Dr. Zakzanis

The applicant sought a determination that she sustained a catastrophic impairment (CAT) as a result of a motor vehicle accident, along with entitlement to attendant care benefits and a special award for unreasonable delay.

The Licence Appeal Tribunal found that the applicant did not meet the CAT threshold under Criterion 8, as she only demonstrated moderate, rather than marked, impairments in the spheres of functioning.

The claim for attendant care benefits was dismissed because the expenses were not incurred.

However, the Tribunal granted a special award under s. 10 of O. Reg. 664, finding that the respondent unreasonably delayed and withheld payment of income replacement benefits and treatment plans.

The respondent was ordered to pay an award equal to 25% of the delayed benefits.

The applicant and the respondent insurer, Aviva, both requested reconsideration of a Licence Appeal Tribunal decision regarding statutory accident benefits.

The applicant alleged procedural fairness breaches and errors of law regarding the denial of attendant care benefits and the reliance on an untested expert report.

The Tribunal dismissed the applicant's request, finding no procedural unfairness as the applicant had not properly summonsed the expert, and no error in the adjudicator's requirement for detailed invoices to prove expenses were incurred.

Aviva's request for reconsideration was granted in part to correct a mathematical error in the calculation of a bad faith award, reducing the quantum to $7,263.45.

The applicant's request for costs was denied.

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 sought statutory accident benefits following a motor vehicle accident but was denied by the respondent on the basis that her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG due to chronic pain and psychological impairments.

The Tribunal found the medical evidence, including clinical notes and psychological assessments, did not support removal from the MIG.

The Tribunal also found the respondent's denial notices complied with section 38 of the Schedule.

The application was dismissed.

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

The Tribunal first dismissed the insurer's preliminary motion to bar the application for non-attendance at an insurer's examination, finding the request was made years after the application was filed.

On the substantive issues, the Tribunal found the applicant entitled to income replacement benefits for the pre-104-week period due to psychological impairments, but not for the post-104-week period as she did not suffer a complete inability to work.

The Tribunal also approved several treatment plans for occupational therapy, chiropractic, physiotherapy, and massage services, finding them reasonable and necessary.

Claims for a social work treatment plan balance and a special award were dismissed.

The appellant appealed a Licence Appeal Tribunal decision finding she did not sustain a catastrophic impairment from a motor vehicle accident.

The appellant argued the adjudicator misapplied the 'but for' test for causation regarding her psychological and behavioural impairments.

The Divisional Court dismissed the appeal, holding that the adjudicator correctly applied the legal test for causation and that her conclusions were factual findings supported by the evidence.

The court also upheld the adjudicator's finding that the appellant failed to prove a marked impairment in three spheres of functioning.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's denial of various treatment plans.

The insurer argued the physical injuries fell within the Minor Injury Guideline (MIG).

The Tribunal held that because the applicant was removed from the MIG due to a psychological impairment, she had access to the second tier of funding for all injuries.

The Tribunal approved the chiropractic treatment plans, finding them reasonable and necessary for pain relief.

However, the claims for occupational therapy, assistive devices, and psychological treatment were dismissed as the applicant failed to provide submissions demonstrating they were reasonable and necessary.

The applicant requested a reconsideration of a decision finding she did not meet the criteria for catastrophic impairment under s. 3(2)(f) of the Statutory Accident Benefits Schedule.

The applicant argued the adjudicator erred in law by treating a brain injury as a necessary element of the test, and erred in fact by misstating her expert's impairment rating.

The Tribunal dismissed the request, finding that the original decision did not add a brain injury requirement but merely noted the absence of one in evaluating the evidence.

Furthermore, the Tribunal confirmed that the original decision explicitly acknowledged the applicant's expert's Class 4 impairment rating but properly exercised its discretion to prefer the respondent's expert report.

The applicant, a pedestrian struck by a vehicle, sought an ongoing Income Replacement Benefit (IRB) and a catastrophic impairment designation.

The adjudicator found that the applicant's pre-existing mental health and substance abuse issues were aggravated by the accident, resulting in a complete inability to engage in suitable employment.

The applicant was awarded the ongoing IRB.

However, the adjudicator determined that the applicant did not meet the criteria for catastrophic impairment, as he did not suffer marked impairments in at least three of the four functional domains under the AMA Guides.

The applicant was injured in a single-vehicle collision when his car left the road and struck a rock face.

The respondent insurer denied accident benefits, arguing the incident was an intentional suicide attempt and therefore not an 'accident' under the Statutory Accident Benefits Schedule.

The Tribunal found the applicant's testimony credible that he lost control of the vehicle and did not intend to commit suicide, despite his history of mental health issues and suicidal ideation.

The Tribunal concluded the incident met the purpose and causation tests for an accident, as the use or operation of the automobile was the direct cause of the injuries.

The plaintiff, a prominent human rights lawyer, was struck by the defendant's motor vehicle while riding her bicycle.

