Domenic Pellegrino

The applicant was injured in a motorcycle accident and sought attendant care benefits (ACBs) of $6,000 per month, claiming a need for 24-7 supervision due to physical, cognitive, and psychological impairments.

The respondent argued the applicant only required just under four hours of care per day.

The Tribunal found the applicant's evidence regarding cognitive decline unreliable and noted limitations in both parties' occupational therapy assessments.

Taking a practical approach based on the evidence, the Tribunal determined the applicant did not require 24-7 supervision but was entitled to ACBs in the amount of $2,724.28 per month.

The applicant requested a reconsideration of a Tribunal decision that found him statute-barred from proceeding with his claim for accident benefits due to a delay in submitting his application.

The applicant argued the Tribunal erred in its assessment of communications between the parties and failed to consider the reasonableness of his explanation or prejudice.

The Tribunal dismissed the request, finding no error of fact or law, as the applicant's explanation for the delay was not credible, which is a prerequisite for considering the remaining principles for delay.

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

The respondent denied the claim because the applicant failed to submit an application for benefits (OCF-1) within the prescribed time limits under section 32 of the Schedule.

The applicant argued he had a reasonable explanation for the delay, claiming he notified the respondent shortly after the accident and was confused by an email regarding a tort claim and WSIB election.

The Tribunal found the applicant did not provide a credible explanation for the 14-month delay, noting the respondent's multiple unanswered attempts to communicate.

The application was dismissed as statute-barred.

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

The insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the funding limits had been exhausted.

The applicant argued she should be removed from the MIG due to pre-existing carpal tunnel syndrome, chronic pain, and psychological injuries.

The Tribunal found the applicant failed to provide compelling medical evidence that her pre-existing condition prevented maximal recovery within the MIG, or that her physical and psychological injuries were more than minor sequelae.

As the MIG limits were exhausted, the disputed treatment plans and claim for interest were dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought a Chronic Pain Assessment outside the Minor Injury Guideline.

The respondent insurer denied the benefit, arguing the applicant's ongoing pain was related to pre-existing conditions and post-accident activities rather than the collision.

The Tribunal found that the accident caused a significant exacerbation of the applicant's pre-existing back pain, satisfying the 'but for' test for causation.

The Tribunal concluded the Chronic Pain Assessment was reasonable and necessary, ordering the respondent to pay the $2,314.26 cost plus interest.

The applicant sought medical benefits for chiropractic treatment following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained predominantly minor injuries, as there was insufficient evidence to prove that her chronic pain was not merely a sequelae of soft tissue injuries or that a pre-existing condition prevented her recovery.

The Tribunal also found the requested medical benefits were not reasonable and necessary, noting the applicant had returned to work and an independent medical examination concluded she had achieved maximum medical recovery.

The application was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued the Tribunal made errors of fact and law by giving little weight to her orthopaedic surgeon's report, failing to consider her family physician's records, and failing to conclude she suffered from chronic pain syndrome due to a partial shoulder tear.

The adjudicator dismissed the request, finding no error in affording the orthopaedic report little weight as it lacked diagnostic criteria and credentials regarding chronic pain.

Furthermore, the family physician's records did not establish the AMA criteria for chronic pain syndrome, and the applicant failed to prove the Tribunal would have reached a different decision based on the shoulder tear.

The applicant sought reconsideration of a Tribunal decision finding his injuries fell within the Minor Injury Guideline (MIG).

Following the initial decision, the respondent conducted a psychological insurer's examination which concluded the applicant sustained a psychological impairment.

The respondent subsequently conceded the applicant was not subject to the MIG and approved the disputed treatment plans, save for a neurological assessment.

The Tribunal granted the reconsideration request, finding the psychological report constituted new evidence that would have affected the result.

The Tribunal remitted the issues of the neurological assessment and a special award back to the hearing adjudicator, while dismissing the applicant's request for costs due to procedural non-compliance.

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

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

The applicant argued her injuries, including a partial rotator cuff tear and chronic pain syndrome, warranted removal from the MIG.

The Tribunal found that the partial rotator cuff tear met the definition of a strain and thus a minor injury under the Schedule.

The Tribunal also rejected the diagnosis of chronic pain syndrome due to a lack of supporting evidence and methodology in the expert report.

As the injuries fell within the MIG and the $3,500 limit was exhausted, the claims for further medical benefits, examination costs, interest, and an award were dismissed.

The applicant was injured in a motor vehicle accident and sought payment of $3,225.80 for a chiropractic treatment plan.

The insurer denied the claim based on an insurer's examination.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment was reasonable and necessary, noting that neither the insurer's orthopaedic surgeon nor the applicant's own orthopaedic assessor supported the recommended manipulation and exercise.

The application was dismissed.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that granted the applicant entitlement to a chronic pain assessment.

The insurer argued that the Tribunal erred in law by applying a standard of proof based on a 'balance of possibilities' rather than a 'balance of probabilities.' The Executive Chair agreed, finding that the Tribunal explicitly applied the wrong standard of proof when assessing whether the assessment was reasonable and necessary.

The reconsideration request was granted, and the matter was remitted to the same Tribunal member for redetermination using the correct balance of probabilities standard.

The applicant's request for costs was denied.