Gina Nardella

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for various treatment plans, including chiropractic, physiotherapy, and psychological services.

The respondent insurer partially approved several plans but denied transportation expenses and disputed the hourly rate for a social worker.

The respondent also fully denied a subsequent chiropractic treatment plan based on an insurer's examination which found no objective evidence of continuing impairments.

The Tribunal found that the applicant failed to meet his burden to prove the denied amounts and the fully denied treatment plan were reasonable and necessary.

The Tribunal also found the insurer's denial notices were compliant with the Schedule.

The application was dismissed in its entirety.

The applicant sought entitlement to a non-earner benefit, various treatment plans for physiotherapy and psychological services, an attendant care assessment, and an award under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Tribunal found the applicant failed to establish a complete inability to carry on a normal life, as there was insufficient evidence comparing his pre- and post-accident activities.

The Tribunal also dismissed the claims for the treatment plans, preferring the respondent's insurer examination reports which indicated the applicant had returned to his activities of daily living and sustained only minor injuries.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to treatment beyond the Minor Injury Guideline (MIG) and a non-earner benefit.

The Licence Appeal Tribunal found that the applicant failed to demonstrate that his chronic pain, psychological impairments, or pre-existing conditions warranted removal from the MIG.

As the MIG limits were exhausted, the disputed treatment plan for physiotherapy was not payable.

The Tribunal also dismissed the claim for a non-earner benefit, finding insufficient evidence to establish that the applicant suffered a complete inability to carry on a normal life.

The applicant sought a non-earner benefit, interest, and an award under Regulation 664 following a motor vehicle accident.

The Licence Appeal Tribunal applied the Heath test to determine if the applicant suffered a complete inability to carry on a normal life.

The Tribunal found that the applicant failed to provide a sufficient comparison of her pre- and post-accident activities to meet the rigid test.

As the applicant did not establish entitlement to the non-earner benefit, the claims for interest and a Regulation 664 award were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including chiropractic treatment, a psychological assessment, a chronic pain assessment, a special award, and interest.

The adjudicator found no jurisdiction over the chiropractic treatment plans as they had already been approved by the respondent and the dispute arose from improper invoicing.

The claim for the remaining cost of a psychological assessment was dismissed because the applicant failed to prove that fees exceeding the guideline rate were reasonable.

However, the adjudicator granted the cost of a chronic pain assessment, finding it necessary to explore the applicant's pain complaints and rejecting the respondent's medical examination report.

The claim for a special award for unreasonable delay was dismissed, but interest was awarded on the approved chronic pain assessment.

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

The insurer raised a preliminary issue that the claim was statute-barred because the applicant failed to submit a Disability Certificate (OCF-3) within 104 weeks of the accident and failed to dispute the denial within the two-year limitation period.

The Tribunal found that the applicant did not submit a qualifying OCF-3 until over four years after the accident and failed to appeal the denial within two years.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act, finding the delay unreasonable and prejudicial to the insurer.

The claim for non-earner benefits was dismissed as statute-barred.

The applicant sought various medical benefits, including a psychological assessment, functional abilities evaluation, vocational assessment, and labour market survey, following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove the assessments were reasonable and necessary pursuant to the Statutory Accident Benefits Schedule.

The Tribunal noted that the applicant failed to provide specific submissions for the assessments and that the respondent's evidence, including comprehensive reports, demonstrated the assessments were either duplicative or unnecessary.

The application was dismissed, and claims for an award, interest, and costs were denied.

The applicant sought income replacement benefits after a 2016 motor vehicle accident.

The respondent insurer raised preliminary issues, arguing the applicant failed to apply within the 104-week timeframe and was statute-barred by the two-year limitation period.

The Tribunal found that the Schedule does not impose a strict timeline to apply for income replacement benefits, provided a completed disability certificate is submitted.

Furthermore, the limitation period was not triggered because the insurer's denial notices lacked medical reasons, failing to meet the requirements established in Varriano.

The application was permitted to proceed to a hearing on the merits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

The respondent initially denied benefits under the Minor Injury Guideline but later approved them upon receiving updated medical records.

The applicant sought a special award for unreasonable delay, interest on overdue benefits, and the respondent sought costs.

The Tribunal found the respondent did not act unreasonably in its delay, as it required the updated records to make a fulsome determination, and dismissed the claim for an award.

The Tribunal granted the applicant interest on the overdue benefits and denied the respondent's request for costs.

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

The disputed benefits included treatment plans for psychometric testing, a neuro-psychological examination, and a neuro-psychological intake interview recommended by her psychologist.

The adjudicator found that the applicant failed to prove the treatment plans were reasonable and necessary.

The adjudicator preferred the evidence of the respondent's multidisciplinary assessors, who concluded there was no ongoing accident-related brain injury or cognitive impairment.

The application was dismissed and no interest was payable.

