request for costs was dismissed.

The applicant sought a determination that he sustained a catastrophic impairment under Criterion 8 of the Schedule and claimed entitlement to a post-104 income replacement benefit (IRB) following a motor vehicle accident.

The Tribunal found that the applicant did not meet the threshold for catastrophic impairment, as he did not demonstrate a marked impairment in at least two of the four functional domains, specifically finding his social functioning was compatible with some useful functioning.

However, the Tribunal granted the applicant's claim for a post-104 IRB, finding that the combination of his physical, psychological, cognitive, and visual impairments resulted in a complete inability to engage in any employment for which he was reasonably suited by education, training, or experience.

Interest was awarded on the overdue IRB payments.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming catastrophic impairment under Criterion 8 due to mental and behavioral disorders.

The Licence Appeal Tribunal found that the applicant's pre-existing irritable bowel syndrome and depression, along with the loss of family members, were the primary causes of her impairments.

The Tribunal preferred the respondent's expert evidence, concluding the applicant suffered only moderate (Class 3) impairments in activities of daily living, social functioning, and concentration, persistence, and pace.

As the applicant did not meet the threshold for catastrophic impairment and had exhausted her $65,000 non-catastrophic limits, all claims for disputed treatment plans and expenses were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs), chronic pain treatment, and a psychological assessment.

The Tribunal found the claim for the psychological assessment was statute-barred as the applicant failed to dispute the denial within the two-year limitation period.

The claims for pre-104 and post-104 IRBs were dismissed because the applicant returned to his pre-accident employment for eight months post-accident, and the medical evidence did not support his claim of an accident-related fused disc or inability to work.

The claim for chronic pain treatment was also dismissed as not reasonable or necessary based on the respondent's medical assessments.

The application was dismissed in its entirety.

The applicant requested a reconsideration of a Tribunal decision denying her entitlement to a post-104 income replacement benefit (IRB).

The applicant argued the adjudicator erred in law and breached procedural fairness by failing to determine substantive entitlement to the IRB, even if the quantum was zero.

The adjudicator agreed it was an error not to address the substantive threshold but found this was not a material breach or an error that would have changed the outcome.

The adjudicator reviewed the medical and vocational evidence, preferring the respondent's multidisciplinary assessments which concluded the applicant did not suffer a complete inability to engage in suitable employment.

The request for reconsideration was dismissed, and the respondent's request for costs was denied.

The applicant sought entitlement to pre-104 and post-104 Income Replacement Benefits (IRBs) following a motor vehicle accident.

The respondent insurer terminated the IRBs based on multidisciplinary assessments indicating the applicant could return to her pre-accident employment as an Uber driver.

The adjudicator found that the applicant failed to provide compelling medical evidence to contradict the respondent's assessors, who concluded there were no ongoing objective musculoskeletal or neurological impairments caused by the accident.

Furthermore, the applicant's own psychological records did not support a diagnosis of PTSD or a driving phobia.

The adjudicator also noted the applicant received CERB and CRB during the disputed period and successfully completed education to become a medical esthetician.

The application was dismissed.

The applicant, a pedestrian struck by a vehicle, sought statutory accident benefits including a catastrophic impairment designation under Criterion 4, income replacement benefits, and various treatment plans.

The adjudicator found the applicant did not meet the test for catastrophic impairment, preferring the respondent's neurologist who concluded there was no diagnostic evidence of brain trauma from the accident.

Claims for income replacement benefits and a central vacuum system were dismissed, while treatment plans for physiotherapy and occupational therapy were approved as reasonable and necessary.

Requests for costs by both parties were denied.

The applicant sought a determination of catastrophic impairment and entitlement to various medical and rehabilitation benefits following a motor vehicle accident.

The Tribunal found the applicant catastrophically impaired under Criterion 8 of the Schedule, concluding he suffered marked impairments in social functioning, concentration, persistence and pace, and adaptation due to a mental and behavioural disorder.

The Tribunal preferred the evidence of the applicant's psychiatrist over the respondent's assessor, who failed to attend the hearing.

