Dr. Salerno

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claims for post-104 week income replacement benefits, a chronic pain assessment, and various medical and rehabilitation benefits.

The applicant argued that the Tribunal breached procedural fairness by admitting late-served surveillance evidence and erred in law and fact in its evaluation of the medical evidence and the legal test for benefits.

The Vice-Chair dismissed the request, finding that the Tribunal properly weighed the prejudice of the late evidence, applied the correct legal tests, and reasonably preferred the respondent's independent medical examinations over the applicant's evidence.

The reconsideration request was deemed an improper attempt to re-litigate the initial hearing.

The applicant requested a reconsideration of a Tribunal decision denying her entitlement to a post-104 income replacement benefit (IRB).

The applicant argued the adjudicator erred in law and breached procedural fairness by failing to determine substantive entitlement to the IRB, even if the quantum was zero.

The adjudicator agreed it was an error not to address the substantive threshold but found this was not a material breach or an error that would have changed the outcome.

The adjudicator reviewed the medical and vocational evidence, preferring the respondent's multidisciplinary assessments which concluded the applicant did not suffer a complete inability to engage in suitable employment.

The request for reconsideration was dismissed, and the respondent's request for costs was denied.

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

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued for removal from the MIG due to a pre-existing psychological condition, an accident-related psychological impairment, and chronic pain.

The Tribunal found that the applicant failed to prove that a pre-existing condition prevented maximal recovery, preferred the respondent's psychological assessment finding no accident-related psychological impairment, and found insufficient evidence of chronic pain.

The application was dismissed.

The applicant sought payment for three psychological treatment plans, a special award, and interest following a motor vehicle accident.

The respondent denied the benefits.

The Tribunal found that the applicant failed to prove the psychological issues were caused by the accident, noting that the treating psychologist's reports focused on family issues and lack of employment.

Relying on the respondent's section 44 assessment, which found insufficient objective evidence of an accident-related psychological impairment, the Tribunal concluded the treatment plans were not reasonable and necessary.

The application was dismissed in its entirety.

The applicant sought various medical and rehabilitation benefits following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant was entitled to funding for physiotherapy, Botox injections, a mental health driving assessment, a virtual social work assessment, a sleep study, an oculo-visual assessment, and prescription medication, as these were reasonable and necessary to treat his accident-related impairments, including a mild traumatic brain injury.

However, claims for a functional cognitive assessment, an attendant care assessment, and occupational therapy were denied because the applicant demonstrated an ability to engage in pre-accident activities and perform necessary tasks independently.

The Tribunal also denied the applicant's request for a special award, finding that the insurer reasonably relied on its assessors' opinions.

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

The respondent denied various treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to establish that his physical, psychological, or chronic pain impairments warranted removal from the MIG.

The Tribunal preferred the respondent's in-person assessments over the applicant's virtual and inconsistent assessments.

As the MIG limit was exhausted, the disputed treatment plans were not payable, and claims for interest and an award were dismissed.

The applicant was injured in a motor vehicle accident and sought pre- and post-104 week income replacement benefits (IRBs), which the respondent insurer denied.

The Tribunal found that the applicant suffered a substantial inability to perform the essential tasks of his pre-accident employment as a sheet metal fabricator and airplane mechanic due to ongoing pain from a right leg fracture.

Furthermore, the Tribunal concluded that the applicant met the more stringent post-104 week test, as his chronic pain and physical limitations resulted in a complete inability to engage in suitable employment.

The Tribunal also ordered a 10% award against the insurer under s. 10 of O. Reg. 664, finding that the insurer unreasonably withheld benefits by failing to adjust the claim after receiving compelling medical reports supporting the applicant's ongoing impairments.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and various medical and rehabilitation expenses.

The insurer denied the benefits, arguing the applicant suffered predominantly minor injuries subject to the $3,500 limit under the Minor Injury Guideline, which had been exhausted.

The Tribunal found the applicant did not suffer a substantial inability to perform the essential tasks of his employment and was therefore not entitled to IRBs.

Furthermore, the Tribunal concluded the applicant's injuries were predominantly minor, and since the $3,500 limit was exhausted, no further medical benefits were payable.

The application was dismissed.

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

The insurer raised a preliminary issue that the applicant was barred from proceeding due to non-attendance at insurer examinations; the Tribunal found the notice of examination was deficient and allowed the claim to proceed.

On the merits, the Tribunal held that the applicant's psychological impairments removed him from the Minor Injury Guideline (MIG).

The Tribunal approved the psychological assessment and treatment plans as reasonable and necessary, but denied the claims for attendant care benefits, physiotherapy, and chiropractic treatment.

The claim for a special award was also dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied his claim for ongoing income replacement benefits following three motor vehicle accidents.

The applicant argued the Tribunal made significant errors of fact regarding medical reports, erred in law by not finding the insurer breached the Statutory Accident Benefits Schedule when terminating and suspending benefits, violated procedural fairness, and that new medical evidence was available.

The Executive Chair dismissed the request, finding the Tribunal's factual conclusions were open to it on the evidence, no errors of law were made regarding the insurer's obligations under sections 33 and 37 of the Schedule, no breach of procedural fairness occurred, and the applicant failed to explain why the new evidence could not have been obtained prior to the hearing.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits and a physiotherapy treatment plan.

The respondent denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that he did not suffer a substantial inability to perform his pre-accident employment.

The Tribunal found that the applicant sustained predominantly minor soft tissue injuries and failed to provide compelling evidence to remove him from the MIG.

As the $3,500 limit was exhausted, the physiotherapy claim was denied.

The Tribunal also dismissed the claim for income replacement benefits, preferring the detailed reports of the respondent's assessors over the applicant's initial disability certificate.

The respondent's claim for costs was dismissed.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's physical injuries, including cervical and thoracic strains, were predominantly minor.

The Tribunal also found that the applicant failed to provide compelling evidence of a psychological injury or a pre-existing medical condition that would remove her from the MIG.

Consequently, the applicant is subject to the $3,500 MIG limit, and the claims for additional treatment plans and examination costs were dismissed.