Dianna Morello

The applicant, a pedestrian struck by a vehicle, sought statutory accident benefits including attendant care benefits (ACBs) and various treatment plans.

The respondent initially denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG), but later removed him from the MIG.

The Tribunal found the applicant eligible for $686.92 per month in ACBs based on left shoulder limitations, but held the benefits were not payable because they had not been incurred.

The Tribunal approved a treatment plan for an optometric assessment but denied plans for Botox injections and an occupational therapy assessment.

Finally, the Tribunal ordered the respondent to pay a $3,473.20 award under s. 10 of O. Reg. 664, finding its 18-month delay in removing the applicant from the MIG was stubborn, unyielding, and unreasonable given the medical evidence.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a massage chair, physiotherapy, and medical marijuana.

The Licence Appeal Tribunal denied the claim for the massage chair, finding insufficient medical evidence that it was reasonable and necessary.

The Tribunal partially approved the physiotherapy plan, relying on the strong recommendation of the applicant's treating family physician.

The Tribunal also approved the plan for medical marijuana, noting the family physician's support for its use in treating the applicant's chronic pain syndrome.

Claims for a special award under s. 10 of Reg. 664 were dismissed, but interest on overdue benefits was granted.

The applicant was injured in a motor vehicle accident and sought an income replacement benefit (IRB).

The respondent insurer sought to deduct the applicant's Employment Insurance (EI) sickness benefits from the IRB as "gross employment income" and requested a repayment of previously paid IRBs.

The Tribunal held that EI sickness benefits are not deductible from an IRB, as they are not considered gross employment income and are specifically excluded from being deductible as temporary disability benefits under the Schedule.

Furthermore, the Tribunal found the respondent's repayment notice was deficient and unclear.

The applicant's claims for a special award and costs were dismissed, as the respondent's conduct in taking a position on a novel legal issue did not meet the threshold of being unreasonable, frivolous, vexatious, or in bad faith.

The applicant sought statutory accident benefits for a $1,000 orthopaedic mattress following a motor vehicle accident.

The respondent denied the benefit, relying on an insurer's examination report which concluded the mattress was unlikely to assist in managing pain.

The Tribunal found the mattress to be reasonable and necessary, noting that multiple treating practitioners and assessors documented the applicant's ongoing sleep disturbances and fatigue.

The Tribunal afforded less weight to the respondent's expert, whose opinion was inconsistent with other medical evidence.

The applicant was awarded the cost of the mattress plus interest.

The applicant sought non-earner benefits following a motor vehicle accident, claiming his soft tissue injuries and headaches prevented him from engaging in his pre-accident activities, including camping, hunting, fishing, and volunteering.

The respondent denied the benefits based on insurer examinations.

The Tribunal applied the Heath framework and found the applicant credible, noting that his pre-existing conditions made him more susceptible to functional impairment from the accident.

The Tribunal gave little weight to the respondent's medical expert who claimed the applicant could perform all pre-accident activities, as the expert failed to list those activities or account for the pre-existing conditions.

The Tribunal concluded the applicant suffered a complete inability to carry on a normal life and awarded non-earner benefits and interest, but dismissed the claim for a special award under Regulation 664.

The applicant sought statutory accident benefits for medical marijuana and related assessment costs following a motor vehicle accident that exacerbated pre-existing workplace injuries.

The insurer denied the treatment plans based on an insurer's examination report which concluded that cannabis was not recommended for treating depression or anxiety.

The Licence Appeal Tribunal found the treatment plans reasonable and necessary, noting that traditional prescription medications and psychotherapy had proven ineffective for the applicant's chronic pain, insomnia, and anxiety, whereas medical marijuana provided marked improvement.

The Tribunal awarded the benefits and interest but declined to make an award for unreasonable delay, finding the insurer had reasonably relied on its assessor's report.

The applicant requested reconsideration of a motion order that granted the respondent's request for an adjournment and partially granted the applicant's request for further productions.

The applicant argued the order was procedurally unfair, erred in law, gave rise to a reasonable apprehension of bias, and caused prejudice due to delay.

The Associate Chair dismissed the reconsideration request, finding no procedural unfairness, no error in granting the adjournment to allow the respondent to respond to new issues, no evidence of bias, and that the delay was largely attributable to the applicant's own actions.

The defendant sought costs on a partial indemnity basis of $45,399.84 following the dismissal of the plaintiff's slip and fall action.

The trial was conducted under the simplified procedure rules and damages had been agreed at $20,000.

The court found the defendant's claimed costs excessive and disproportionate to the agreed damages and the complexity of the case.

Costs were fixed at $20,000 inclusive of disbursements.

The plaintiff brought an action for damages after tripping and falling in a parking lot owned by the defendant.

She alleged that she tripped over an insufficiently marked and maintained speed bump.

The court found that the speed bump's markings complied with industry standards and provided adequate warning.

Furthermore, the plaintiff could not objectively prove what caused her fall, relying only on speculation after returning to the scene weeks later.

The action was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The disputed benefits included a treatment plan for assistive devices, a treatment plan for physiotherapy and massage, a non-earner benefit, and a special award.

The Tribunal found that the applicant was entitled to the non-earner benefit, as she demonstrated a complete inability to carry on a normal life, having gone from an active, independent lifestyle to being dependent on her grandson and church community.

The Tribunal also approved the assistive devices, except for blind spot mirrors, but denied the treatment plan for physiotherapy and massage, finding it was not reasonable and necessary given the lack of improvement and the recommendation for alternative treatment.

The claim for a special award was dismissed, but interest was awarded on the overdue payments.

The applicant, an 88-year-old pedestrian, was struck by a pole knocked over by a truck insured by the respondent.

She sought interim medical, rehabilitation, and attendant care benefits pending a full arbitration hearing to determine if she is catastrophically impaired.

The applicant had exhausted her non-catastrophic limits and required 24-hour care.

The arbitrator found that the applicant established a prima facie case for catastrophic impairment, noting that the insurer's own neurologist found severe cognitive impairment secondary to the accident, which was improperly omitted from the insurer's multidisciplinary whole person impairment rating.

Considering the applicant's financial hardship, the risk of irreparable harm, the low risk of prejudice to the insurer (who was also the tort insurer), and the delay in scheduling the hearing, the arbitrator granted interim benefits of up to $3,000 per month.