Dr. Konstantine K. Zakzanis

The applicant sought statutory accident benefits following a motor vehicle accident, which was followed by a second accident less than two months later.

The insurer denied several treatment plans for physiotherapy, psychotherapy, and various assessments.

The Tribunal found that the applicant's physical injuries were caused by the first accident, but she failed to prove her psychological injuries were caused by it.

The Tribunal ordered the insurer to pay for an impairment assessment and a neurological assessment because its denial notices failed to comply with the medical reasons requirement under s. 38(8) of the Schedule.

The remaining claims for treatment plans, an award for unreasonable delay, and costs were dismissed.

The insurer appealed an Arbitrator's decision finding the insured catastrophically impaired, entitled to post-104 week income replacement benefits (IRBs), and awarding a special award of 35% for unreasonably withholding benefits.

The insurer argued the Arbitrator reversed the onus of proof and failed to properly consider causation, specifically the insured's pre-existing psychological issues stemming from childhood abuse.

The Director's Delegate dismissed the appeal, finding the Arbitrator properly applied the 'but for' test, correctly weighed the medical evidence, and reasonably concluded the insurer's reliance on flawed and inconclusive reports justified the special award.

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

The central issues were whether he sustained a catastrophic impairment based on a Glasgow Coma Scale (GCS) score of 9 or less, and whether he was entitled to post-104 week income replacement benefits (IRBs) and attendant care benefits.

The Insurer argued the low GCS score was caused by a pre-accident drug overdose and high blood sugar, not a brain injury.

The arbitrator rejected this theory, finding the Applicant suffered a traumatic brain injury resulting in a GCS score of 9, meeting the catastrophic impairment definition.

The arbitrator also found the Applicant suffered a complete inability to engage in suitable employment due to cognitive and physical deficits, awarding ongoing IRBs.

The Applicant was deemed eligible for attendant care benefits pending a new Form 1.

Claims for a special award were dismissed.

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

The Licence Appeal Tribunal found the applicant suffered a complete inability to engage in any employment for which he was reasonably suited, entitling him to a post-104 week income replacement benefit.

The Tribunal also determined the applicant sustained a catastrophic impairment, as his combined physical, neurocognitive, and mental/behavioural impairments met the 55% whole person impairment threshold under the AMA Guides.

However, the applicant's claims for specific medical and rehabilitation benefits were dismissed for lack of evidence proving they were reasonable and necessary.

The applicant sought judicial review of a decision by the Director's Delegate of the Financial Services Commission of Ontario, which upheld an arbitrator's dismissal of her claims for statutory accident benefits following a motor vehicle accident.

The applicant argued procedural unfairness, errors in calculating income for income replacement benefits, and failure to consider a treatment plan.

The Divisional Court applied the reasonableness standard of review and found no error in fact or law, nor any breach of natural justice.

The application for judicial review was dismissed.

The appellant appealed an arbitrator's decision dismissing her claims for income replacement benefits, medical and rehabilitation benefits (including a Tempur mattress and laptop computer), a neuropsychological re-assessment, and a special award under the Statutory Accident Benefits Schedule.

She also appealed the arbitrator's order awarding the insurer $15,344.05 in expenses.

The Director's Delegate dismissed the appeal, finding no breach of natural justice or procedural fairness by the arbitrator.

The Delegate upheld the arbitrator's factual findings that the appellant was not disabled from her pre-accident employment, that the claimed medical and rehabilitation items were not reasonable and necessary, and that the appellant's conduct unnecessarily prolonged the hearing, justifying the expenses award.