Nadia Mauro

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 applicant argued for removal from the MIG based on a diagnosis of chronic pain syndrome.

The Tribunal found the applicant's medical evidence, specifically a chronic pain assessment, unpersuasive due to a gap in the medical records reviewed and a lack of corroborating evidence for functional impairment.

The Tribunal concluded the applicant's injuries were predominantly minor and subject to the MIG limits.

The application for treatment plans, an award, and interest was dismissed.

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

The respondent denied a treatment plan for physiotherapy, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on chronic back pain and functional impairment.

The Tribunal found the applicant's evidence, including a physical medicine report and clinical notes, insufficient to establish chronic pain with functional impairment on a balance of probabilities.

The Tribunal concluded the injuries were predominantly minor and subject to the MIG limit.

Consequently, the claims for the treatment plan, interest, and an award were dismissed.

The applicant's request for costs was also denied as there was no evidence of unreasonable conduct by the respondent during the proceedings.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

The respondent denied benefits because the applicant failed to submit a completed OCF-1 application within 30 days of receiving the forms, ultimately submitting it nearly three years later.

The applicant argued that personal circumstances and medical conditions caused the delay, but provided no specific evidence to support this claim.

The Tribunal found the applicant's explanation was not credible or worthy of belief, and therefore did not meet the threshold for a "reasonable explanation" under section 34 of the Schedule.

The application was dismissed pursuant to section 55(1) of the Schedule.

The applicant sought a death benefit of $16,250.00 following the death of his brother in a motor vehicle accident.

The applicant argued that due to his disability, he was principally dependent on his brother for financial support and care.

The Tribunal found that the applicant failed to provide sufficient evidence to establish dependency under s. 3(7)(b) of the Schedule.

The application for death benefits, interest, and an award was dismissed.

The applicant sought a death benefit of $16,250 following the death of her brother in a motor vehicle accident.

The insurer denied the claim on the basis that the applicant was not principally dependent on the deceased.

The Tribunal found that the applicant failed to provide sufficient evidence to establish financial or care dependency under s. 3(7)(b) of the Statutory Accident Benefits Schedule.

The application for death benefits, interest, and an award was dismissed.

The applicant sought a death benefit and reimbursement for interpretation services under the Statutory Accident Benefits Schedule following the death of his son in a motor vehicle accident.

The central issue was whether the applicant was 'principally dependent' on his son for financial support or care pursuant to s. 3(7)(b) of the Schedule.

The Tribunal found that the applicant failed to establish financial dependency, as the evidence indicated only 7% of the funds deposited into his account came from his son, and there was insufficient evidence regarding his financial needs or inability to support himself.

The Tribunal also found no evidence of dependency for care.

Consequently, the claims for death benefits, interpretation services, interest, and an award were dismissed.

The applicant sought a death benefit of $16,250.00 following the death of her son in a motor vehicle accident.

The respondent denied the benefit on the basis that the applicant was not principally dependent on the deceased for financial support or care.

The Tribunal found that the applicant failed to provide sufficient evidence, such as banking records or specific details of care, to establish dependency under the Statutory Accident Benefits Schedule.

The application for death benefits and an award for unreasonable delay 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 applicant claimed his injuries, including cervical radiculopathy and chronic pain, warranted removal from the MIG.

The Tribunal found the applicant failed to prove his physical impairments or chronic pain were accident-related or caused functional limitations sufficient to remove him from the MIG.

The application for additional treatment plans was dismissed.

The applicant sought non-earner benefits, reimbursement for clothing and prescription expenses, an award, and costs following a motor vehicle accident.

The Tribunal found it lacked jurisdiction to determine the non-earner benefit claim because the applicant had never submitted a disability certificate (OCF-3) and the insurer had never issued a denial.

The claims for clothing and prescription expenses were dismissed due to a lack of evidence demonstrating that the items were damaged in the accident or that the prescriptions were reasonable and necessary.

The requests for an award and costs were also dismissed.

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

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

The Tribunal found that the applicant failed to prove his injuries warranted removal from the MIG.

However, the Tribunal determined that the respondent's denial notice for the first treatment plan was non-compliant with s. 38(8) of the Schedule, rendering those expenses payable under s. 38(11).

The denial notice for the second treatment plan was compliant, and thus it was not payable.

The applicant's claim for an award was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and various medical and rehabilitation treatment plans.

The Tribunal found that the applicant, a personal support worker, suffered a substantial inability to perform the essential tasks of her employment and was entitled to pre-104 week IRBs.

However, the applicant was not entitled to post-104 week IRBs as she was currently employed as a Lab Patient Technician, demonstrating she did not suffer a complete inability to engage in suitable employment.

The Tribunal dismissed the claims for the proposed treatment plans and assessments, finding insufficient corroborating medical evidence to prove they were reasonable and necessary.

