Donata Di Iorio

The applicant sought accident benefits following a motor vehicle accident, claiming her injuries warranted removal from the Minor Injury Guideline (MIG) due to pre-existing conditions, chronic pain, and psychological impairment.

The Licence Appeal Tribunal found that the applicant failed to prove her pre-existing conditions precluded recovery within the MIG, or that she suffered from chronic pain with functional impairment or a psychological impairment caused by the accident.

As the applicant remained subject to the MIG limit, her claims for a psychological assessment, an award, and interest were dismissed.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident.

The respondent denied treatment plans on the basis that the applicant's injuries were predominantly minor and subject to the $3,500 limit under the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG due to chronic pain and psychological injuries.

The Tribunal found that the applicant's injuries were minor soft-tissue sprains and strains, and that his ongoing pain was related to pre-existing conditions rather than the accident.

The Tribunal also found the respondent complied with notice requirements and did not unreasonably withhold benefits.

The application was dismissed.

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

The respondent insurer limited the applicant to the Minor Injury Guideline (MIG) and denied several treatment plans.

The Tribunal found that the applicant suffered a right knee meniscus tear caused by the accident, which falls outside the MIG definition, and removed him from the MIG.

The Tribunal approved a $2,000 chronic pain assessment but denied other treatment plans for chiropractic services, a medical assessment, and a psychological assessment as they were either duplicative, premature, or not reasonable and necessary.

The applicant's claim for an award for unreasonable withholding of benefits was dismissed.

The applicant sought entitlement to numerous treatment plans for physical and psychological therapy, assistive devices, and assessments following a motor vehicle accident.

The Licence Appeal Tribunal denied the majority of the treatment plans, finding the applicant failed to prove they were reasonable and necessary, largely due to a lack of corroborating medical evidence and inconsistencies in the expert reports provided.

However, the Tribunal granted entitlement to translation services, a chronic pain assessment, and an attendant care assessment.

The Tribunal also ordered the respondent to pay a $250 special award under s. 10 of O. Reg. 664 for unreasonably withholding funding for the applicant's attendant care assessment while funding its own.

The applicant sought statutory accident benefits following a motor vehicle accident, which were denied by the respondent insurer.

The Licence Appeal Tribunal reviewed multiple treatment plans for physical and psychological therapies, attendant care assessments, and assistive devices.

The Tribunal found the applicant was entitled to partial payment for several treatment plans, including massage, acupuncture, physiotherapy, and psychological treatment, as well as attendant care assessments.

The Tribunal also awarded a $450 special award under s. 10 of O. Reg. 664, finding the insurer unreasonably denied the psychological components of a treatment plan without addressing them in its denial or submissions.

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

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

The applicant sought removal from the MIG based on chronic pain, psychological impairments, and a pre-existing headache condition.

The Tribunal found that the applicant failed to provide compelling medical evidence to justify removal from the MIG under section 18(2) or the AMA Guides criteria for chronic pain.

As the MIG limits were exhausted, the disputed treatment plans were deemed not reasonable and necessary, and claims for interest and a section 10 award were dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits for chiropractic, physiotherapy, and psychological assessments.

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

The Tribunal found that the applicant failed to prove her injuries were not predominantly minor.

The medical evidence did not support a diagnosis of chronic pain or a psychological impairment that would warrant removal from the MIG.

As the injuries were within the MIG, the Tribunal did not need to determine the reasonableness and necessity of the treatment plans, and no interest was payable.

The appellant, a licensed paralegal, appealed an arbitrator's order holding him personally liable for the insurer's arbitration expenses.

The appellant had commenced an arbitration application on behalf of an insured person who had died months prior, without obtaining authority from an appointed estate administrator.

The Director's Delegate confirmed the arbitrator's decision, finding that the proceeding was an irremediable nullity and that the representative commenced it without authority.

The appeal was dismissed and the appellant was ordered to pay the insurer's appeal expenses.

The appellant insurer sought to appeal an arbitrator's preliminary decision allowing the respondent, who was a minor at the time of a purported settlement, to resume a pre-hearing discussion because the settlement was never approved by a court.

The Director's Delegate found that the arbitrator's decision was a preliminary or interim order that did not finally decide the issues in dispute.

The Delegate declined to exercise discretion to accept the appeal, finding no apparent strength to the appeal and significant prejudice to the respondent if the appeal were allowed to proceed, given the small amount in dispute.

The appeal was rejected.

The applicant, a minor at the time of the accident, sought to reopen his arbitration file and resume a pre-hearing discussion after a reported settlement failed to obtain court approval.

The insurer argued the file had been administratively dismissed by FSCO and that the applicant delayed too long in seeking to resume the matter.

