Aly Pabani

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of several treatment plans for physiotherapy and occupational therapy, as well as attendant care benefits.

The Tribunal found the applicant partially entitled to one physiotherapy treatment plan and one occupational therapy plan, noting that a compression fracture was linked to the accident and justified further treatment.

The Tribunal also found the applicant entitled to attendant care benefits of $1,034.58 per month due to chronic pain limitations, but held they were not yet payable because the applicant failed to prove the expenses had been incurred.

The claim for a special award was dismissed.

The applicant sought statutory accident benefits after fracturing his foot while disembarking from a parked shuttle van onto uneven pavement.

The respondent insurer denied benefits, arguing the incident did not meet the definition of an 'accident' under s. 3(1) of the Schedule.

The Tribunal applied the purpose and causation tests, finding that disembarking is an ordinary use of a vehicle and that this use was a direct cause of the injuries, despite the uneven surface also being a contributing factor.

The Tribunal concluded the incident was an accident.

The applicant sought statutory accident benefits after fracturing his foot while disembarking from a parked shuttle van onto uneven pavement.

The respondent insurer denied benefits, arguing the incident did not meet the definition of an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal applied the purpose and causation tests, finding that disembarking is an ordinary use of a vehicle and that the use of the vehicle was a direct cause of the injuries, despite the uneven surface being a contributing factor.

The Tribunal concluded the applicant was involved in an accident.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found that his injuries fell within the Minor Injury Guideline and that the respondent insurer had complied with the notice requirements under s. 38(8) of the Statutory Accident Benefits Schedule.

The applicant argued the adjudicator erred in law and fact by failing to apply the consequences of s. 38(11) and by failing to properly apply the principles from Hedley v. Aviva regarding boilerplate denial letters.

The Tribunal dismissed the request, finding that the adjudicator had considered Hedley and reasonably concluded that the denial letters, while generic, sufficiently cited a medical reason for denial.

The Tribunal held that the applicant was merely attempting to re-litigate the initial decision, which does not meet the high threshold for reconsideration.

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

The respondent denied the claims 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 physical or psychological injuries warranted removal from the MIG.

However, the Tribunal determined that the respondent's denial letters were boilerplate and failed to comply with the notice requirements under s. 38(8) of the Schedule.

Consequently, pursuant to s. 38(11), the respondent was ordered to pay the incurred expenses for the disputed treatment plans, plus interest.

The applicant's request for a special award was dismissed.

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

The insurer denied treatment plans for psychological and chiropractic services, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued he sustained a psychological impairment warranting removal from the MIG and relied on a psychological report.

The Tribunal found the psychological report unreliable due to methodological flaws and inconsistencies with contemporaneous clinical records.

The Tribunal concluded the applicant failed to prove his injuries fell outside the MIG and dismissed the claims for the disputed treatment plans.

The Tribunal also found the insurer's denial letters complied with the notice requirements under s. 38(8) of the Schedule.

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

The respondent insurer denied income replacement benefits, arguing the applicant was barred under s. 31(1)(b) of the Schedule for intentionally failing to notify it of his move from Kitchener to Toronto, which would have increased his premiums.

The Tribunal found that while the address change was a material risk, the respondent failed to meet its burden of proving the failure to disclose was intentional.

The applicant testified he informed his broker of the move, and the respondent provided insufficient evidence to refute this.

The applicant is not barred from proceeding with his claim.

The applicant requested a reconsideration of a preliminary decision which found him precluded from receiving accident benefits under s. 31(1)(a) of the Schedule because his motorcycle was uninsured.

The applicant argued the Tribunal erred in its findings regarding vehicle ownership, his reasonable belief of insurance coverage under s. 2.2.3 of the OAP-1, and the interpretation of condition 5 of s. 2.2.3.

The adjudicator dismissed the request, finding no significant errors of law or fact that would have led to a different outcome, and noting that the Tribunal is not required to act as an advocate for arguments not raised by the parties at the original hearing.

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

The adjudicator found that the applicant failed to prove her injuries warranted removal from the Minor Injury Guideline (MIG), as there was insufficient evidence of chronic pain or psychological impairment.

However, three treatment plans were approved because the insurer failed to provide adequate medical and other reasons for denial under s. 38(8) of the Schedule.

The applicant's claim for non-earner benefits was dismissed because she did not establish a complete inability to carry on a normal life.

The request for a special award was also denied.

The applicant was injured in a motorcycle accident and sought statutory accident benefits.

The respondent denied benefits on the basis that the applicant was operating an uninsured vehicle at the time of the accident.

The Tribunal found that the applicant, a mechanic, failed to prove he purchased the motorcycle within 14 days of the accident to qualify for newly acquired vehicle coverage under his existing policy.

The Tribunal concluded the applicant knew or ought to have known the motorcycle was uninsured, precluding him from receiving benefits under section 31(1)(a)(i) of the Schedule.

The applicant sought accident benefits for a motor vehicle accident that occurred on March 21, 1999.

The respondent insurer first became aware of the accident on July 23, 2020, over 20 years later.

The respondent brought a preliminary issue hearing arguing the applicant was statute-barred from proceeding for failing to submit an application for benefits within the prescribed timelines.

The Tribunal found that the applicant failed to notify the respondent within 30 days of the accident and failed to submit an OCF-1 application within the prescribed timelines.

The applicant did not provide a reasonable explanation for the delay.

The application was dismissed.

The applicant requested a reconsideration of a previous decision which found that his accident-related injuries, including tinnitus, met the definition of a 'minor injury' under the Statutory Accident Benefits Schedule and were subject to the Minor Injury Guideline (MIG) limit.

The applicant argued the Tribunal erred in its interpretation of a minor injury and by requiring proof of a serious psychological impairment to access a psychological assessment.

The Tribunal dismissed the request, finding no error of law or fact in the original decision, as the tinnitus was a clinically associated sequelae of the minor injury and there was no compelling evidence of a psychological impairment warranting removal from the MIG.

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

The respondent denied a treatment plan for a psychological assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The Tribunal found that the applicant's physical injuries were predominantly minor and that there was insufficient evidence of a psychological impairment caused by the accident to remove him from the MIG.

As the MIG limit was exhausted, the applicant was not entitled to the disputed treatment plan or interest.

The applicant sought non-earner benefits after slipping on black ice and fracturing her ankle while exiting her parked vehicle.

The respondent denied the benefits on the basis that the incident was not an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal applied the two-part purpose and causation test and found that while the purpose test was met, the causation test was not.

The Tribunal concluded that the ice was an independent intervening event that directly caused the injuries, breaking the chain of causation from the use or operation of the automobile.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought a medical benefit for psychological services, arguing her pre-existing depression and anxiety warranted removal from the Minor Injury Guideline (MIG).

The respondent denied the benefit, relying on a section 44 psychological assessment.

The Tribunal found that the applicant sustained predominantly minor injuries and failed to prove her pre-existing conditions were exacerbated by the accident or prevented maximal medical recovery within the MIG.

The Tribunal preferred the respondent's expert evidence and concluded the proposed treatment plan was not reasonable and necessary.

The application was dismissed.

The applicant sought statutory accident benefits for physiotherapy and various assessments following a motor vehicle accident.

The respondent denied the claims on the basis that the treatments were not reasonable and necessary.

The Tribunal dismissed the application, finding that the applicant failed to meet the burden of proof.

The Tribunal entirely rejected the applicant's occupational therapy expert report, finding the assessor was biased, partisan, and provided opinions outside the scope of their expertise.

As no benefits were payable, the claim for interest was also dismissed.