Laura Meschino

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a catastrophic impairment due to mental and behavioural disorders.

The Tribunal found that the applicant did not suffer a marked impairment in social functioning, as she demonstrated abilities compatible with some useful functioning, such as maintaining friendships, dating, and travelling.

Consequently, she did not meet the threshold for catastrophic impairment.

The Tribunal approved treatment plans for massage therapy, physiotherapy, and specific occupational therapy items (snow removal and a cervical pillow) as reasonable and necessary, but denied funding for general occupational therapy and the unapproved balance of catastrophic impairment assessments.

The applicant's claim for an award for unreasonable delay was dismissed, but she was awarded $500 in costs due to the respondent's failure to produce an adjuster at the hearing.

The applicant sought statutory accident benefits following a motor vehicle accident in September 2021.

The respondent denied benefits and raised preliminary issues regarding the applicant's failure to comply with timelines under the Statutory Accident Benefits Schedule.

The Tribunal found that while the applicant properly notified the respondent of the accident within seven days, he failed to submit his application for benefits (OCF-1) within 30 days, delaying submission for over three and a half years.

The applicant's explanations for the delay, including an inability to attend treatment and a schizophrenia diagnosis, were not supported by medical evidence and were deemed unreasonable.

Consequently, the applicant was barred under section 55(1) of the Schedule from proceeding with his application before the Tribunal, and the application was dismissed.

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

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

The applicant applied to the Licence Appeal Tribunal, arguing her injuries warranted removal from the MIG due to chronic pain and psychological impairment.

The Tribunal found that the applicant failed to demonstrate injuries outside the MIG, preferring the respondent's insurer examination reports over the applicant's medical evidence, which lacked objective support and was inconsistent with clinical records.

The application was dismissed, and the applicant remained subject to the $3,500 MIG limit.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that her injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed her shoulder injury, psychological impairments, and chronic pain warranted removal from the MIG.

The Tribunal found that the shoulder injury was likely a pre-existing condition related to her employment as a personal support worker and was not caused by the accident.

Furthermore, the applicant failed to provide compelling medical evidence of an accident-related psychological impairment or functional limitations due to chronic pain.

The Tribunal concluded the applicant's injuries were subject to the MIG and dismissed the claims for additional medical benefits, examination expenses, interest, and an award.

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

After multiple adjournments to allow the applicant to retain legal counsel, a videoconference hearing was scheduled.

The applicant failed to attend the hearing despite receiving proper notice.

As the applicant failed to adduce any evidence to support his claims for income replacement benefits, medical benefits, and other relief, the Tribunal dismissed the applications for failing to meet the burden of proof.

The applicant was injured in a motor vehicle accident and sought non-earner benefits, claiming a complete inability to carry on a normal life.

The respondent denied the benefits after an initial period of payment.

The adjudicator found that the applicant had significant pre-existing conditions, including avascular necrosis and hip pain, which already limited his pre-accident activities.

Applying the Heath test, the adjudicator concluded that the applicant failed to prove his accident-related impairments continuously prevented him from engaging in substantially all of his pre-accident activities.

The application was dismissed.

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

The central issue was whether her injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain, psychological injuries, or a pre-existing condition.

The Tribunal found that the applicant failed to meet her burden of proving her injuries warranted removal from the MIG.

Her evidence regarding chronic pain did not meet the AMA Guides criteria, her psychological symptoms were not formally diagnosed, and there was insufficient evidence that her pre-existing shoulder tear prevented maximal recovery within the MIG limits.

As the MIG limits were exhausted, no further benefits, interest, or awards were payable.

The applicant was injured in a motor vehicle accident and sought medical benefits beyond the $3,500 Minor Injury Guideline (MIG) limit.

The respondent denied the treatment plans, arguing the injuries were minor.

The Tribunal found insufficient evidence of psychological injuries or chronic pain that would warrant removal from the MIG.

The application was dismissed, and the applicant was found not entitled to the disputed treatment plans or interest.

The applicant was injured in a motor vehicle accident and sought an income replacement benefit (IRB).

The respondent insurer delayed payment of the IRB for over a year despite receiving all necessary documentation.

The Tribunal found the insurer's conduct in handling the claim was imprudent, immoderate, and unyielding.

The Tribunal ordered a special award under s. 10 of O. Reg. 664 in the amount of $4,025.00, representing 25% of the total IRB payable, plus interest.

The applicant sought reconsideration of a Licence Appeal Tribunal decision that found the respondent insurer did not unreasonably withhold or delay payment of a psychological assessment.

Upon reviewing the hearing transcript, the adjudicator found a material error of fact: the respondent's adjuster had admitted on cross-examination that an in-person insurer examination was not required to approve the benefit.

