Dr. Franco Tavazzani

The applicant sought non-earner benefits (NEBs) following a motor vehicle accident, arguing the insurer failed to properly deny the NEB claim after initially paying income replacement benefits (IRBs).

The Tribunal held that the acceptance and payment of IRBs implied a denial of NEBs, as the two benefits are mutually exclusive under the current Schedule.

Furthermore, the applicant failed to meet the substantive test for NEBs, as evidence demonstrated she had returned to work, drove her own vehicle, and performed housekeeping tasks, meaning she did not suffer a complete inability to carry on a normal life.

The application was dismissed.

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

The respondent denied the treatment plan, arguing the applicant had not provided sufficient evidence that further facility-based treatment was beneficial more than six years post-accident.

The Tribunal found that the applicant failed to provide contemporaneous medical evidence or objective proof that the proposed treatment was reasonable and necessary.

The application for the treatment plan and interest was dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including attendant care and various medical and rehabilitation benefits.

The respondent denied the benefits, and the applicant applied to the Licence Appeal Tribunal.

The Tribunal found that the applicant was not entitled to ongoing attendant care benefits, as the medical evidence demonstrated he was mostly independent in his activities of daily living and failed to prove the expenses were incurred.

The Tribunal granted one physiotherapy treatment plan for $4,022.42, finding it reasonable and necessary for pain reduction, despite the respondent's argument that the injuries fell within the Minor Injury Guideline.

The remaining claims for further treatment, assessments, and treatment provider mileage were dismissed as they were either duplicative, not reasonable and necessary, or not payable under the Schedule.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a chronic pain assessment and a functional assessment, as well as a special award for unreasonable delay.

The Licence Appeal Tribunal found the chronic pain assessment to be reasonable and necessary, preferring the evidence of the applicant's assessors over the respondent's assessors.

However, the Tribunal denied the functional assessment because it was based solely on a telephone consultation.

The claim for a special award was also dismissed as the respondent's denial did not constitute unreasonable conduct.

The applicant was injured in a motor vehicle accident and sought non-earner benefits, claiming a complete inability to carry on a normal life.

The respondent denied the benefits after an initial period of payment.

The adjudicator found that the applicant had significant pre-existing conditions, including avascular necrosis and hip pain, which already limited his pre-accident activities.

Applying the Heath test, the adjudicator concluded that the applicant failed to prove his accident-related impairments continuously prevented him from engaging in substantially all of his pre-accident activities.

The application was dismissed.

The applicant sought statutory accident benefits for chiropractic treatment and an orthopedic assessment following a 2015 motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the chiropractic treatment plan was not reasonable and necessary due to a lack of supportive medical evidence, the applicant's failure to disclose a subsequent accident to the insurer's assessors, and her failure to utilize previously approved treatment.

The cost of the orthopedic assessment was also denied because the treatment plan lacked detail and the assessor's conclusions were unsupported by his physical examination findings.

Claims for interest and a special award were consequently dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits, medical benefits, transportation expenses, an assessment expense, interest, and a special award.

The arbitrator found that credible psychological and orthopedic evidence established chronic pain and related psychological sequelae, taking the claim outside the Minor Injury Guideline and supporting entitlement to the disputed physiotherapy treatment plans.

Applying the Schedule's pre-104-week test, the arbitrator held that the applicant had a substantial inability to perform the essential tasks of his pre-accident employment and was entitled to weekly income replacement benefits for that period only.

The post-104-week claim failed because the evidence did not prove a complete inability to engage in any suitable employment.

Transportation and interest were awarded, the in-home assessment expense and special award were denied, and expenses were left to further determination if necessary.

The applicant was injured in a motor vehicle accident and sought attendant care benefits, medical benefits, and the cost of examinations under the Statutory Accident Benefits Schedule.

The Tribunal found the applicant was entitled to attendant care benefits for the initial period as the expenses were properly incurred, but denied benefits for the subsequent period based on the applicant's admissions of self-sufficiency and surveillance evidence.

Several treatment plans, including those for a TMJ assessment, chiropractic services, an orthopaedic assessment, and a chronic pain assessment, were deemed reasonable and necessary given the applicant's chronic pain and objective medical evidence.

Other treatment plans were denied for lack of supporting evidence.

The respondent's request for costs was dismissed.

The insurer appealed an arbitrator's preliminary decision that the insured's medical and rehabilitation claim was not subject to the $3,500 limit under the Minor Injury Guideline (MIG).

The Director's Delegate allowed the appeal, finding that the arbitrator erred by failing to apply the correct test of whether the impairment was predominantly a minor injury, improperly shifting the burden of proof to the insurer, and incorrectly concluding that the MIG was non-binding.

Furthermore, the arbitrator breached procedural fairness by conducting independent research and relying on legal arguments without giving the parties an opportunity to respond.

The decision was rescinded and the matter remitted for a full hearing before a different arbitrator.

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

The insurer took the position that the applicant's injuries were restricted by the Minor Injury Guideline (MIG), limiting his benefits to $3,500.

The applicant argued that he suffered from pre-existing conditions and subsequent psychological disabilities, including chronic pain, PTSD, and TMJ syndrome, which took him outside the MIG.

The arbitrator found that the insurer bears the burden of proving that an insured falls within an exception to coverage, such as the MIG.

The arbitrator concluded that the applicant's TMJ, chronic pain, and psychological impairments were separate and distinct from his soft tissue injuries and were supported by credible evidence.

Therefore, the applicant was not precluded from claiming benefits beyond the $3,500 limit.