Nadia Mauro

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

The applicant had been laid off due to the COVID-19 pandemic prior to the accident and had only worked 22 weeks in the 52 weeks preceding the accident, falling short of the 26-week statutory requirement.

The Tribunal found that the applicant was not 'employed' at the time of the accident within the meaning of section 5(1) of the Schedule, as intent to return to work does not satisfy the requirement of receiving wages for services.

Furthermore, the applicant failed to prove a substantial inability to perform the essential tasks of his employment.

The application for IRBs and interest was dismissed.

The applicant sought $1,710 for chiropractic services following a 2019 motor vehicle accident.

The respondent denied the treatment plan based on a section 44 physiatry assessment.

The Tribunal found that the applicant failed to prove the treatment was reasonable and necessary, as the supporting medical evidence predated the treatment plan by over a year and the contemporaneous section 44 assessment concluded the applicant had reached maximum medical improvement.

The application was dismissed, and claims for interest and an award were denied.

The applicant sought various medical, rehabilitation, and attendant care benefits following a motor vehicle accident.

The respondent denied the benefits, and the applicant applied to the Licence Appeal Tribunal.

The Tribunal found that the applicant was entitled to some of the proposed psychological, physiotherapy, and chiropractic treatment plans, primarily for the completion of OCF-18 forms and where contemporaneous medical evidence supported the need for treatment.

However, the Tribunal dismissed the claims for attendant care benefits, medication expenses, and several other treatment plans due to a lack of supporting evidence.

The request for a special award under s. 10 of Reg. 664 was also dismissed, as the applicant failed to prove the respondent acted unreasonably.

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

The Tribunal found the applicant was not entitled to the cost of personal protective equipment (PPE) in four partially approved physiotherapy treatment plans, as PPE is considered an administrative expense.

However, the Tribunal approved a subsequent physiotherapy treatment plan, a chronic pain assessment, and a physiatry assessment, finding them reasonable and necessary based on the applicant's ongoing complaints and the recommendations of his family doctor.

A proposed neurological assessment was denied.

The Tribunal also dismissed the applicant's claim for a special award under s. 10 of Reg. 664, finding the insurer's conduct was not unreasonable, and denied the respondent's request for costs.

The applicant requested a reconsideration of a Tribunal decision that denied her entitlement to a physiotherapy treatment plan and dismissed her motion to exclude the respondent's section 44 insurer examination reports.

The applicant argued the Tribunal breached procedural fairness and made errors of law and fact by admitting late documents, misapprehending medical evidence, and failing to find that pain relief is a reasonable goal of treatment.

The Tribunal dismissed the reconsideration request, finding no jurisdictional error, breach of procedural fairness, or errors of fact or law, noting that the reconsideration process is not an opportunity to re-litigate disagreements with the original decision or the weight assigned to evidence.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming she was unable to work as a self-employed aesthetician.

The respondent insurer denied the benefits based on section 44 assessments and sought repayment of a $557.50 overpayment.

The Tribunal found the applicant failed to provide contemporaneous medical evidence proving a substantial or complete inability to perform the essential tasks of her employment.

The applicant's claim for IRBs, interest, and a special award was dismissed.

The respondent's request for repayment was granted, as the overpayment was an error and timely notice was provided.

The applicant sought funding for physiotherapy and psychological services following a motor vehicle accident.

The adjudicator found that the applicant failed to prove the physiotherapy treatment plans were reasonable and necessary, relying on the insurer's section 44 assessor who opined the applicant had reached maximum medical recovery.

The adjudicator also denied the claim for psychological services at a higher hourly rate, finding insufficient evidence to justify paying a psychotherapist at the rate of a psychologist.

The application was dismissed.

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

The respondent denied various treatment plans, arguing the applicant's injuries fell within the $3,500 Minor Injury Guideline (MIG) limit.

The applicant argued for removal from the MIG based on pre-existing physical and psychological impairments, accident-related psychological impairment, and chronic pain.

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

The Tribunal also found insufficient evidence that the applicant suffered from accident-related psychological impairment or chronic pain with functional impairment.

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

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline (MIG) and claiming entitlement to a non-earner benefit.

The Licence Appeal Tribunal found that the applicant failed to provide submissions or evidence to warrant removal from the MIG.

Furthermore, relying on section 44 assessments, the Tribunal concluded the applicant did not suffer a complete inability to carry on a normal life, as she was able to engage in lighter tasks and various activities of daily living.

The application was dismissed.

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

The respondent insurer denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline.

The applicant challenged the denials, arguing that the respondent's notices failed to comply with the medical reasons requirement under s. 38(8) of the Statutory Accident Benefits Schedule.

