Angela Comella

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 chronic pain and a psychological condition.

The Tribunal found insufficient evidence of functional impairment due to pain or a psychological condition to warrant removal from the MIG.

As the MIG limit was exhausted, the disputed treatment plans for chiropractic services and a psychological assessment were denied.

Claims for an award and interest were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including treatment plans for psychological services, a psychological assessment, a dental assessment, and a chronic pain assessment.

The Licence Appeal Tribunal found the psychological services plan reasonable and necessary based on the treating psychotherapist's records and a supporting psychiatric assessment.

The remaining treatment plans were denied due to insufficient evidence or failure to make submissions.

The claim for a special award under s. 10 of Regulation 664 was dismissed as the applicant failed to demonstrate unreasonable conduct by the insurer.

The applicant sought income replacement benefits (IRBs) post-104 weeks, as well as payment for chiropractic services and catastrophic assessments following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove a complete inability to engage in suitable employment, relying on surveillance evidence and independent medical examinations showing the applicant could perform employment-type activities.

The Tribunal also found the proposed treatment plans and assessments were not reasonable and necessary, as they were duplicative of previously completed programs or lacked justification.

Claims for interest and an 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 applicant claimed a psychological impairment (PTSD) warranted removal from the MIG.

The Tribunal found the medical evidence did not support a psychological diagnosis, noting the family physician's records contradicted the PTSD claim.

As the applicant's injuries were minor and the MIG limit was exhausted, the claims for physiotherapy, medical services, interest, and an award for unreasonable delay were dismissed.

The applicant was involved in a motor vehicle accident and sought various medical benefits, transportation expenses, and an attendant care assessment from the respondent insurer.

The insurer denied the benefits on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant failed to establish on a balance of probabilities that the disputed treatment plans were reasonable and necessary, preferring the evidence of the insurer's physiatrist over the applicant's family physician.

The application was dismissed.

The applicant sought reconsideration of a decision denying him income replacement benefits.

The applicant had signed a contract for future employment prior to the accident but had not yet started working.

The adjudicator found no error of law in the original decision, which held that the definition of 'employed at the time of the accident' under the current Statutory Accident Benefits Schedule does not include individuals with contracts for future employment.

The request for reconsideration was dismissed.

The applicant sought payment for the costs of an accounting report obtained to calculate her income replacement benefit following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the accounting report was not reasonable and necessary because the calculation of the applicant's income was straightforward and did not require professional expertise.

The Tribunal also dismissed the applicant's request for a costs award, as there was no evidence of unreasonable, frivolous, vexatious, or bad faith conduct by the respondent.

The applicant insurer sought repayment of income replacement benefits (IRBs) paid to the respondent following a motor vehicle accident.

The insurer alleged the respondent failed to notify it of his return to work, resulting in an overpayment.

The respondent did not participate in the written hearing.

The Tribunal found the insurer met the requirements under section 52 of the Statutory Accident Benefits Schedule and ordered the respondent to repay $10,428.55 plus interest.

The applicant sought medical benefits for physiotherapy and occupational therapy following a motor vehicle accident.

The insurer denied the treatment plans and sought to rely on Insurer's Examination reports.

The Tribunal found that the insurer failed to provide adequate 'medical and any other reasons' for the examinations as required by s. 44(5) of the Schedule, and excluded the reports as a remedy.

Applying the 'but for' test for causation, the Tribunal found that the subject accident was a necessary cause of the applicant's impairments, despite pre-existing injuries and a subsequent accident.

The Tribunal ordered the insurer to pay the disputed treatment plans with interest.

The insurer requested a reconsideration of a Tribunal decision that awarded the insured up to $6,000 per month in attendant care benefits and a 25% special award under section 10 of O. Reg. 664.

The reconsideration adjudicator granted the request, finding that the first-instance Tribunal erred in law by failing to calculate the attendant care benefits using the mandatory hourly rates prescribed by the Guideline.

The adjudicator recalculated the incurred attendant care based on a ratio derived from the occupational therapist's recommendations.

Furthermore, the adjudicator set aside the 25% special award, concluding that the insurer's conduct in relying on its own experts' reports to partially approve benefits was not excessive, imprudent, or inflexible, and did not meet the threshold for an unreasonable withholding or delay of benefits.

The applicant was catastrophically injured in a motor vehicle accident.

Ten days prior to the accident, he had signed an employment contract but had not yet started working.

He applied for income replacement benefits, arguing that having a valid employment contract meant he was 'employed at the time of the accident' under section 5(1) of the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant was not employed, as he had not commenced work or received remuneration.

Applying principles of statutory interpretation, the Tribunal noted that previous versions of the Schedule explicitly included future employment contracts, but the current version does not.

The application for income replacement benefits was dismissed.

The applicant was catastrophically impaired in a motor vehicle accident and sought statutory accident benefits, including attendant care and home modifications.