The adjudicator concluded that the respondent maintained a stubborn and inflexible position by insisting on an unnecessary examination, thereby unreasonably delaying payment.

The reconsideration was granted, the original decision was varied, and the respondent was ordered to pay a special award of 45% of the assessment amount under s. 10 of Regulation 664.

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

The respondent insurer denied the benefits, arguing the applicant's injuries were predominantly minor and subject to the $3,500 limit of the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's meniscal tear and unopposed psychological diagnoses warranted removal from the MIG.

However, the Tribunal only approved one treatment plan for $2,800, finding the applicant failed to provide sufficient evidence to prove the remaining claimed expenses were reasonable and necessary.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and funding for chiropractic services and a chronic pain assessment.

The Licence Appeal Tribunal dismissed the claim for a non-earner benefit, finding that surveillance evidence and inconsistencies in the applicant's self-reporting undermined her claim of a complete inability to carry on a normal life.

However, the Tribunal granted the medical benefits, concluding that the applicant suffered from an accident-related pain condition and that the proposed treatments were reasonable and necessary to address her physical and psychological impairments.

The respondent's request for costs was denied.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision.

The insurer denied a $5,185 treatment plan for chiropractic services on the basis of insurer examinations.

The Tribunal found that the insurer's denial notice failed to comply with s. 38(8) of the SABS because it did not state whether the MIG applied, precluding the insurer from relying on the MIG limit.

However, the Tribunal concluded the proposed treatment was not reasonable and necessary, preferring the evidence of the insurer's assessors that the applicant's accident-related injuries had resolved and his ongoing complaints stemmed from pre-existing degenerative disc disease.

Due to the defective notice, the insurer was ordered to pay any amounts the applicant had already expended on the treatment plan.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a multi-disciplinary chronic pain management treatment plan and two physiotherapy treatment plans.

The adjudicator found the chronic pain management treatment plan to be reasonable and necessary, relying on the applicant's orthopaedic expert who established a direct causal relationship between the accident and the applicant's severe chronic pain.

However, the adjudicator dismissed the claims for the physiotherapy treatment plans, noting that the applicant had reached maximal medical recovery from a musculoskeletal perspective and that the chronic pain program already included multiple body sites therapy.

The applicant was awarded interest on the overdue chronic pain benefit.

The applicant brought a motion requesting that the adjudicator recuse herself and set aside a previous decision denying a special award under the Insurance Act.

The applicant alleged a reasonable apprehension of bias, arguing the adjudicator fabricated evidence and imposed her own legal tests.

The adjudicator dismissed the motion, finding that the applicant's allegations amounted to alleged errors of fact and law, which do not in themselves establish a reasonable apprehension of bias.

No costs were awarded.

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

Although the applicant had been removed from the Minor Injury Guideline for psychological reasons, the adjudicator found that the physical injuries were minor sprains and strains.

The applicant failed to provide objective medical evidence to prove the physical treatments were reasonable and necessary, relying only on a clinic letter and OHIP summary.

The adjudicator accepted the respondent's section 44 medical examination report, which concluded the applicant had reached maximum medical recovery physically.

The application was dismissed.

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

The respondent insurer denied several treatment plans for chiropractic, massage, and psychological services on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained predominantly minor physical injuries, such as soft tissue sprains and strains, and that her psychological symptoms did not remove her from the MIG.

As the applicant failed to prove her injuries warranted treatment outside the MIG, the application for the disputed treatment plans was dismissed.

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

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

The Tribunal found that while the applicant did not establish a psychological impairment, she did prove on a balance of probabilities that she suffered from chronic pain as a result of the accident, which removed her from the MIG.

Consequently, the Tribunal approved a disputed physiotherapy treatment plan as reasonable and necessary, but denied a psychological assessment.

Interest was awarded on overdue payments.

The applicant sought payment for a psychological assessment following a motor vehicle accident.

The insurer denied the treatment plan and required an insurer's examination (IE).

The applicant attended the IE but it did not proceed because she wished to record the session.

The insurer refused to pay for the assessment, alleging non-attendance, and brought a preliminary motion to preclude the applicant from proceeding with her Tribunal application.

The Tribunal dismissed the insurer's motion, finding that the insurer's notice of the IE was deficient because it failed to provide sufficient medical and other reasons for the examination as required by the Statutory Accident Benefits Schedule.

The applicant sought medical benefits for chiropractic services following a motor vehicle accident.

The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the treatment plans were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant's injuries were minor and subject to the MIG funding limit, as there was no compelling medical evidence of a pre-existing condition that would preclude recovery within the MIG.

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

The application was dismissed.