Jeffrey Pasternak

The applicant was injured in a motor vehicle accident and sought $1,524.00 for a chiropractic treatment plan.

The respondent insurer denied the benefit, relying on an insurer's examination which concluded the applicant had reached maximum medical improvement.

The Tribunal found the treatment plan reasonable and necessary, placing less weight on the insurer's examination as it was inconsistent with diagnostic imaging and the longitudinal clinical record showing ongoing shoulder and chest impairments.

The applicant was awarded the cost of the treatment plan.

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

The respondent denied a treatment plan for physiotherapy, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant did not provide sufficient medical evidence to warrant removal from the MIG.

However, the Tribunal ordered the respondent to pay the $3,282.81 treatment plan because the respondent failed to comply with the notice requirements under ss. 38(8) and 38(9) of the Schedule, triggering the mandatory payment provision under s. 38(11).

The applicant's claim for an award under s. 10 of Reg. 664 was dismissed, but interest was awarded on the overdue payment.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries fell outside the Minor Injury Guideline (MIG) due to a pre-existing condition, chronic pain, and psychological impairment.

The Licence Appeal Tribunal found the applicant failed to meet his onus.

The medical evidence did not establish that his pre-existing back and neck pain would prevent maximal recovery within the MIG.

Furthermore, the evidence did not support a diagnosis of chronic pain with functional impairment or a psychological impairment caused by the accident.

As the applicant's injuries were predominantly minor, he was not entitled to the disputed treatment plans which exceeded the remaining MIG limit, nor was he entitled to interest.

The applicant sought statutory accident benefits, including an income replacement benefit (IRB), following a motor vehicle accident.

In a prior application, the Tribunal found the applicant was not entitled to the IRB.

The applicant subsequently filed a new application claiming an IRB and a catastrophic impairment determination.

The respondent argued the IRB claim was barred by res judicata.

The Tribunal agreed, finding the preconditions for res judicata were met and the applicant failed to establish that the doctrine should be waived based on fresh evidence or fairness.

The applicant was barred from proceeding with the IRB claim.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and a chronic pain assessment.

The respondent insurer denied the treatment plans.

The Tribunal found that the applicant met her onus of proving the physiotherapy plans were reasonable and necessary, relying on her family doctor's records showing ongoing pain and benefit from treatment.

The Tribunal also approved the chronic pain assessment, noting the respondent's own medical examiner acknowledged the applicant's ongoing pain, but reduced the assessment cost to the $2,000 maximum under s. 25(5) of the Schedule.

The applicant was awarded the treatment plans and interest.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claims for Income Replacement Benefits, two treatment plans (OCF-18s) for chiropractic services, interest, and an award.

The applicant argued that the Tribunal erred in law by finding that an OCF-18 alone is not compelling evidence and that a denial issued by a non-health practitioner (an adjuster) could be compliant with s. 38(8) of the Statutory Accident Benefits Schedule.

The adjudicator dismissed the reconsideration request, holding that an OCF-18 is a form used to apply for treatment rather than compelling medical evidence on its own, and that s. 38(8) requires the insurer—not necessarily a health practitioner—to provide the medical and other reasons for denying a treatment plan.

As no error of law or fact was established, the original decision was upheld.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied catastrophic impairment and various benefits.

The applicant argued the Tribunal committed a material breach of procedural fairness by shortening the scheduled 12-day hearing to six days, which prevented one of their witnesses from testifying due to a scheduling conflict.

The Vice-Chair agreed, finding that the Tribunal failed to exercise its discretion in a procedurally fair manner and did not consider alternative options to accommodate the witness.

The reconsideration was granted and the original decision was cancelled.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs), chronic pain treatment, and a psychological assessment.

The Tribunal found the claim for the psychological assessment was statute-barred as the applicant failed to dispute the denial within the two-year limitation period.

The claims for pre-104 and post-104 IRBs were dismissed because the applicant returned to his pre-accident employment for eight months post-accident, and the medical evidence did not support his claim of an accident-related fused disc or inability to work.

The claim for chronic pain treatment was also dismissed as not reasonable or necessary based on the respondent's medical assessments.

The application was dismissed in its entirety.

The court dismissed the defendants’ motion for summary judgment in a motor vehicle accident case, finding that there was a genuine issue for trial regarding the location of the vehicles at the time of the collision and the potential contributory negligence of the parties.

The decision reviews the summary judgment test, the reverse onus in rear-end collisions, and the application of negligence principles, concluding that conflicting evidence and credibility issues require a full trial.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and two treatment plans for chiropractic services.

The Tribunal found that the applicant failed to meet her burden of proof to establish entitlement to a higher quantum of pre-104 IRBs or entitlement to post-104 IRBs, as she provided no substantive submissions on these points.

The Tribunal also rejected the applicant's arguments that the respondent's notices were non-compliant with the Schedule, finding that the respondent provided adequate medical and other reasons for its denials under s. 38(8) and properly requested an insurer's examination under s. 37(1).

As the applicant failed to establish that the proposed treatments were reasonable and necessary, the application was dismissed.

The plaintiff, Patrick Addai, brought an action for damages for personal injuries sustained in a motor vehicle accident.

The defendant, Kelly Parkinson, moved for a determination that the plaintiff's claim for non-pecuniary loss was barred under s. 267.5(5) of the Insurance Act.

