Mr. Luigi Grimaldi

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident.

The respondent denied the benefit, relying on insurer's examinations.

The Tribunal found the applicant met the test for an IRB, preferring the evidence of the applicant's treating physicians and the respondent's own kinesiologist, who found the applicant demonstrated functional limitations below the physical demands of his pre-accident job as a café supervisor.

The Tribunal rejected the respondent's other experts, noting inconsistencies in their reasoning.

The applicant was awarded the IRB with interest, but his claim for an award for unreasonable delay was dismissed due to lack of evidence.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her entitlement to post-104 income replacement benefits and certain treatment plans.

The applicant argued that the Tribunal committed a material breach of procedural fairness by allowing the respondent's experts to testify without producing clinical notes and records, and by denying her the opportunity to cross-examine an adjuster.

The applicant also alleged errors of law and fact regarding the weighing of medical and vocational evidence.

The Tribunal dismissed the request, finding no breach of procedural fairness as the adjuster was not summoned or listed as a witness, and concluding that the applicant was attempting to re-litigate the weighing of evidence without demonstrating any actual errors of law or fact.

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

The Licence Appeal Tribunal denied the applicant's claim for post-104 income replacement benefits, finding she did not suffer a complete inability to engage in suitable employment, noting her post-accident work in creative fields and non-accident-related psychiatric conditions.

The Tribunal also denied claims for a catastrophic impairment assessment balance, physiotherapy, costs, and an award.

However, the Tribunal granted entitlement to a passenger/driver assessment, finding the applicant's driving anxiety was well-documented and a valid driver's license was not a prerequisite for the assessment.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming she was unable to work as a self-employed aesthetician.

The respondent insurer denied the benefits based on section 44 assessments and sought repayment of a $557.50 overpayment.

The Tribunal found the applicant failed to provide contemporaneous medical evidence proving a substantial or complete inability to perform the essential tasks of her employment.

The applicant's claim for IRBs, interest, and a special award was dismissed.

The respondent's request for repayment was granted, as the overpayment was an error and timely notice was provided.

The insurer applied to vary or revoke an arbitration order that granted the insured ongoing income replacement benefits (IRBs).

The insurer argued that the transition from the 'own occupation' test to the stricter 'any occupation' test at the 104-week mark constituted a material change in circumstances under s. 284 of the Insurance Act, and relied on new insurer examinations to argue the insured did not meet the stricter test.

The Director's Delegate held that a change in the legal test alone does not automatically constitute a material change in circumstances where a final order for benefits has been made, noting the protection of benefits under s. 287 of the Insurance Act.

The Delegate found that the insurer's medical assessors failed to document any material change in the insured's condition, as they largely ignored the Arbitrator's previous findings of psychological disability.

The application for variation or revocation was dismissed.