Joseph Filice

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

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

The applicant argued that he suffered from radiculopathy, a rotator cuff injury, psychological impairments, and chronic pain, warranting removal from the MIG.

The Tribunal found that the applicant's physical injuries were predominantly soft-tissue sprains and strains, and that he failed to provide sufficient objective medical evidence of radiculopathy, a psychological impairment, or chronic pain that caused functional impairment.

As the respondent had already approved the $3,500 MIG limit, the disputed treatment plans were not payable.

The application was dismissed.

The applicant sought statutory accident benefits following two minor motor vehicle accidents in 2011 and 2012.

He had previously suffered a severe workplace injury in 2002, resulting in chronic pain and psychological impairments.

The arbitrator found the applicant's evidence lacked credibility, largely due to extensive surveillance showing him performing activities he claimed he could not do, and his failure to disclose his pre-existing conditions to his assessors.

Applying the 'but for' test for causation, the arbitrator concluded that the applicant's impairments were solely attributable to his 2002 workplace injury and that he suffered no verifiable decline in function following the motor vehicle accidents.

All claims for non-earner benefits, attendant care benefits, medical benefits, and cost of examinations were dismissed.

The applicant, who was catastrophically impaired in a motor vehicle accident, sought attendant care benefits of $6,000 per month.

The respondent conceded entitlement but disputed the quantum and whether past services provided by the applicant's sister were 'incurred' under the Schedule.

The Tribunal found the applicant required 24-hour basic supervisory care due to unpredictable cognitive and visual episodes, entitling her to $6,000 per month for most of the claimed period.

The Tribunal also found the sister provided services in a professional capacity, satisfying the incurred test.

The claim for a special award was dismissed as the insurer's delay was reasonable given accounting and documentation issues.

The appellant appealed two arbitration orders denying her claims for non-earner benefits, medical benefits, and a special award, and ordering her to pay HST on the insurer's disbursements.

The Director's Delegate dismissed the appeal, finding no errors of law.

The Arbitrator correctly applied the test for non-earner benefits, properly concluded medical benefits were not incurred, and correctly applied the legislative requirement that treatment plans be signed.

The Delegate also refused to admit a new invoice as fresh evidence because it could have been adduced at the arbitration hearing.

Finally, the Delegate upheld the order requiring the appellant to pay HST on expert witness disbursements.

The applicant sought a determination that he was catastrophically impaired under section 3(2)(f) of the Statutory Accident Benefits Schedule due to mental or behavioural disorders following two motor vehicle accidents.

The applicant had significant pre-existing impairments from a 2002 workplace fall, including chronic pain and depression.

The adjudicator found that while the applicant suffered from a pain disorder and depression, his functional limitations were overstated and did not meet the threshold for a marked (Class 4) impairment.

Furthermore, applying the material contribution test, the adjudicator concluded that the applicant's current level of impairment was not materially caused by the motor vehicle accidents, as his condition was essentially the same as before the accidents.

The application for catastrophic impairment was dismissed.

However, the applicant was awarded $1,500 in costs due to the respondent's unreasonable conduct in delaying the closing submissions.

The applicant sought various medical and rehabilitation 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 that the ongoing complaints were related to pre-existing conditions, including fibromyalgia.

The Tribunal found that the applicant failed to provide sufficient medical evidence to remove her from the MIG or to prove that the accident aggravated her pre-existing conditions.

The Tribunal concluded that the claimed benefits were not reasonable and necessary, and dismissed the application.

The applicant, who has autism, was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, primarily for chiropractic services, as well as interest and an award under Regulation 664.

The Licence Appeal Tribunal dismissed the claims, finding that the applicant failed to prove on a balance of probabilities that her ongoing neck, shoulder, and back pain were caused by the accident.

Relying on insurer examination reports, the adjudicator concluded that the requested treatments were neither reasonable nor necessary, and consequently denied the claims for interest and a special award.

The insurer sought expenses following a successful arbitration where no accident benefits were awarded to the three applicants.

The applicants argued that no costs should be awarded against two of the applicants as they were persons under a disability.

The arbitrator found that the estate was legally responsible for costs, but declined to award costs against the autistic applicant, as there was no evidence of a substitute decision-maker agreeing to be bound for costs.

The arbitrator awarded proportionate costs to the insurer against the remaining two applicants, applying legal aid rates.

The respondent in a statutory accident benefits dispute brought a motion to exclude a letter from the case file, arguing it contained privileged case conference information and inflammatory content.

Following discussions between the parties, the respondent withdrew its motion.

The three applicants were involved in a motor vehicle accident and sought various statutory accident benefits, including non-earner benefits, attendant care benefits, and medical rehabilitation benefits.

The insurer denied the claims based on independent medical examinations indicating that the applicants' ongoing impairments were related to pre-existing conditions rather than the accident.

The arbitrator found that none of the applicants suffered a complete inability to carry on a normal life, and that the proposed treatment plans and attendant care were neither reasonable nor necessary.

All claims for benefits were dismissed.

The applicant was injured in a motor vehicle accident and sought accident benefits, claiming he sustained a catastrophic impairment.

The insurer denied the claim, arguing that any catastrophic impairment was the result of a stroke the applicant suffered two years after the accident.

The arbitrator found that the applicant's psychological impairments resulting from the accident met the threshold for catastrophic impairment, and that the accident materially contributed to the stroke.

The arbitrator awarded attendant care benefits for incurred professional services but denied them for family-provided care due to a lack of evidence of economic loss.

A special award was granted against the insurer for unreasonably withholding payments.