The court found the plaintiff's evidence regarding the causation and permanence of his alleged injuries (shoulders, wrists, dental, neck, back, headaches, psychological) to be inconsistent and unreliable.

The court preferred the defendant's expert evidence and concluded that the plaintiff failed to prove that his injuries constituted a permanent serious impairment of an important physical, mental, or psychological function caused by the accident.

Consequently, the defendant's motion was granted, and the plaintiff's claim for non-pecuniary loss was dismissed.

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

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

The applicant sought removal from the MIG based on chronic pain and psychological impairment.

The Tribunal found insufficient evidence of chronic pain but accepted the applicant's psychological impairment, relying on a psychological assessment diagnosing trauma and somatic symptom disorders.

The Tribunal ordered the respondent to pay for the incurred psychological assessment and proposed psychological treatment, plus interest.

The applicant's claim for an award for unreasonable delay was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident in March 2019.

The respondent denied income replacement benefits (IRBs) and a physiotherapy treatment plan.

The Tribunal found that the applicant suffered a mild traumatic brain injury and whiplash, causing a substantial inability to perform the essential tasks of her self-employment for the first 104 weeks.

However, this inability ceased when she applied for the Canada Emergency Response Benefit (CERB) in March 2020, attesting she was ready and able to work.

The Tribunal denied IRBs beyond the 104-week mark, finding no complete inability to engage in any employment.

The claim for physiotherapy services was dismissed as the applicant failed to demonstrate the treatment was reasonable and necessary.

Interest was awarded on the overdue IRB payments.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a catastrophic impairment and was entitled to post-104 income replacement benefits, attendant care, and various medical benefits.

The Licence Appeal Tribunal dismissed the application.

The Tribunal gave no weight to the applicant's key expert psychiatrist, who recanted his findings during cross-examination when confronted with evidence of the applicant's actual functional capabilities, including international travel and childcare.

Consequently, the applicant failed to prove she met the criteria for catastrophic impairment or that she suffered a complete inability to engage in suitable employment.

As the non-catastrophic benefit limits were exhausted, all claims were dismissed.

The appellant appealed a Licence Appeal Tribunal (LAT) decision denying her entitlement to post-104-week income replacement benefits under the Statutory Accident Benefits Schedule.

The Divisional Court dismissed the appeal, finding no errors of law.

The court affirmed that new binding case law does not constitute new evidence for a reconsideration request, and held that the insurer's denial letter adequately complied with the statutory notice requirements under s. 37(4) of the SABS.

The applicant insurer sought repayment of $19,068.20 in Income Replacement Benefits (IRBs) paid to the respondent insured, alleging wilful misrepresentation because the respondent failed to disclose her receipt of long-term disability (LTD) benefits.

The Tribunal found that the respondent's silence and failure to report the LTD benefits for over a year constituted wilful misrepresentation.

As a result, the temporal restrictions for repayment notices under the Schedule did not apply.

The Tribunal ordered the respondent to repay the requested amount but denied the applicant's claim for interest, as no interest had been requested in the repayment notices.

The applicant sought statutory accident benefits for chiropractic, physiotherapy, and massage therapy treatments following a motor vehicle accident.

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

The Tribunal excluded the applicant's submissions beyond the 10-page limit set by a prior order.

On the merits, the Tribunal found that while the applicant's goal of pain reduction was reasonable, she failed to provide medical evidence demonstrating the specific treatment plans were necessary.

The Tribunal preferred the respondent's insurer's examinations, which concluded the treatments were not reasonable and necessary due to a lack of objective impairments.

The application was dismissed.

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

The respondent subsequently discovered the applicant was concurrently receiving long-term disability benefits, which reduced the IRB quantum to zero.

The respondent sought repayment of $54,552.79 in overpaid IRBs.

The Tribunal found the respondent provided timely notice of the overpayment within 12 months of the lump-sum payment, as required by section 52 of the Schedule.

The Tribunal rejected the applicant's argument that the insurer was restricted to recovering the overpayment via a 20% clawback from future IRBs, noting the provision is permissive and the applicant was not currently receiving IRBs.

The respondent was awarded the full repayment amount plus interest.

The applicant sought a chronic pain assessment following a motor vehicle accident.

The respondent denied the treatment plan and argued the application was barred by res judicata due to a prior Tribunal decision that denied similar treatment plans.

The Tribunal found that the four preconditions for res judicata were met and no new medical evidence was provided to warrant waiving the doctrine.

The application was dismissed.

Following the settlement of a motor vehicle accident tort claim for $100,000, the parties disputed the plaintiff's entitlement to costs.

The plaintiff sought costs of the action as well as 'Cadieux costs'—the costs incurred in recovering collateral benefits from her disability insurer, automobile insurer, and the Canada Pension Plan, which reduced her tort claim.

The defendant argued that legislative changes giving the Licence Appeal Tribunal exclusive jurisdiction over benefit disputes precluded the court from awarding such costs, and that Cadieux costs could not be awarded where an action settles before trial.

The court rejected these arguments, finding it retained jurisdiction to award costs incidental to the recovery of benefits that benefitted the tortfeasor.

The court awarded the plaintiff $90,000 in total costs, including $30,000 in Cadieux costs.