Nicholas Livadas

The applicant sought entitlement to various treatment plans for home devices, a sleep system, workplace modifications, and kitchen devices following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove on a balance of probabilities that the proposed treatment plans were reasonable and necessary.

The Tribunal assigned little weight to the applicant's occupational therapist's recommendations due to a lack of contemporaneous assessment and failure to account for a subsequent accident.

Conversely, the Tribunal accepted the contemporaneous insurer's examination reports which concluded the treatments were not required.

Claims for interest and a special award were also dismissed.

The applicant sought a non-earner benefit, interest, and an award under s. 10 of O. Reg. 664 following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove a complete inability to carry on a normal life.

The Tribunal preferred the respondent's multidisciplinary insurer's examination reports, which showed the applicant retained functional capacity and continued to engage in self-care and childcare, over the applicant's incomplete disability certificate.

As no benefits were payable, the claims for interest and an award were also dismissed.

The applicant sought attendant care benefits and payment for two treatment plans following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant's testimony lacked credibility and the medical evidence, including surveillance and family physician records, demonstrated she did not require the claimed attendant care.

The Tribunal also denied the treatment plans, noting a lack of evidence for the first and finding the second sought unreasonable duplicate fees for catastrophic impairment assessments under section 25(5) of the Schedule.

Claims for an award and interest were consequently dismissed.

The applicant, who sustained a catastrophic impairment in a 2017 motor vehicle accident, sought attendant care benefits (ACBs) and various medical and rehabilitation benefits.

The Tribunal found the applicant entitled to ACBs for specific periods based on his psychological impairments, but held the benefits were not payable because the applicant failed to prove they were incurred.

The Tribunal partially approved treatment plans for social work, aquatherapy, concussion treatment, and a home renovation assessment, while denying others that were reasonably available through OHIP.

The Tribunal ordered Aviva to pay a special award of $9,041.12 under s. 10 of Regulation 664, finding that the insurer acted unreasonably and in bad faith by pre-emptively denying treatment plans and failing to comply with procedural timelines.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including income replacement benefits, treatment plans for physiotherapy and psychological services, assessments, and assistive devices.

The Licence Appeal Tribunal found that the applicant failed to prove entitlement to income replacement benefits, psychological services, and most assessments.

However, the Tribunal approved several physiotherapy plans and a portion of the requested assistive devices, finding them reasonable and necessary to manage the applicant's chronic pain.

The applicant's claim for a special award under s. 10 of O. Reg. 664 was dismissed, as the insurer's reliance on its assessors' reports was not unreasonable.

The applicant sought statutory accident benefits following a 2013 motor vehicle accident, claiming entitlement to attendant care benefits, incurred attendant care expenses, various medical and rehabilitation benefits, and an award for unreasonable delay.

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal found that the applicant failed to meet her evidentiary burden, largely due to significant discrepancies between her written submissions and her hearing brief, which omitted crucial evidence.

The applicant failed to prove that the proposed attendant care and medical benefits were reasonable and necessary, or that the claimed expenses were incurred.

The applicant sought various statutory accident benefits, including attendant care benefits, medical benefits, and assessments, following a 2013 motor vehicle accident.

The Licence Appeal Tribunal held a written hearing to resolve the disputes.

The Tribunal dismissed the application in its entirety, finding that the applicant's case was significantly hampered by discrepancies between her written submissions and her hearing brief, including missing evidence and failure to pinpoint relevant documents.

The applicant failed to meet her onus to prove entitlement to attendant care benefits, incurred expenses, or the reasonableness and necessity of the proposed treatment and assessment plans.

Claims for interest and a special award were also dismissed.

The applicant, a pedestrian struck by a vehicle, sought various statutory accident benefits including attendant care, multiple treatment plans, and assessments.

The respondent denied the benefits, arguing many of the claimed needs arose from a subsequent accident rather than the subject accident.

The Licence Appeal Tribunal found the applicant was not entitled to attendant care or most of the treatment plans, as she failed to differentiate her injuries between the two accidents and lacked corroborating recommendations from treating physicians.

