Domenic Nicassio

The applicant, who was deemed catastrophically impaired following a motor vehicle accident, sought payment for various treatment plans and an award for unreasonable delay.

Several issues were withdrawn or resolved prior to the hearing.

The Tribunal found that the applicant was not entitled to brokerage fees or provider travel time associated with occupational therapy services, as they were not reasonable and necessary and would effectively increase the hourly rate beyond the permitted maximums.

The Tribunal also denied the request for an award, finding that the respondent acted in good faith and its ability to adjust the file was hindered by the applicant's failure to produce requested documents.

The applicant sought entitlement to various medical assessments and interest on income replacement benefits (IRBs) following a motor vehicle accident.

The Licence Appeal Tribunal found the proposed psychological and chronic pain assessments were reasonable and necessary, and not reasonably available through OHIP, ordering them payable with interest.

However, the orthopaedic assessment was denied as available through OHIP, and the physiatry assessment was denied as duplicative.

The Tribunal also denied the claim for interest on IRBs, finding the insurer's delay in payment was justified by the applicant's failure to provide reasonably requested documentation under section 33 of the Schedule.

A claim for a bad faith award under section 10 was dismissed.

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

The matter was scheduled for a 7-day videoconference hearing.

The applicant, who was self-represented after her counsel withdrew, failed to attend the hearing despite receiving proper notice.

The Tribunal proceeded in her absence pursuant to section 7(3) of the Statutory Powers Procedure Act.

As the applicant tendered no evidence and made no submissions, she failed to meet her burden of proof.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and funding for various medical assessments and treatments.

The Licence Appeal Tribunal found that the applicant was not entitled to pre-104 or post-104 week IRBs, as she failed to prove a substantial inability to perform her pre-accident employment tasks or a complete inability to engage in any suitable employment, largely due to credibility issues and lack of effort during assessments.

The Tribunal also denied funding for chiropractic services and a functional abilities assessment.

However, the Tribunal granted funding for a physiatry assessment and a psychological examination to further explore the applicant's chronic pain and psychological symptoms, along with interest on these overdue amounts.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his pre-existing conditions and injuries warranted treatment beyond the $3,500 Minor Injury Guideline (MIG) limit.

The respondent denied the benefits, arguing the injuries were predominantly minor.

The Licence Appeal Tribunal found that the applicant suffered soft tissue injuries and did not have a pre-existing condition that would prevent maximal recovery within the MIG.

As the MIG limits were exhausted, the applicant was not entitled to the disputed chiropractic treatment plan, nor to an award or interest.

The application was dismissed.

The respondent insurer requested a reconsideration of a decision which found that the applicant's accident-related injuries were not predominantly minor injuries and that a psychological assessment was reasonable and necessary.

The insurer argued the Tribunal erred in finding the applicant sustained a concussion and psychological impairment.

The adjudicator dismissed the request, finding that the insurer was attempting to reweigh the evidence and re-litigate issues already determined, failing to meet the high threshold for reconsideration under Rule 18.2(b) of the Common Rules.

The applicant sought reconsideration of a decision denying a psychological assessment, arguing the adjudicator made errors of fact and law regarding her pre-accident medical history, the nature of her assessment interview, and the requirement for objective testing.

The adjudicator acknowledged a minor factual error regarding the interview format but found it would not have changed the outcome.

The adjudicator concluded there was no significant error of law or fact that would warrant varying the initial decision, as the medical evidence did not support the necessity of the psychological assessment.

The request for reconsideration was denied.

The applicant sought medical benefits following a motor vehicle accident, which the respondent denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant failed to provide any medical evidence or objective evidence to support his claim that his injuries warranted treatment beyond the MIG framework.

The Tribunal found that the applicant did not meet his burden of proof and dismissed the application for a chronic pain assessment, chiropractic treatment, interest, and an award.

The applicant sought accident benefits following a motor vehicle accident.

The insurer denied a psychological assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained a concussion and psychological injuries, including driving anxiety, which removed him from the MIG.

The Tribunal ordered the insurer to pay for the psychological assessment, finding it reasonable and necessary.

The applicant's claim for an award for unreasonable delay was dismissed because the compelling medical evidence was only provided during the hearing.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for chronic pain and psychological impairments, arguing his injuries fell outside the Minor Injury Guideline (MIG).

The respondent denied the claims, asserting the injuries were predominantly minor.

The Licence Appeal Tribunal found that the applicant's soft tissue injuries and associated chronic back pain were predominantly minor, as there was insufficient evidence of functional impairment or disability.

The Tribunal also found no evidence of psychological injury.

Consequently, the MIG applied, and since the $3,500 limit had been exhausted, the claims for further assessments and treatment were dismissed.

The applicant sought to withdraw her application for arbitration of accident benefits three days before the scheduled hearing.

The insurer requested that the withdrawal be with prejudice and sought its expenses for the proceeding.

The arbitrator permitted the withdrawal without prejudice but awarded expenses to the insurer, finding that the insurer was entirely successful as the applicant did not proceed with her claims.

After reducing the insurer's claimed legal fees for excessive hours and duplication of effort, the arbitrator awarded the insurer $42,134.02 in total expenses.

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

The insurer denied medical benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing for removal from the MIG due to psychological impairments.

The Tribunal found that the applicant failed to meet the onus of proving his injuries were not predominantly minor, as his medical evidence lacked corroboration and was contradicted by the insurer's examination.

The application for assessment costs was dismissed, and the applicant's request for costs was denied due to a lack of evidence of unreasonable conduct by the insurer.

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

After her counsel was removed from the record, the applicant failed to attend a pre-hearing discussion and did not respond to notices or orders to participate in the proceedings.

The insurer brought a motion to dismiss the application for arbitration and sought expenses.

The arbitrator found the applicant's failure to participate rendered her conduct frivolous and dismissed the application.

The applicant was ordered to pay $1,100 in expenses to the insurer.

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

After the insurer terminated benefits, the applicant applied for arbitration.

However, the applicant failed to attend the pre-hearing, failed to comply with production orders, and failed to attend the arbitration hearing.

The applicant's former counsel had removed himself from the record, and mail to the applicant was returned as undeliverable.

The arbitrator found that the applicant had abandoned his claim, dismissed the application in its entirety, and ordered the applicant to pay $2,260.00 in expenses to the insurer.

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

After the insurer terminated benefits, the applicant applied for arbitration.

The applicant failed to attend the pre-hearing, failed to comply with production orders, and failed to attend the arbitration hearing.

The arbitrator found that the applicant had abandoned his claim and dismissed the application in its entirety.

The applicant was ordered to pay $2,260 in costs to the insurer.