Julian DiBattista

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

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and she did not suffer a substantial inability to perform the essential tasks of her self-employment.

The Tribunal found the applicant failed to prove entitlement to an IRB, preferring the respondent's assessors who personally evaluated her over the applicant's paper-review assessor.

The Tribunal also concluded the applicant's physical, dental (TMJ), and psychological injuries did not warrant removal from the MIG.

The application was dismissed.

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

The respondent denied the benefits, arguing the applicant failed to comply with a section 33 request for information and that her injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant did not prove a substantial inability to perform the essential tasks of her employment and failed to provide compelling medical evidence to warrant removal from the MIG.

The application was dismissed.

The applicant insurer sought repayment of income replacement benefits paid to the respondent after he had returned to work.

The respondent did not file submissions for the written hearing.

The Tribunal found that the respondent returned to work on July 8, 2023, but the insurer was not notified until November 2023, resulting in an overpayment.

The Tribunal ordered the respondent to repay the benefits paid in error and awarded interest on the overdue amount.

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

The insurer denied the benefit on the non-medical ground that the applicant may qualify for an income replacement benefit, as he had indicated he was working at the time of the accident.

The Tribunal, applying Varriano, held that the insurer was not required to provide medical reasons for denying the benefit when a valid non-medical reason existed.

The application for the non-earner benefit, along with claims for interest and an award under s. 10 of Reg. 664, was dismissed.

The applicant, a self-employed food delivery driver, sought an income replacement benefit (IRB) following a motor vehicle accident.

The insurer suspended benefits due to the applicant's failure to provide proof of income and file his 2016 tax return, calculating his IRB quantum at $0.00 pursuant to s. 4(5) of the Statutory Accident Benefits Schedule.

The Tribunal found that while s. 4(5) excludes unreported income from IRB calculations, it does not negate the $185.00 weekly minimum under s. 7(2)1ii.

The Tribunal held the applicant was entitled to the minimum IRB for the period after he complied with the insurer's information requests until he no longer met the medical test.

The applicant's claim for a special award under s. 10 of Regulation 664 was dismissed as no submissions were made on the issue.

The applicant sought an income replacement benefit and funding for a physiotherapy treatment plan following a motor vehicle accident.

The respondent raised a preliminary issue that the applicant was barred from proceeding for failing to attend insurer's examinations.

The Tribunal found the respondent's notices of examination were non-compliant with the Schedule, allowing the hearing to proceed.

On the substantive issues, the Tribunal dismissed the application, finding the applicant failed to prove a substantial inability to perform the essential tasks of her employment due to inconsistencies in her evidence regarding her return to work.

The Tribunal also denied the treatment plan as the applicant failed to provide goals or corroborating medical evidence to establish it was reasonable and necessary.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits, meal preparation and delivery services, a visual skills assessment, and nutrition counselling.

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal preferred the respondent's occupational therapy assessment over the applicant's regarding attendant care, finding the applicant could safely feed herself.

The Tribunal also held that the cost of food and nutritional supplements are not payable as medical or rehabilitation benefits under the Schedule, and that meal preparation is exclusively an attendant care benefit.

Claims for a visual skills assessment and further nutrition counselling were also dismissed as not reasonable or necessary.

The applicant insurer sought repayment of an income replacement benefit in the amount of $15,428.57 paid to the respondent following a motor vehicle accident.

The insurer submitted that the payment was made in error.

The respondent consented to the repayment order.

The Licence Appeal Tribunal ordered the respondent to repay the $15,428.57 along with applicable interest pursuant to section 52(5) of the Statutory Accident Benefits Schedule.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied additional Attendant Care Benefits.

The applicant argued the Tribunal committed a material breach of procedural fairness by ignoring evidence, made errors of fact and law regarding the assessment of care needs, and demonstrated a reasonable apprehension of bias.

The Tribunal dismissed the request, finding that the original decision properly weighed the competing Form 1s and accompanying reports, correctly applied the requirement that expenses be incurred, and that the applicant failed to establish any specific grounds for bias beyond mere disagreement with the outcome.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit and several treatment and assessment plans.

The respondent did not make submissions.

The Tribunal found that the applicant failed to meet his burden of proof, as he did not identify the essential tasks of his employment or provide the disputed treatment plans as evidence.

The application was dismissed in its entirety.

The insurer applied for repayment of $50,571.43 in income replacement benefits, alleging the respondent engaged in wilful misrepresentation regarding his employment status.

The Tribunal found no misrepresentation in the initial application, as the insurer failed to prove the respondent was not an employee of his wife's business.

However, the Tribunal found the respondent committed wilful misrepresentation by returning to work as a real estate agent without notifying the insurer.

The insurer was awarded repayment of $30,800.00 for the period after the respondent returned to work, plus interest.

