Avi Kaplun

The applicant sought statutory accident benefits following a 2015 motor vehicle accident, claiming catastrophic impairment due to mental and behavioural disorders and entitlement to income replacement benefits (IRB).

The Licence Appeal Tribunal found that the applicant did not meet the threshold for catastrophic impairment under Criterion 8, as he sustained only moderate, rather than marked, impairments in activities of daily living and adaptation.

The Tribunal preferred the respondent's psychiatric assessment, noting the applicant maintained useful functioning such as driving, going to the gym, and caring for his parents.

The Tribunal also dismissed the claim for IRB, finding insufficient objective medical evidence that the applicant suffered a substantial inability to perform the essential tasks of his pre-accident employment as an IT technician.

Claims for an award and interest were consequently dismissed.

The applicant, a self-employed bicycle delivery person, was injured in a motor vehicle accident and sought a determination of catastrophic impairment under criterion 8 of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal assessed the applicant's mental and behavioural impairments across four spheres of function.

Preferring the evidence of the applicant's experts, the Tribunal found the applicant sustained marked impairments in activities of daily living, social functioning, concentration, persistence and pace, and adaptation.

The Tribunal concluded the applicant suffered a catastrophic impairment.

The applicant sought statutory accident benefits, claiming a catastrophic impairment under Criterion 8 due to mental and behavioural disorders following a motor vehicle accident.

The respondent denied the claim.

The Licence Appeal Tribunal found that the applicant's self-reporting was inconsistent and unreliable.

The Tribunal concluded that the applicant did not suffer from a marked impairment in three functional domains (activities of daily living, social functioning, and adaptation) and therefore did not meet the definition of a catastrophic impairment.

The application was dismissed.

The applicant brought a motion seeking an order from the Tribunal to state a case to the Divisional Court for a contempt hearing, alleging that the respondent's counsel interfered with a summonsed witness and violated the Rules of Professional Conduct.

The Tribunal found that the respondent's counsel's conduct, while uncooperative, did not establish a prima facie case for contempt of court.

The motion was dismissed.

The applicant, an elderly pedestrian who was struck by a motor vehicle in a parking lot, applied for statutory accident benefits including non-earner benefits, attendant care benefits, and medical/rehabilitation benefits.

The adjudicator dismissed the application in its entirety.

The adjudicator found that the applicant failed to prove she suffered a complete inability to carry on a normal life, noting inconsistencies in her self-reporting and relying on insurer's examinations that found no objective impairment preventing her pre-accident activities.

Claims for attendant care and medical benefits were similarly dismissed due to a lack of persuasive medical evidence and inconsistencies in the applicant's submitted treatment plans.

The applicant sought statutory accident benefits, including non-earner benefits, medical benefits for psychological services, chronic pain treatment, physiotherapy, and assessments, following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove her entitlement to the benefits.

The Tribunal gave substantial weight to the respondent's insurer's examination reports, noting that the applicant's self-reporting to her own experts was inconsistent with her statements to the respondent's assessors, undermining her claims of complete inability to carry on a normal life, psychological impairment, and chronic pain syndrome.

The applicant's requests for interest and a special award were also denied.

The applicant sought caregiver and housekeeping benefits following a motor vehicle accident.

The insurer denied the claims, arguing the applicant was permanently disentitled for failing to submit a Disability Certificate (OCF-3) in a timely manner.

The Arbitrator held that the applicant was disentitled to housekeeping benefits because she never submitted an OCF-3 for that claim.

However, the insurer could not rely on the late submission of the caregiver OCF-3 to deny benefits because it failed to clearly communicate the consequence of permanent disentitlement to the applicant.

On the merits, the Arbitrator dismissed the caregiver claim, finding the applicant's evidence regarding her pre-accident caregiving responsibilities and post-accident needs to be inconsistent and unreliable.