The Tribunal found that the initial denial letters for a psychological assessment, chiropractic services, and a chronic pain assessment were non-compliant, triggering the consequences under s. 38(11) and making the expenses payable until the defective notices were cured.

However, the denial for psychological treatment was found to be compliant.

The Tribunal awarded interest on the overdue benefits but declined to order an award under s. 10 of Reg. 664, finding the insurer's non-compliance was a wrong adjusting decision rather than unreasonable conduct.

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

The respondent denied the benefits.

The Tribunal found that the applicant failed to provide contemporaneous medical evidence demonstrating a substantial inability to perform the essential tasks of his pre-accident employment.

The Tribunal dismissed the application, finding the applicant was not entitled to IRBs or interest.

The applicant sought payment for a psychological services treatment plan under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The applicant argued that the respondent's denial notice was deficient under s. 38(8) of the Schedule.

The Tribunal found that the respondent's Explanation of Benefits complied with the notice requirements by clearly indicating partial approval and referencing an insurer's examination report for the medical reasons.

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

The respondent's request for costs due to the applicant's late and lengthy submissions was also dismissed, as the conduct did not meet the high threshold for costs.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to several treatment plans for psychological services and an orthopaedic assessment.

The respondent had partially approved the psychological services at the rate of a psychotherapist ($99.75/hour) rather than the requested rate of a psychologist ($149.61/hour).

The Tribunal found that the applicant failed to provide evidence, such as the treating psychotherapists' credentials, to justify payment at the higher psychologist rate.

The Tribunal also denied the orthopaedic assessment, noting the applicant failed to submit the treatment plan into evidence and giving significant weight to the respondent's s. 44 assessor who found the assessment unnecessary.

Claims for interest and a special award were consequently 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 on a balance of probabilities that she suffered from chronic pain or a psychological impairment warranting removal from the MIG.

The Tribunal preferred the respondent's psychological assessment over the applicant's and noted a lack of ongoing accident-related complaints in the clinical records.

The application for disputed treatment plans and interest was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to non-earner benefits and various treatment plans outside the Minor Injury Guideline (MIG).

The adjudicator found that the applicant failed to prove her psychological impairments, physical injuries, or chronic pain warranted removal from the MIG.

Furthermore, the applicant did not provide sufficient evidence comparing her pre- and post-accident activities to establish a complete inability to carry on a normal life.

The application was dismissed, and the applicant was found not entitled to the disputed benefits or interest.

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

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

The Tribunal found the applicant's accident-related dental injuries, which required surgery, warranted removal from the MIG.

The Tribunal ordered the respondent to pay for chiropractic services, incurred dental expenses, and replacement prescription eyeglasses.

Furthermore, the Tribunal found the respondent unreasonably delayed payment for the dental services and ordered a 15% special award under s. 10 of Regulation 664, along with interest on overdue benefits.

The applicant's request for costs was dismissed.

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

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG), as she failed to establish that her physical injuries or chronic pain warranted removal.

However, the Tribunal ordered the respondent to pay for a $2,000 chronic pain assessment because the respondent's denial letter failed to provide sufficient medical reasons, violating section 38(8) of the Schedule.

Claims for physiotherapy and a section 10 award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to physiotherapy services, a physiatry assessment, and a neurological assessment.

The respondent denied the benefits, relying on s. 44 assessments that concluded the applicant's injuries fell within the Minor Injury Guideline.

The Tribunal found the physiotherapy and physiatry assessment reasonable and necessary based on consistent clinical records from the applicant's treating practitioners.

However, the Tribunal denied the neurological assessment, noting a prior normal neurological consultation and a lack of compelling evidence of neurological impairment.

The applicant was awarded interest on overdue benefits but denied a special award under s. 10 of Reg. 664.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The respondent denied the benefits.

The Tribunal found the applicant partially entitled to physical therapy treatments, a chronic pain program, and a social work assessment, as well as interest on overdue payments.

The Tribunal found the applicant was not entitled to PRP and Botox injections, as there was insufficient evidence to prove they were reasonable and necessary.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of treatment plans for occupational therapy, assistive devices, physiotherapy, and a driving rehabilitation assessment.

The Licence Appeal Tribunal found the applicant partially entitled to the occupational therapy services and assistive devices, noting that the reasonableness of the benefits must be assessed at the time they were proposed.

However, the Tribunal denied the physiotherapy services as duplicative and exceeding guideline rates, and denied the driving rehabilitation assessment due to a lack of compelling evidence of ongoing psychological impairment.

Interest was awarded on the overdue benefits.