The respondent insurer requested a reconsideration of a Tribunal decision that found the applicant's injuries fell outside the Minor Injury Guideline (MIG) and awarded various medical benefits and assessments.

The insurer argued the Tribunal failed to provide adequate reasons, ignored its independent medical examiners, and erred in law by relying on a chiropractor for a chronic pain diagnosis.

The adjudicator denied the request, finding the Tribunal provided adequate reasons, properly weighed the competing medical evidence, and did not require a formal chronic pain diagnosis to determine the injuries were not predominantly minor.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and various medical assessments.

The respondent denied the claims, arguing they were not reasonable and necessary.

The Licence Appeal Tribunal found that the physiotherapy treatment plans were reasonable and necessary to help the applicant manage chronic pain, noting that the respondent's physiatry assessor's conclusion of no impairment was inconsistent with his own physical examination.

However, the Tribunal denied the claims for the impairment, catastrophic, and neurological assessments, finding insufficient evidence that they were required or would provide new information.

The applicant was awarded the physiotherapy costs with interest.

The applicant sought income replacement benefits following a motor vehicle accident.

The respondent denied the benefits and requested a preliminary issue hearing to determine whether the applicant was precluded from proceeding with his claim under s. 55 of the Schedule for failing to attend an insurer's examination.

The Tribunal found that the respondent failed to provide sufficient notice of the examination, as the medical and other reasons provided were contradictory and confusing.

The Tribunal also determined that the applicant's Disability Certificate (OCF-3) was submitted in or around November 18, 2016.

The applicant was not precluded from proceeding to a hearing on the merits.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, including psychological testing, psychological services, and physiotherapy.

The insurer partially approved the psychological treatment plans based on independent medical examinations and denied the physiotherapy plans.

The Tribunal found the applicant failed to prove the unapproved portions of the psychological plans were reasonable and necessary.

However, the Tribunal approved one of the two identical physiotherapy treatment plans to determine if further passive modalities could provide tangible benefit.

The claim for an award for unreasonable delay was dismissed.

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

The Licence Appeal Tribunal found that the applicant's pre-existing knee impairments were not worsened by the accident and that he did not meet the test for a substantial or complete inability to work.

Consequently, the claims for ongoing IRBs and physical treatment plans were dismissed.

However, the Tribunal found that the insurer had unreasonably delayed payment of the initial IRBs and failed to pay interest.

The Tribunal ordered the insurer to pay interest on the delayed payments along with a 20% special award under O. Reg. 664.

Both parties' requests for costs were denied.

The insurer requested a reconsideration of a case conference decision that ordered the production of the adjuster's log notes.

The insurer argued that the log notes were not relevant because the applicant had not claimed a special award.

The Tribunal dismissed the request for reconsideration, finding no error of law or fact.

The Tribunal held that adjuster's log notes are prima facie relevant to an entitlement claim to understand the adjuster's deliberations in refusing benefits, and a claim for a special award is not a prerequisite for their disclosure.

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

The insurer raised preliminary issues, arguing the applicant was barred from proceeding with her appeal for failing to attend an in-home occupational therapy assessment, and that the Tribunal lacked jurisdiction over an unpaid but approved psychological assessment.

The Tribunal found the applicant was not barred from proceeding with her non-earner benefits claim because the insurer failed to provide sufficient reasons for the requested assessment.

However, the Tribunal concluded it lacked jurisdiction over the psychological assessment claim because the insurer had approved it and was merely awaiting requested information from the provider, meaning no dispute over entitlement existed.

The applicant, a pedestrian struck by a vehicle, sought a non-earner benefit, the cost of a chronic pain assessment, and a medical benefit for chiropractic treatment under the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, as she continued to engage in many pre-accident activities, and therefore denied the non-earner benefit.

The Tribunal also denied the cost of the chronic pain assessment, finding it was not reasonable and necessary as it would not add new information to the file.

However, the Tribunal ordered the respondent to pay the outstanding balance for the chiropractic treatment plan, noting that the respondent's own assessor recommended continued facility-based active treatment.

The applicant sought statutory accident benefits for a Functional Abilities Evaluation (FAE), vocational assessments, and a Chronic Pain Assessment (CPA) following a motor vehicle accident.

The adjudicator found the FAE and vocational assessments were reasonable and necessary to determine the applicant's capacity to work as a drywaller and painter, awarding the prescribed maximum of $4,400.00 plus interest.

However, the claim for a CPA was denied because the applicant already had a comprehensive chronic pain diagnosis and the proposed assessment would not provide new medical guidance.

The respondent's request for costs was dismissed.

The appellant appealed a Licence Appeal Tribunal decision dismissing her application for non-earner benefits.

The LAT had found her application void because she failed to elect between non-earner and income replacement benefits before commencing the proceeding, as required by section 35 of the Statutory Accident Benefits Schedule.

The Divisional Court dismissed the appeal, finding no error of law in the LAT's determination that an election was required and that a dispute could not exist until the insurer had made a decision following that election.