The Tribunal approved the majority of the disputed treatment plans, including occupational therapy, chiropractic services, physiotherapy, and a catastrophic assessment, but denied a pharmacotherapy plan for medical cannabis as the requested amount exceeded the applicant's stated needs.

The applicant requested a reconsideration of a previous Tribunal decision which found his injuries fell within the Minor Injury Guideline (MIG) and denied his treatment plans.

The applicant argued errors of fact and law regarding his psychological condition, pre-existing back condition, and the respondent's compliance with notice requirements under section 38 of the Schedule.

The Adjudicator granted the reconsideration in part, finding that one of the respondent's explanation of benefits letters was deficient and confusing.

As a result, the associated physiotherapy treatment plan in the amount of $1,318.00 was deemed payable with interest.

The remainder of the reconsideration request was dismissed.

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

The matter was scheduled for a videoconference hearing, but neither the applicant nor their paralegal attended.

The Tribunal proceeded in their absence pursuant to section 7(1) of the Statutory Powers and Procedure Act.

As the applicant failed to present any evidence to satisfy their burden of proof, the application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain.

The Licence Appeal Tribunal found that the applicant failed to establish a diagnosis of chronic pain syndrome under the AMA Guides, noting he had returned to work, was independent in self-care, and did not exhibit excessive dependence on medication or family.

The Tribunal concluded the applicant's injuries were predominantly minor, dismissing the claims for disputed treatment plans and assessments.

The insurer applied to the Licence Appeal Tribunal for repayment of income replacement benefits, medical and rehabilitation benefits, independent examination costs, and investigation costs, alleging the respondent staged the motor vehicle accident.

The adjudicator found that the accident was staged, relying on expert evidence that the vehicle damage was caused by a tow truck stinger rather than a rear-end collision.

The respondent was ordered to repay the income replacement and medical/rehabilitation benefits with interest under section 52 of the Schedule.

However, the adjudicator held that the Schedule does not provide for the repayment of insurer examination or investigation costs, and declined to award them as costs under Rule 19.

The applicant was injured in a motor vehicle accident and sought an income replacement benefit (IRB) beyond the 104-week mark.

The insurer denied the benefit, arguing the applicant did not suffer a complete inability to engage in employment.

The Tribunal found that the applicant's accident-related chronic pain syndrome and functional impairments caused a complete inability to engage in any employment for which he was reasonably suited by education, training, or experience.

The Tribunal preferred the evidence of the applicant's chronic pain expert over the insurer's assessors.

The applicant was awarded the IRB of $600 per week and interest on overdue payments.

The applicant sought a determination that he was catastrophically impaired under Criterion 8 of the Statutory Accident Benefits Schedule due to mental and behavioral disorders resulting from a motor vehicle accident.

While the Tribunal accepted that the applicant sustained post-traumatic stress disorder, a major depressive episode, and substance use disorder as a result of the accident, it found that these impairments did not reach the threshold of a marked (Class 4) impairment in any of the four functional domains.

The Tribunal concluded that the applicant retained some useful functioning in activities of daily living and social functioning, and therefore dismissed the application.

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

A four-day videoconference hearing was scheduled, but the applicant failed to attend or provide a reason for his absence.

The adjudicator proceeded in the applicant's absence pursuant to section 7(1) of the Statutory Powers Procedure Act.

As the applicant presented no evidence to meet his burden of proof, the application for benefits was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to physiotherapy and psychological treatment plans outside the $3,500 Minor Injury Guideline (MIG) limit.

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

The Tribunal found insufficient medical evidence to establish chronic pain with functional impairment or a psychological impairment caused by the accident, preferring the respondent's insurer's examinations.

As the applicant remained within the MIG and the limits were exhausted, the disputed treatment plans and interest were denied.

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

The respondent denied three treatment plans for physiotherapy on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG due to chronic pain, a pre-existing back condition, and a psychological condition, and claimed the respondent provided insufficient reasons for the denials.

The Tribunal found the respondent's denial notices were compliant and that the applicant failed to provide sufficient medical evidence to establish chronic pain, a pre-existing condition precluding recovery, or a psychological impairment.

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