Frank Comella

The applicant was injured in a motor vehicle accident and sought payment for a chronic pain assessment and two physiotherapy treatment plans under the Statutory Accident Benefits Schedule.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the treatment plans were reasonable and necessary.

The Tribunal preferred the evidence of the insurer's examination physician over the applicant's assessor, noting that the applicant's reports of pain were inconsistent and uncorroborated by contemporaneous clinical notes and records.

The applicant sought various statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB), medical benefits, and an award under s. 10 of O. Reg 664.

The Tribunal found the applicant did not suffer a substantial inability to perform the essential tasks of his employment as a personal support worker and Lyft driver, relying on the respondent's medical assessments and the applicant's family doctor's clinical notes.

The Tribunal denied the claims for IRB, psychological services, a chronic pain assessment, and a driving reintegration assessment.

However, the Tribunal partially approved a treatment plan for a chronic pain program, awarding $2,346.70 for physical therapy and an SI belt based on a neutral OHIP-funded assessment.

The claim for a s. 10 award was dismissed.

The applicant requested a reconsideration of a Tribunal decision that found he was not removed from the Minor Injury Guideline (MIG) and was not entitled to disputed treatment plans.

The applicant argued the adjudicator made errors of law and fact in evaluating his chronic pain syndrome claim.

The Tribunal dismissed the request, finding the applicant was attempting to re-litigate the case and reweigh evidence, specifically regarding the expert report of a physiatrist and the application of the AMA Guidelines for diagnosing chronic pain.

The applicant sought the unapproved balance of two treatment plans for psychological services provided by a social worker following a motor vehicle accident.

The dispute centered on whether the social worker should be paid the enhanced hourly rate of $149.61, commensurate with a psychologist or psychotherapist, rather than the $99.75 rate approved by the respondent.

The Tribunal found that the applicant failed to provide sufficient evidence that the social worker was under the active supervision of a psychologist or possessed specialized training in psychotherapy.

Consequently, the Tribunal deemed the $99.75 hourly rate reasonable and dismissed the claims for the unapproved balances, interest, and an award under s. 10 of Reg. 664.

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

The insurer denied the claims and raised a preliminary issue regarding the two-year limitation period.

The Tribunal found that the claims for income replacement benefits and a psychological assessment were time-barred, but allowed the claims for other medical and rehabilitation benefits to proceed due to the Covid-19 limitation period extension under O. Reg. 73/20.

On the merits, the Tribunal dismissed the claims for medical benefits, finding the applicant failed to prove they were reasonable and necessary given his significant pre-existing chronic pain and active post-accident lifestyle.

Claims for an award, interest, and costs were also dismissed.

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

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

The Tribunal found that the applicant failed to prove her injuries fell outside the MIG or that pre-existing conditions prevented her recovery within the MIG limits.

The Tribunal also dismissed the claims for a non-earner benefit, treatment plans, and a special award, as the applicant provided insufficient evidence to support her claims.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of an income replacement benefit, a physiotherapy treatment plan, and the application of the Minor Injury Guideline.

The matter proceeded to a written hearing.

The applicant failed to file initial written submissions and evidence in accordance with the Tribunal's orders.

Consequently, the Tribunal found the applicant failed to meet her evidentiary burden and dismissed the application.

The respondent's request for costs was denied, as the applicant's mere failure to file submissions did not constitute unreasonable, frivolous, vexatious, or bad faith conduct.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her entitlement to income replacement benefits (IRBs).

She argued the Tribunal violated procedural fairness and made an error of law by applying the post-104 week test instead of the pre-104 week test.

The Tribunal dismissed the request, finding that the period in dispute was entirely post-104 weeks, the applicant had ample notice and opportunity to present her case, and the correct legal test was applied.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) for 104 weeks.

The respondent terminated IRBs at the 104-week mark.

The applicant applied to the Licence Appeal Tribunal for ongoing IRBs.

The Tribunal held that the stricter post-104 test applied, requiring the applicant to prove a complete inability to engage in any employment for which she is reasonably suited by education, training, or experience.

The Tribunal found the applicant's expert evidence unpersuasive and noted the lack of supportive evidence from her long-term family doctor.

The application for ongoing IRBs and interest was dismissed.

The applicant sought non-earner benefits following a motor vehicle accident.

The insurer argued the applicant was barred from proceeding because he failed to submit an Election of Income Replacement, Non-Earner Benefit or Caregiver Benefit (OCF-10) form.

The Tribunal found that the applicant's initial application documents provided conflicting information about his employment status, creating ambiguity as to whether he was entitled to income replacement or non-earner benefits.

Because of this ambiguity, the insurer's request for an OCF-10 was valid.

As the applicant failed to submit the required form, he was barred from proceeding with his claim for non-earner benefits.