However, the Tribunal granted entitlement to a chronic pain assessment and an MRI, preferring the evidence of the applicant's specialized medical assessor over the respondent's family physician.

Interest was awarded on the overdue benefits.

The applicant sought various statutory accident benefits following a 2017 motor vehicle accident, including attendant care benefits, occupational therapy, assistive devices, and assessments.

The Licence Appeal Tribunal found that the applicant's ongoing impairments were caused by pre-existing degenerative conditions rather than the accident, relying on the respondent's orthopaedic assessment.

The Tribunal denied further attendant care benefits and most treatment plans, but approved a psychological assessment, an attendant care assessment, and an inner bathmat.

The claim for a special award was dismissed as the respondent did not act unreasonably or in bad faith.

The applicant sought a non-earner benefit and a physiotherapy treatment plan following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove a complete inability to carry on a normal life, relying on insurer examination reports that indicated symptom magnification and an ability to perform pre-accident activities.

The claim for physiotherapy was also dismissed as the applicant provided no supporting evidence or submissions.

The respondent's request for costs was denied for failing to comply with the Tribunal's procedural rules.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care and rehabilitation benefits.

The Licence Appeal Tribunal denied attendant care benefits for the initial period because the expenses were not incurred by the applicant's daughters.

However, the Tribunal granted attendant care benefits for a subsequent period, finding them reasonable and necessary, and deemed the expenses incurred because the insurer unreasonably withheld payment by relying on an insurer's examination without explaining why it preferred that report over contemporaneous medical evidence.

The Tribunal also approved a treatment plan for life skills training.

Due to the insurer's lack of transparency and unreasonable conduct in denying the attendant care benefits, the Tribunal ordered a special award of 35% under s. 10 of O. Reg. 664, plus interest.

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

The insurer denied treatment plans for chiropractic treatment, occupational therapy, and assistive devices.

The adjudicator found that the chiropractic treatment was reasonable and necessary because temporary pain relief and maintaining function are valid rehabilitative goals.

However, the claim for occupational therapy was dismissed because the treatment plan had been withdrawn and the sessions were not incurred.

The claim for assistive devices was also dismissed as the headphones were purchased before the treatment plan was submitted, and the applicant failed to show why a new cell phone was necessary.

The adjudicator denied an award for unreasonable withholding of benefits, finding the insurer's reliance on its assessor was an error but not unreasonable conduct.

Interest was awarded on the overdue chiropractic benefits.

The applicant sought various statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs), attendant care benefits (ACBs), transportation costs, and a chronic pain assessment.

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal found the applicant failed to prove a substantial or complete inability to work to qualify for IRBs, noting she had returned to work and later received CERB due to pandemic-related job loss.

Claims for ACBs, transportation costs, and the chronic pain assessment were also dismissed for lack of supporting evidence and failure to meet the respective legal thresholds.

Consequently, claims for interest and a Regulation 664 award were denied.

The applicant sought income replacement benefits (IRB), attendant care benefits (ACB), and approval for numerous treatment plans following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal found the applicant failed to prove a substantial inability to perform her pre-accident employment as a cashier or a complete inability to work post-104 weeks, relying on video surveillance showing no physical distress and independent medical examinations.

The ACB claim was dismissed because the care was provided by family members who did not suffer an economic loss, and the benefit was not deemed incurred as it was not unreasonably withheld.

The disputed treatment plans were found not reasonable and necessary, as the medical evidence did not support the claimed injuries, including a concussion, and the applicant had reached maximum medical improvement.

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

The respondent denied treatment plans for chiropractic care and occupational therapy, and the applicant sought an award for unreasonable delay in paying income replacement benefits.

The Tribunal found the treatment plans reasonable and necessary, noting they were supported by the applicant's treating practitioners and consistent with the medical evidence, while rejecting the respondent's independent medical examinations as inconsistent.

The Tribunal awarded the treatment plans and interest but declined to order an award under Regulation 664, finding the respondent's two-month delay in paying the reinstated income replacement benefit was an error promptly corrected and did not constitute unreasonable conduct.