Angela Comella

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, which the insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The arbitrator found that the applicant's injuries, which included chronic pain, a head injury resulting in hearing impairment, and psychological impairments, took him outside the MIG.

The arbitrator ordered the insurer to pay for the disputed medical benefits and the costs of various examinations.

Although the applicant established an entitlement to attendant care benefits, the claim was dismissed because the quantum could not be proven under section 19(3)4 of the Schedule.

The arbitrator also ordered the insurer to pay a $5,000 special award for unreasonably delaying and withholding benefits, noting the insurer's failure to properly investigate the applicant's head injury and chronic pain.

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

The insurer argued the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered a concussion and post-concussion syndrome, removing the claims from the MIG.

However, the Tribunal dismissed the applicant's claims for a chronic pain assessment and an in-home assessment, finding the applicant failed to prove they were reasonable and necessary.

Claims for interest and a special award were also dismissed.

The applicant sought reconsideration of a Licence Appeal Tribunal decision denying her claim for attendant care benefits following a 2014 motor vehicle accident.

The applicant argued the Tribunal breached procedural fairness by holding a written hearing and erred in its causation analysis by applying the 'but for' test instead of the 'material contribution' test.

The Executive Chair dismissed the request, finding that the applicant had acquiesced to the written hearing format and failed to adduce sufficient evidence to establish causation under either legal test.

The applicant sought Attendant Care Benefits following a motor vehicle accident.

The insurer denied the benefits after an insurer's examination assessed the needs at $0.00.

The applicant filed for mediation on other benefits but did not dispute the attendant care denial within the two-year limitation period.

Almost three years later, the applicant submitted new assessments and argued that a subsequent finding of catastrophic impairment restarted the limitation clock.

The Tribunal held that the initial denial was clear and unequivocal, triggering the limitation period.

The Tribunal found that subsequent applications and a change in circumstances do not restart the limitation clock, and therefore the applicant was precluded from proceeding with the claim.

The applicant sought Attendant Care Benefits (ACB) following a 2014 motor vehicle accident.

The insurer denied the claim, arguing the need for ACB arose from a subsequent, unrelated fall in 2015 where the applicant injured her knee while chasing her daughter.

The Tribunal found that the applicant failed to establish causation between the 2014 accident and the 2015 knee injury.

Furthermore, the Tribunal held that the applicant was not entitled to retroactive ACB because there was no urgency or impracticability preventing the timely submission of a Form-1.

The application for ACB was dismissed.