Julia Vilorio Peguero

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

The Respondent denied several treatment plans and prescription expenses.

The Tribunal found that the Applicant was not barred from proceeding to a hearing regarding an occupational therapy plan because the Respondent failed to provide medical reasons for requiring an insurer's examination.

The Tribunal ordered the Respondent to pay for the occupational therapy plan due to its non-compliant response, regardless of the funding limit.

The Tribunal also approved a neuropsychological assessment and certain prescription expenses as reasonable and necessary, but denied an MRI and SPECT scan.

An award of $1,448.86 was granted under section 10 of Regulation 664 for the Respondent's unreasonable withholding of benefits.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claims for a non-earner benefit and nine treatment plans.

The applicant argued the adjudicator erred in law and fact regarding the limitation period for the non-earner benefit, the validity of the insurer's examination notice, and the assessment of medical evidence for the treatment plans.

The Vice-Chair found no errors of law or fact that would have changed the outcome, noting the applicant was attempting to re-litigate issues already decided.

The request for reconsideration was dismissed.

The applicant sought a non-earner benefit and various treatment plans following a 2016 motor vehicle accident.

The respondent denied the benefits.

The Tribunal found that the applicant was barred from pursuing the non-earner benefit and several treatment plans because she failed to dispute the denials within the two-year limitation period under s. 56 of the Schedule.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act.

The applicant was also barred from pursuing one treatment plan for failing to attend a s. 44 insurer examination.

The remaining treatment plans were dismissed as the applicant failed to provide compelling, contemporaneous medical evidence to prove they were reasonable and necessary.

The application was dismissed in its entirety.

The defendant, Mohammed Ghandehari, brought a motion for security for costs and for an order requiring the plaintiff, Gobinath Papiah, to attend an in-person defence medical examination in Toronto, with the plaintiff to pay his own travel and accommodation expenses.

The court dismissed the motion for security for costs due to the defendant's delay in bringing the motion and the fact that India is a reciprocating jurisdiction for costs orders.

The court ordered the in-person medical examination but required the defendant to pay the plaintiff’s reasonable costs of attending.

The plaintiff was awarded $1,500 in costs for the motion.

The insurer appealed a Licence Appeal Tribunal (LAT) decision finding that the insured's election of benefits under s. 31(5) of the Statutory Accident Benefits Schedule was invalid due to the insurer's non-compliance with s. 32(2)(b).

The Divisional Court dismissed the appeal, holding that the LAT's factual findings regarding the insurer's non-compliance were not reviewable on a question of law.

The Court agreed that because the initial election was invalid, the insured had not made an election within the meaning of the SABS, and therefore the general prohibition against changing an election did not apply.

The respondent insurer requested a reconsideration of a Tribunal decision which found that the applicant was not catastrophically impaired and could change her election from a non-earner benefit to an income replacement benefit.

The insurer argued the Tribunal made errors of fact and law in finding the initial election invalid.

The Tribunal dismissed the request, finding no error of fact, as the applicant qualified for the income replacement benefit and thus did not meet the criteria for the non-earner benefit.

Furthermore, the Tribunal found no error of law in its determination that the insurer's failure to comply with the mandatory 10-day notice requirement under s. 35(1) of the Schedule rendered the applicant's election not final.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident.

She applied for a catastrophic impairment determination based on psychological and neurological impairments.

The Tribunal found the applicant was not catastrophically impaired, as her mental and behavioural disorders resulted in only mild impairments in social functioning and concentration, persistence, and pace, and there was insufficient evidence of a mild traumatic brain injury to meet the 55% whole person impairment threshold.

The Tribunal allowed the applicant to change her election from a non-earner benefit to an income replacement benefit, finding the initial election invalid because the insurer failed to provide a proper explanation of benefits.

The insurer was granted a repayment of the non-earner benefit due to deductible collateral benefits.

The Tribunal approved one occupational therapy treatment plan and awarded a 10% special award under s. 10 of O. Reg. 664, finding the insurer unreasonably maintained its denial despite acknowledging the plan should have been reassessed.

Claims for a massage chair, attendant care benefits, and other assessments were dismissed.

The applicant in a statutory accident benefits dispute brought motions to state a case for contempt, add the respondent's counsel and adjuster as witnesses, seek third-party productions, and adjourn the hearing.

The applicant alleged that the respondent's counsel interfered with her attempts to obtain personal information from independent medical examiners under PIPEDA.

The Tribunal denied the motion to add witnesses, finding no evidence that counsel or the adjuster were necessary witnesses and noting that the applicant's communications with the examiners were inappropriate attempts to cross-examine them outside the hearing.

The production motion was denied as untimely.

The adjournment motion was granted, and a case conference was ordered to address the contempt motion.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found his OCF-10 election valid and denied his claim for a non-earner benefit.

The applicant argued the Tribunal failed to consider his submissions, erred in its limitation period findings, and violated procedural fairness regarding adjuster log notes.

The adjudicator dismissed the request, finding no errors of law or fact, and noted the applicant was attempting to re-argue his case.

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

The insurer denied the claim on the basis that the applicant had previously elected to receive an income replacement benefit, which is a final election under section 35(3) of the Schedule.

The Tribunal found the election was valid and final.

Furthermore, the application was barred by the two-year limitation period under section 56 of the Schedule.

On the merits, the Tribunal found the applicant failed to prove a complete inability to carry on a normal life, as he did not testify or provide evidence comparing his pre- and post-accident life.

The application was dismissed.