The claim for a special award was also dismissed as there was no evidence the insurer unreasonably withheld or delayed benefits.

The applicant sought a special award under s. 10 of O. Reg. 664, alleging the respondent insurer unreasonably delayed payment of attendant care and housekeeping benefits.

The Tribunal found that the delay was the result of an inadvertent clerical error by an adjuster covering the file, and that the respondent immediately paid the outstanding amounts with interest upon being notified.

The Tribunal concluded the insurer's conduct was not excessive, imprudent, or stubborn, and dismissed the application for an award.

The applicant was involved in a motor vehicle accident and reported property damage to his insurer on the same day, explicitly denying any injuries.

Over seven months later, he notified the insurer of his intention to claim accident benefits.

The insurer denied the claim for non-compliance with the 7-day notice requirement under s. 32(1) of the Schedule.

The Tribunal found that the applicant failed to provide a credible or reasonable explanation for the delay, noting he had a prior accident benefits claim and his evidence regarding his lack of knowledge was unpersuasive.

The application was dismissed as the applicant was barred from proceeding under s. 55(1) of the Schedule.

The applicant, who was catastrophically impaired in a motor vehicle accident, sought statutory accident benefits for physiotherapy, chiropractic services, and the cost of preparing a guardianship application.

The Licence Appeal Tribunal found the physiotherapy and chiropractic treatment plans to be reasonable and necessary, preferring the evidence of the applicant's treating practitioners over the respondent's paper-review assessor.

However, the Tribunal denied the claim for the guardianship application, ruling that legal costs associated with obtaining an order appointing a litigation guardian are not covered under the Schedule.

The applicant sought a non-earner benefit and attendant care benefits following a motor vehicle accident.

The Tribunal found the applicant was not entitled to a non-earner benefit, as the evidence did not establish a complete inability to carry on a normal life compared to his pre-accident baseline, which already included functional limitations.

The Tribunal also denied the claim for attendant care benefits, finding the applicant failed to prove the expenses were incurred or that the requested quantum was reasonable and necessary given his demonstrated abilities.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits (NEBs) and several treatment plans for psychological services, a physiatry assessment, and an in-home assessment.

The Tribunal found the applicant was not entitled to NEBs, as the medical evidence and self-reported limitations did not establish a complete inability to carry on a normal life under the Heath test.

The Tribunal denied the unapproved portions of two psychological treatment plans, finding them not reasonable and necessary, and upheld the insurer's denial notices as compliant with s. 38(8) of the Schedule.

However, the Tribunal found the insurer's denial notice for a third psychological treatment plan was non-compliant, rendering the incurred expenses payable under s. 38(11).

The Tribunal also approved the physiatry and in-home assessments as reasonable and necessary based on the applicant's ongoing physical complaints.

Claims for an award and costs were dismissed.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including treatment plans for chiropractic, occupational therapy, dietician, dental, and physiotherapy services, as well as an in-home functional assessment.

The respondent denied the benefits.

The Tribunal found that the applicant failed to prove on a balance of probabilities that the proposed treatment plans were reasonable and necessary, noting a lack of contemporaneous and corroborating medical evidence.

The claims for interest and an award for unreasonable delay were also dismissed.

The application was dismissed in its entirety.

The applicant sought payment for the balance of three treatment plans for psychological services following a motor vehicle accident.

The respondent had partially approved the plans at an hourly rate of $99.75 for a psychotherapist, while the applicant claimed entitlement to the psychologist rate of $149.61 per hour.

The Tribunal found that the applicant failed to prove the treating qualifying registered psychotherapist provided equivalent treatment to a psychologist or required the higher rate.

The application for the balance of the treatment plans and interest was dismissed.

The applicant was injured in a motor vehicle accident and sought payment for three treatment plans for psychological services.

The respondent partially approved the plans at an hourly rate of $99.75, arguing the services were provided by a qualifying registered psychotherapist rather than a psychologist.

The applicant sought the balance, arguing the provider should be paid at the psychologist rate of $149.61 per hour.

The Tribunal found the applicant failed to prove the higher rate was reasonable and necessary, noting the provider was a qualifying psychotherapist and there was no evidence they provided the equivalent treatment as a psychologist.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing her psychological and physical injuries warranted removal from the Minor Injury Guideline (MIG).

The Tribunal found the applicant's injuries were predominantly minor, preferring the respondent's psychological assessment over the applicant's because it better aligned with contemporaneous medical records.

While most of the respondent's denial letters complied with s. 38(8) of the Schedule, one denial for a psychological assessment was found non-compliant for failing to provide specific medical reasons.

Consequently, the respondent was ordered to pay expenses incurred under that plan until the defective notice was cured.

The applicant's claim for an award under s. 10 of Reg. 664 was dismissed, as the non-compliant notice was deemed a wrong adjusting decision rather than unreasonable conduct.