The arbitrator found that the file was never closed, as court approval for the minor's settlement was never obtained and settlement funds were never paid.

The arbitrator held that the delay did not unduly prejudice the insurer and granted the motion to resume the pre-hearing discussion.

A paralegal commenced an arbitration for statutory accident benefits in the name of an applicant who had died months prior, without disclosing her death or obtaining authority from her estate.

The arbitrator dismissed the proceeding as a nullity and found it to be frivolous and vexatious.

Pursuant to section 282(11.2) of the Insurance Act, the paralegal was ordered to personally pay the insurer's expenses of $2,138.52 for commencing and conducting the proceeding without authority.

The applicant died prior to mediation and the filing of an application for arbitration for statutory accident benefits.

The paralegal filed the application in the deceased's name without disclosing her death or obtaining authorization from a legally appointed estate representative.

The arbitrator held that the application was a nullity because it was brought without authorization from anyone legally entitled to bind the estate.

The arbitrator reserved the final determination on whether the paralegal should personally pay the insurer's expenses to allow the deceased's son an opportunity to make submissions.

The applicant was injured in a motor vehicle accident and sought approval for a neuropsychological assessment.

The insurer denied the request in September 2005, stating it was unreasonable and unnecessary, and offered a Designated Assessment Centre (DAC) assessment, which never took place.

The applicant underwent the assessment anyway and submitted the invoice in 2006, which the insurer refused to pay.

The applicant filed for mediation in January 2008.

The insurer raised a preliminary issue that the application was filed beyond the two-year limitation period under the Insurance Act and the Statutory Accident Benefits Schedule.

The arbitrator held that the insurer's September 2005 refusal was clear and unequivocal, and the failure to conduct a DAC assessment did not invalidate the refusal.

The applicant was therefore precluded from proceeding to arbitration.

The applicant sought photocopying expenses in the amount of $8,341.43 following a successful arbitration for statutory accident benefits.

The insurer did not contest the invoices.

The arbitrator found it reasonable that significant photocopying was required given the large number of exhibits and medical experts.

However, the arbitrator declined to award $1,817.84 in expenses incurred between the date final written submissions were received and the date the decision on the merits was issued, as the applicant did not explain why significant photocopying was required during that period.

The insurer was ordered to pay $6,089.29 in photocopying expenses.

The appellant, who was catastrophically injured in a motor vehicle accident, appealed an arbitration decision that awarded him an additional $37.10 per month in attendant care benefits on top of the amounts paid by the insurer to his long-term care facility.

The appellant argued he was entitled to $5,474.74 per month based on an occupational therapist's Form 1, and raised new issues regarding the insurer's failure to arrange a DAC assessment and the deduction of co-payments.

The Director's Delegate dismissed the appeal, finding that the new issues were not raised at the arbitration hearing and that the Arbitrator did not err in law in her treatment of the Form 1, as the onus remained on the appellant to prove the expenses were reasonable and necessary.

Following an arbitration decision on the merits of a statutory accident benefits claim, the applicant sought expenses including expert witness fees, legal fees, and disbursements.

The arbitrator assessed the claimed amounts under the Insurance Act and the Dispute Resolution Practice Code.

The arbitrator awarded reduced amounts for expert witness preparation and attendance, approved an increased hourly rate of $125 for lead counsel based on experience and complexity, and applied a 3:1 ratio of preparation to hearing time for legal fees.

The issue of photocopying expenses was deferred to allow the parties to exchange supporting documentation.

The applicant sought expenses following an arbitration decision in which he was partially successful in his claims for statutory accident benefits.

The insurer argued that the parties should bear their own expenses or that the applicant should pay the insurer's expenses, relying on a $10,000 settlement offer.

The arbitrator reviewed the criteria under section 12 of O. Reg. 664 and the history of the expenses regime.

The arbitrator found that the applicant's limited success was materially greater than the settlement offer, which also required a full and final release.

The arbitrator awarded the applicant his reasonable expenses, reducing the claimed amounts for legal fees and disbursements, resulting in an award of $12,261.55 inclusive of GST.

The applicant was injured in a motor vehicle accident and sought income replacement and housekeeping benefits from his insurer.

The insurer terminated benefits, arguing the applicant failed to attend an insurer's examination and was no longer disabled.

The arbitrator found the applicant had a reasonable excuse for missing the examination due to confusing correspondence and language barriers.

The arbitrator awarded income replacement benefits for the initial period and up to February 17, 2004, finding insufficient evidence of disability beyond that date, as the applicant's leg numbness was likely a benign condition.

Housekeeping benefits were awarded at a reduced rate of $20 per week based on an in-home assessment, as the applicant's evidence regarding his pre-accident housekeeping was vague and unsupported.