The respondent insurer partially denied the claims based on its own assessments.

The Licence Appeal Tribunal found that the applicant's functional limitations, including cognitive and physical impairments, necessitated the maximum attendant care benefit of $6,000 per month and home modifications totaling $344,864, which included an in-home elevator and therapy room.

The Tribunal also awarded the cost of a housing analysis assessment but denied the cost of a second attendant care assessment submitted prematurely.

Finally, the Tribunal ordered a special award under s. 10 of Regulation 664, finding the respondent unreasonably withheld benefits by failing to properly investigate the applicant's functional needs despite having access to medical evidence supporting the claims.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found she was not catastrophically impaired and denied her claims for attendant care and medical benefits.

The applicant argued the adjudicator failed to properly consider her medical evidence, including her family doctor's opinion and a psychiatric report.

The Vice-Chair dismissed the request, finding that the original adjudicator adequately weighed the competing medical reports and provided sufficient reasons for preferring the respondent's assessment.

The Vice-Chair concluded there was no significant error of law or fact, nor any breach of procedural fairness, to warrant a reconsideration.

The applicant sought post-104-week income replacement benefits following a motor vehicle accident.

The respondent argued the claim was barred by res judicata and the expiry of the limitation period, as a previous Tribunal decision had already denied the applicant's entitlement to these benefits.

The Tribunal agreed, finding that the previous decision was a final judgment on the merits between the same parties.

Furthermore, the Tribunal declined to extend the limitation period under section 7 of the Licence Appeal Tribunal Act, noting the unreasonable delay, lack of bona fide intention to appeal, prejudice to the respondent, and lack of merit to the claim.

The applicant was injured in a rear-end motor vehicle accident and sought accident benefits.

The insurer determined the injuries fell within the Minor Injury Guideline (MIG) and denied a $1,553.76 chiropractic treatment plan because the $3,500 funding limit was exhausted.

The applicant argued that pre-existing conditions, chronic pain, and PTSD removed him from the MIG.

The Tribunal found no compelling evidence that pre-existing conditions prevented maximal recovery within the MIG, and no medical diagnosis of chronic pain or PTSD.

The Tribunal concluded the injuries were minor, the MIG limit applied, and the disputed treatment plan was not payable.

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

A preliminary issue hearing was held to determine whether the costs of assessments to determine catastrophic impairment (CAT assessments) are included in the $50,000 limit on medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The Tribunal held that CAT assessments are not included in the $50,000 cap, as section 25(1)5 of the Schedule requires the insurer to pay reasonable fees for preparing a CAT application, independent of the section 18(3) limits.

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

The insurer denied an income replacement benefit because the applicant was convicted of impaired driving in relation to the accident, and denied a medical benefit for counselling and case management.

The Tribunal held that the applicant was excluded from the income replacement benefit under s. 31(1)(d)(i) of the Schedule due to his conviction.

However, the Tribunal found that the insurer's denial letter for the medical benefit failed to provide sufficient medical reasons, breaching s. 38(8).

Consequently, the benefit was deemed incurred under s. 3(8) and payable under s. 38(11).

The Tribunal also awarded the applicant a 20 per cent special award under Regulation 664 for the unreasonable withholding of the medical benefit.

The applicant, an uninsured pedestrian struck by a vehicle, applied for statutory accident benefits.

The insurer denied funding for catastrophic determination assessments, arguing they were captured under the $65,000 non-catastrophic limit which had already been exhausted by hospital bills.

The Tribunal held that catastrophic determination assessments do not fall under the financial limit of s. 18(3) of the Schedule because they are not conducted in connection with any specific benefit or payment.

The Tribunal awarded $7,718.00 for the reasonable and necessary portions of the assessments, but denied the clinic file review portion as duplicative.

The claim for a special award under Regulation 664 was dismissed as the insurer's interpretation, though incorrect, was not unreasonable.

The applicant sought statutory accident benefits following a motor vehicle accident, including a determination of catastrophic impairment, attendant care benefits, and various medical and assessment expenses.

The Licence Appeal Tribunal found that the claim for attendant care benefits was statute-barred as it was filed beyond the two-year limitation period, and declined to extend the time.

The Tribunal also concluded that the applicant failed to prove she suffered a catastrophic impairment, preferring the respondent's expert evidence over the applicant's.

Consequently, the claims for housekeeping benefits, chiropractic treatment, and a chronic pain assessment were all dismissed.

During a jury trial, the plaintiff brought a motion under Rule 52.10 of the Rules of Civil Procedure to allow the jury to determine if past and future care costs were warranted, despite having called no evidence on these issues.

The plaintiff proposed that if the jury found such costs warranted, the quantum could be determined later by a judge.

The court dismissed the motion, finding that the plaintiff failed to exercise reasonable diligence in obtaining the necessary expert evidence before trial.

The court also held that bifurcating the issue would improperly remove the determination of the extent and quantum of future care costs from the jury.