The insurer's request for costs was dismissed.

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 Tribunal found that the applicant failed to prove a psychological impairment warranting removal from the MIG, preferring the respondent's psychological assessment over the applicant's pre-screening report.

The Tribunal also dismissed the claim for an income replacement benefit because the applicant failed to identify the essential tasks of his employment.

As the MIG limits were exhausted, the claims for treatment plans and expenses were dismissed.

The applicant was involved in a motor vehicle accident and sought an income replacement benefit of $400 per week.

The respondent paid $23.49 per week for the first 104 weeks and $185 per week thereafter.

The dispute centered on the calculation of the applicant's pre-accident income, as he was self-employed.

The Tribunal found that under s. 4(3) of the Schedule, the applicant's income must be calculated using the last completed tax year, rather than the 52 weeks prior to the accident under s. 4(2)2.

As the applicant had no self-employment income in the 2021 tax year, the respondent's calculation of $23.49 per week was correct.

The claims for an award and interest were dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her entitlement to an Income Replacement Benefit.

The applicant argued that the Tribunal breached procedural fairness by ignoring medical records and erred in law by improperly weighing expert evidence from a psychiatrist versus a psychologist and chiropractor.

The Tribunal dismissed the request, finding no breach of procedural fairness as all evidence was reviewed, and holding that the weighing of expert evidence within their scope of practice is the role of the trier of fact and not grounds for reconsideration.

The applicant sought various statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB), medical benefits, and an award under s. 10 of O. Reg 664.

The Tribunal found the applicant did not suffer a substantial inability to perform the essential tasks of his employment as a personal support worker and Lyft driver, relying on the respondent's medical assessments and the applicant's family doctor's clinical notes.

The Tribunal denied the claims for IRB, psychological services, a chronic pain assessment, and a driving reintegration assessment.

However, the Tribunal partially approved a treatment plan for a chronic pain program, awarding $2,346.70 for physical therapy and an SI belt based on a neutral OHIP-funded assessment.

The claim for a s. 10 award was dismissed.

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

The parties agreed the applicant met the medical test for an IRB, but disputed the quantum.

The applicant argued that non-taxable employer-paid benefits should be excluded from the calculation of gross employment income and other income replacement assistance.

The Tribunal found that the Statutory Accident Benefits Schedule does not differentiate between taxable and non-taxable income or assistance, and the Income Tax Act definition of income is not applicable.

The Tribunal preferred the respondent's accountant report, which included the non-taxable benefits, resulting in an IRB quantum of $0.00.

The application was dismissed.

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

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

The Tribunal found the applicant suffered a psychological impairment, supported by a psychological assessment and family physician records, warranting removal from the MIG.

The applicant's claim for an income replacement benefit was dismissed for failing to prove a substantial inability to perform the essential tasks of her employment as a personal support worker.

However, the Tribunal approved all four disputed treatment and assessment plans for physiotherapy and psychological services, finding them reasonable and necessary, and awarded interest on overdue payments.

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

The insurer denied benefits, arguing the applicant was subject to the Minor Injury Guideline (MIG) and ineligible for an Income Replacement Benefit (IRB).

The Tribunal found the applicant did not meet the employment or self-employment criteria for an IRB.

However, the Tribunal removed the applicant from the MIG based on a documented concussion diagnosis from a treating emergency physician, rejecting the insurer's s. 44 assessor who failed to address the hospital records.

The Tribunal approved several treatment plans for occupational therapy, psychological assessment, massage therapy, and social rehabilitation counselling as reasonable and necessary.

The Tribunal also ordered the insurer to pay for an accounting report used to calculate the IRB claim, noting the Schedule only requires the applicant to be applying for the benefit, not entitled to it.

The claim for a special award under s. 10 of Reg. 664 was dismissed because the insurer reasonably relied on a s. 44 assessment.

The applicant sought various statutory accident benefits following a motor vehicle accident, including increased attendant care benefits, multiple treatment plans, and expenses for eyeglasses.

The Licence Appeal Tribunal dismissed all claims.

The Tribunal found the applicant failed to provide evidence of incurred past attendant care expenses and preferred the respondent's occupational therapy assessment for ongoing care, concluding that 24/7 care was not justified.

The claims for treatment plans and assessments were dismissed due to a complete lack of supporting evidence, and the claims for eyeglasses were denied because the expenses had not been incurred.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident, claiming physical and psychological impairments prevented her from working.

The Tribunal reviewed conflicting medical assessments and found the applicant's presentation of pain and limitation to be inconsistent and lacking full effort.

Preferring the respondent's medical evidence, the Tribunal concluded the applicant did not suffer a substantial inability to perform the essential tasks of her employment.

The application for IRBs, interest, and a special award was dismissed.