Christos Kakaletris

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming $2,000 for an executive summary related to a catastrophic impairment assessment.

The Licence Appeal Tribunal found that the executive summary constituted a separate, reasonable, and necessary assessment, ordering the respondent to pay the benefit with interest.

However, the Tribunal dismissed the applicant's claims for an award under section 10 of O. Reg. 664 and for breach of good faith, finding the respondent's initial denial was not unreasonable.

The Tribunal awarded $250 in costs to the respondent due to the applicant's frivolous threat of a contempt motion.

The applicant sought an award under section 10 of Regulation 664, arguing the respondent insurer unreasonably delayed approving his catastrophic impairment designation until a case conference.

The Tribunal dismissed the claim for an award, finding the insurer's initial reliance on its own assessments was not imprudent or stubborn, and the Schedule does not require medical reasons for approving a designation.

However, the Tribunal awarded the applicant $500 in costs because the respondent misrepresented at the case conference that the reasons for the reversal would be found in the adjuster's log notes.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that awarded a 15% special award under section 10 of O. Reg. 664 but failed to address the mandatory interest on that award.

The adjudicator found that the failure to specify that interest was payable on the lump sum award was an error of law, as section 10 interest is mandatory and distinct from the discretionary lump sum component.

The decision was varied to include entitlement to interest in accordance with Reg. 664, but the adjudicator declined to quantify the exact amount owing due to insufficient information.

The applicant requested reconsideration of a Licence Appeal Tribunal decision regarding statutory accident benefits.

The applicant argued the Tribunal erred by failing to award interest for the pre-application period under s. 51(3) of the Schedule and by failing to award interest on the s. 10 special award itself.

The Vice-Chair dismissed the first ground, finding no evidence that the benefits were incurred and therefore overdue.

However, the Vice-Chair granted the second ground, holding that s. 10 of O. Reg. 664 mandates the inclusion of interest on the award amount.

The original decision was varied to include interest payable under s. 10.

The applicant applied to the Licence Appeal Tribunal seeking a determination that the respondent's counsel was in a conflict of interest for requesting an examination under oath regarding accident benefits after previously conducting one for a priority dispute.

The applicant did not dispute any specific entitlement to accident benefits.

The Tribunal held that under s. 280(1) of the Insurance Act, its jurisdiction is limited to disputes regarding entitlement to or the amount of statutory accident benefits.

Because the conflict of interest was raised as a standalone issue without an underlying benefits dispute, the Tribunal found it lacked jurisdiction and dismissed the application.

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

The respondent insurer raised a preliminary issue that the applicant was statute-barred from proceeding to a hearing because she failed to attend scheduled insurer's examinations.

The applicant argued the notices of examination were non-compliant and the insurer failed to prove it arranged the examinations at its expense.

The Tribunal found the notices were compliant with section 44 of the Schedule and the applicant failed to provide a reasonable explanation for her non-attendance.

The application was dismissed as statute-barred under section 55(1)2, and the applicant's request for costs was denied.

The applicant sought statutory accident benefits, claiming a catastrophic impairment under Criterion 4 due to a traumatic brain injury sustained in a 2018 motor vehicle accident.

The respondent argued the application was barred by res judicata, as a prior 2023 Licence Appeal Tribunal decision had already determined the applicant did not sustain a neurological injury.

The Tribunal agreed, finding that the same question had been decided, the prior decision was final, and the parties were the same.

The Tribunal declined to exercise its discretion to waive res judicata, noting the applicant had the opportunity to present evidence of a brain injury at the first hearing but failed to do so.

The application was dismissed, with no costs awarded to either party.

The applicant, who sustained a catastrophic brain injury in a 1997 motor vehicle accident, applied for retroactive attendant care benefits (ACBs) in 2021.

The respondent insurer denied the retroactive claim.

The Tribunal found that the applicant was entitled to retroactive ACBs for the period after his discharge from the hospital, as well as for two weekends spent at home during his hospital stay, because the services were reasonably necessary and quantifiable.

The Tribunal also held that interest on the overdue benefits began to accrue 10 business days after the 2021 application was submitted.

Finally, the Tribunal granted a special award of $42,000 under s. 10 of Regulation 664, finding that the respondent unreasonably withheld benefits by failing to adequately inform the applicant of his potential entitlement to ACBs shortly after the accident.

The applicant sought statutory accident benefits following a 2013 motor vehicle accident, claiming catastrophic impairment due to psychiatric issues.

The Licence Appeal Tribunal found the applicant sustained a catastrophic impairment under Criterion 8 (marked impairment in social functioning) based on psychiatric evidence showing severe social isolation and altercations.

The Tribunal awarded $2,000 for a psychiatric assessment but denied the remaining $13,005 claimed for other assessments.

Claims for an award under s. 10 of Reg. 664 were dismissed.

Procedural requests by the applicant for the adjudicator's recusal and a video recording of the hearing were also denied.