Lori Marzinotto

The applicant requested a reconsideration of a preliminary issue decision that found her claim for non-earner benefits was statute-barred.

The applicant argued the insurer's denial letter was not clear and unequivocal and that subsequent actions created reasonable doubt.

The Vice-Chair dismissed the request, finding no significant error of law or fact in the original decision, as the denial was clear and the insurer's subsequent actions were part of its ongoing obligation to adjust the file.

The insurer requested a reconsideration of a case conference decision that ordered the production of the adjuster's log notes.

The insurer argued that the log notes were not relevant because the applicant had not claimed a special award.

The Tribunal dismissed the request for reconsideration, finding no error of law or fact.

The Tribunal held that adjuster's log notes are prima facie relevant to an entitlement claim to understand the adjuster's deliberations in refusing benefits, and a claim for a special award is not a prerequisite for their disclosure.

The applicant requested a reconsideration of a case conference decision that denied their request for the production of raw test data from the respondent's psychological IME assessor.

The applicant expanded their request to include data from two additional assessors not mentioned in the original decision.

The Tribunal denied the reconsideration request, finding that the applicant failed to specify the grounds for reconsideration under Rule 18.2 and improperly advanced new claims.

The applicant failed to make a prima facie case that the original decision contained any error meriting reconsideration.

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

The respondent denied income replacement benefits and medical benefits, arguing the applicant failed to attend a required section 44 insurer examination and that his injuries fell within the Minor Injury Guideline.

The Tribunal found the applicant was statute-barred under section 55(2) of the Schedule for failing to attend the scheduled ophthalmology examination.

In the alternative, the Tribunal found the applicant's injuries were predominantly minor, he had exhausted the Minor Injury Guideline limits, and he failed to establish a substantial inability to perform the essential tasks of his employment.

The applicant sought non-earner benefits following a motor vehicle accident, claiming a complete inability to carry on a normal life.

The applicant had a significant pre-accident medical history, including fibromyalgia, which had previously rendered her unable to work.

The Tribunal reviewed medical evidence, including insurer examinations and surveillance footage, which demonstrated that the applicant was able to engage in most of her pre-accident activities of daily living.

The Tribunal found that the applicant's ongoing impairments were largely attributable to her pre-existing conditions and dismissed the application for non-earner benefits.

The applicant brought a motion to adjourn a scheduled three-day hearing regarding non-earner and attendant care benefits.

The applicant had recently served an Application for Determination of Catastrophic Impairment (OCF-19) and argued that proceeding with the hearing before the catastrophic impairment issue was resolved could result in a multiplicity of proceedings.

The respondent opposed the adjournment, citing delay.

The adjudicator granted the adjournment, finding that the delay in serving the OCF-19 was justified by the need for medical testing, and that adjourning the hearing would avoid duplicative proceedings and allow for a full and fair hearing on the merits.

The respondent insurer brought a preliminary motion to dismiss the applicant's claim for statutory accident benefits on the basis that the applicant failed to attend multiple scheduled insurer's examinations.

The applicant argued that the notices of examination were not compliant with the Statutory Accident Benefits Schedule.

The Tribunal found that the notices were compliant and that the applicant's failure to attend was unjustified.

The application was dismissed pursuant to section 55 of the Schedule.

The Tribunal declined to order reimbursement of non-attendance fees, finding no jurisdiction to do so.

The applicant was injured in a motor vehicle accident and sought a medical benefit of $698.83 for the denied portions of a psychological treatment plan, specifically for documentation support and three additional progress evaluations.

The Licence Appeal Tribunal found that the applicant failed to explain the documentation fee and that the request for four progress evaluations over twelve sessions exceeded the Ontario Psychological Association Guidelines.

The application was dismissed as the applicant did not prove the treatment plan was reasonable and necessary.

The applicant, who was deemed catastrophically impaired following a motor vehicle accident, sought payment for various denied and partially approved treatment plans, as well as attendant care benefits.

The Licence Appeal Tribunal dismissed the claims for the medical benefits and treatment plans, finding the applicant failed to provide sufficient evidence that they were reasonable and necessary.

Regarding attendant care benefits, the Tribunal found the applicant was not entitled to additional amounts for the period prior to February 2016.

However, the Tribunal determined that the applicant had incurred attendant care expenses from February 2016 onwards and awarded partial attendant care benefits based on a detailed assessment of the required levels of care and the applicable hourly rate guidelines.

The applicant was injured in a motor vehicle accident in Alberta and applied for statutory accident benefits in Ontario.

The respondent denied the application on the basis that the applicant was a resident of Alberta.

At a preliminary hearing, the Tribunal considered whether the applicant was a resident of Ontario under the Schedule.

Applying the holistic test for residency, the Tribunal found that the applicant maintained significant ties to Ontario, including a fiancé, friends, and a rented apartment, and that his stay in Alberta was temporary.

The Tribunal concluded the applicant was a resident of Ontario and an insured person entitled to seek benefits.

The applicant sought income replacement benefits (IRBs) and various medical benefits following a motor vehicle accident.

The insurer terminated IRBs and denied further medical benefits on the basis that the applicant's injuries were predominantly minor and the $3,500 Minor Injury Guideline (MIG) limit had been exhausted.

The Tribunal found that the applicant did not suffer a substantial inability to perform the essential tasks of her pre-accident employment, relying on insurer examinations that showed her impairment was temporary and self-limited.

The Tribunal also held that the applicant failed to provide compelling medical evidence that her pre-existing conditions prevented her from achieving maximal recovery under the MIG.

The application was dismissed.

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

The parties agreed to proceed by way of a written hearing.

The applicant failed to provide any written submissions or evidence by the required deadline.

As the applicant bore the onus of proof and provided no evidence, the adjudicator dismissed the application without further notice, pursuant to the Statutory Powers Procedure Act and the Licence Appeal Tribunal Rules of Practice and Procedure.

The Applicant sought both non-earner benefits and income replacement benefits following a motor vehicle accident.

The insurer argued the Applicant was required to elect one benefit and that she had qualified for income replacement benefits, barring her from non-earner benefits.

The Tribunal found that the insurer failed to provide the required notice of election under s. 35(1) of the Schedule when it became aware the Applicant was self-employed.

As no election was provided, the Applicant is entitled to seek both benefits at the hearing, though she cannot recover both concurrently.

The Applicant sought non-earner benefits following a motor vehicle accident.

The insurer terminated the benefits after the Applicant failed to attend a scheduled insurer's examination.

The Applicant argued he did not receive the notice because he was moving between various addiction treatment facilities at the time.

The Tribunal found the Applicant's evidence credible and concluded he had a reasonable explanation for his non-attendance.

The insurer was ordered to pay the withheld non-earner benefits for the period of non-compliance.