The defendant failed to discharge the reverse onus under the Highway Traffic Act and was found wholly liable.

The court accepted expert medical evidence that the plaintiff suffered a permanent mild traumatic brain injury (mTBI) and chronic migraines, which effectively ended her legal career.

The court dismissed the defendants' threshold motion, finding the plaintiff sustained a permanent serious impairment of an important function, and awarded substantial damages including $250,000 in general damages, past and future income loss, and future care costs.

The applicant was injured when his vehicle left the road and struck a rock face.

The respondent insurer denied statutory accident benefits, arguing the incident was an intentional suicide attempt and therefore not an 'accident' under section 3 of the Schedule.

The Tribunal found the applicant's testimony credible that he lost control of the vehicle and did not intend to commit suicide, despite his history of mental health issues and police/hospital notes suggesting a suicide attempt.

The Tribunal concluded the incident met the purpose and causation tests for an accident, as the use or operation of the vehicle was the direct cause of the injuries.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, claiming she sustained a catastrophic impairment due to mental and behavioural disorders.

The Licence Appeal Tribunal found that the applicant sustained a marked impairment (Class 4) in Adaptation, qualifying her for catastrophic impairment status.

The Tribunal awarded attendant care benefits, professional organizing services, and vision therapy, but denied aquatherapy sessions.

The Tribunal also denied the applicant's request for a special award under Regulation 664, finding the insurer's denials were not unreasonable.

The plaintiff brought a motion to conditionally strike the defendant's jury notice in a personal injury action arising from a 2008 motor vehicle accident.

The trial had previously resulted in a mistrial in January 2020 due to the plaintiff's health crisis.

Citing the ongoing COVID-19 pandemic and the resulting backlog of civil jury trials in Brampton, the plaintiff argued that further delay would cause prejudice, particularly regarding income loss limits and increasing statutory deductibles under the Insurance Act.

The court granted the motion, conditionally striking the jury notice to allow the trial to proceed before a judge alone if a jury trial could not be accommodated during the January 2022 sittings.

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

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

The Tribunal found that the applicant's physical injuries were limited to soft tissue strains and that she failed to prove any psychological impairment or pre-existing condition that would remove her from the MIG.

As the $3,500 MIG funding limit had already been exhausted, the disputed treatment plans were not payable.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits (IRBs) and treatment beyond the Minor Injury Guideline (MIG) limit due to chronic pain and psychological impairments.

The Licence Appeal Tribunal found that the applicant's physical injuries were predominantly soft tissue sprains and strains falling within the MIG.

The Tribunal gave little weight to the applicant's medical reports regarding chronic pain and psychological issues, preferring the respondent's independent medical examinations which found no objective evidence of ongoing impairment.

Consequently, the Tribunal held that the applicant did not suffer a substantial inability to perform the essential tasks of his pre-accident employment as a delivery truck driver.

The application was dismissed.

The applicant, who was involved in a motor vehicle accident, sought payment for various treatment plans including a neurological assessment, physiotherapy, chiropractic treatment, and psychological services under the Statutory Accident Benefits Schedule.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that the disputed treatment plans were reasonable and necessary.

The adjudicator noted inconsistencies in the applicant's self-reporting to assessors compared to her family doctor's records, and found the expert reports provided by both parties to be problematic or unpersuasive.

The application was dismissed in its entirety.

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

The insurer denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that while the applicant's physical injuries were predominantly minor, her psychological diagnosis of Adjustment Disorder with Mixed Anxiety and Depressed Mood justified removal from the MIG.

The Tribunal approved a psychological assessment as reasonable and necessary, but denied the proposed chiropractic treatment plans, finding the applicant had reached maximum medical recovery for her physical impairments.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) until the insurer terminated them.

Prior to the arbitration hearing, the insurer conceded the issue and paid the IRBs retroactively.

The arbitrator held that interest on the overdue IRBs began to accrue from the date they were initially terminated, as the insurer bears the consequence of a decision not to pay benefits later found owing.

The arbitrator also awarded a special award of $36,280.00, finding the insurer acted unreasonably by ignoring the conclusions of its own medical and vocational assessors, who noted that the alternative job options proposed did not provide the same remuneration as the applicant's pre-accident employment.

The insurer was ordered to pay $25,000.00 in expenses.

The applicant sought reconsideration of a Tribunal decision finding his injuries fell within the Minor Injury Guideline (MIG).

Following the initial decision, the respondent conducted a psychological insurer's examination which concluded the applicant sustained a psychological impairment.

The respondent subsequently conceded the applicant was not subject to the MIG and approved the disputed treatment plans, save for a neurological assessment.

The Tribunal granted the reconsideration request, finding the psychological report constituted new evidence that would have affected the result.

The Tribunal remitted the issues of the neurological assessment and a special award back to the hearing adjudicator, while dismissing the applicant's request for costs due to procedural non-compliance.