Michelle Panagiotakos

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that awarded the applicant various medical and rehabilitation benefits.

The Vice-Chair found that the Tribunal made errors of fact and material breaches of procedural fairness by failing to address the respondent's submissions regarding occupational therapy, physiotherapy, medication, and an eye exam.

The reconsideration was granted in part, and a re-hearing in writing was ordered for the disputed benefits.

The applicant was struck by a truck while crossing an intersection on her mobility scooter and sought statutory accident benefits.

The respondent insurer denied several treatment plans for occupational therapy, physiotherapy, and psychological services, as well as claims for out-of-pocket expenses.

The Licence Appeal Tribunal found the applicant entitled to certain occupational therapy services due to a defective denial notice, as well as reimbursement for medication, damaged glasses, and dental repairs.

The Tribunal also ordered a special award under s. 10 of Regulation 664, finding the insurer acted unreasonably by expecting a family member to install a bed rail gratuitously instead of paying the installation cost.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, attendant care benefits, and various treatment plans for assessments and therapy.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to establish a complete inability to carry on a normal life, noting her pre-existing arteriovenous malformation and lack of evidence comparing pre- and post-accident functional abilities.

The Tribunal also dismissed the claims for treatment plans and attendant care benefits due to insufficient medical evidence and failure to prove the expenses were incurred.

Claims for an award, interest, and costs were also dismissed.

The applicant was riding an e-bike when she lost control and crashed, sustaining injuries including a fractured jaw.

She applied for statutory accident benefits, claiming a third-party vehicle encroached on her path, forcing her to swerve.

The respondent denied benefits, arguing there was no third-party vehicle involved and the incident did not meet the definition of an 'accident'.

The Tribunal found that the evidence, including 911 call transcripts and medical records, supported the applicant's version of events.

The Tribunal concluded that the use or operation of the third-party vehicle directly caused the impairments, satisfying both the purpose and causation tests under section 3(1) of the Schedule.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to non-earner benefits and various treatment plans outside the Minor Injury Guideline (MIG).

The adjudicator found that the applicant failed to prove her psychological impairments, physical injuries, or chronic pain warranted removal from the MIG.

Furthermore, the applicant did not provide sufficient evidence comparing her pre- and post-accident activities to establish a complete inability to carry on a normal life.

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

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 Tribunal found that the applicant's physical injuries were soft tissue in nature and that she failed to establish a psychological impairment that would remove her from the MIG.

Because the MIG limit was exhausted and the respondent's denial notices complied with the Schedule, the applicant was not entitled to the disputed treatment plans.

The Applicant was injured in a motorcycle accident and sought a determination that she sustained a catastrophic impairment under the Statutory Accident Benefits Schedule.

The Tribunal assessed her mental and behavioural impairments under criterion 8, applying the AMA Guides.

The Tribunal preferred the evidence of the Applicant's psychiatrist over the respondent's psychologist, finding the latter's report inconsistent with his testimony and test results.

The Tribunal concluded the Applicant suffered a marked impairment in three spheres of function (Activities of Daily Living, Social Functioning, and Adaptation) due to Somatic Symptom Disorder, Major Depressive Disorder, and Posttraumatic Stress Disorder.

The Tribunal declared the Applicant catastrophically impaired.

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

The respondent denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that she was barred from claiming a non-earner benefit (NEB) due to misrepresenting her primary residence.

The Tribunal found the applicant failed to prove her physical, psychological, or chronic pain injuries warranted removal from the MIG.

Furthermore, the Tribunal found the applicant misrepresented her primary residence to obtain a lower premium, disentitling her to an NEB.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing that her chronic pain and psychological impairments warranted removal from the Minor Injury Guideline (MIG).

The adjudicator found that the applicant failed to meet her burden of proof, as her chronic pain claims lacked objective medical corroboration and her psychological claims were inconsistent with her self-reported functionality to other assessors.

The adjudicator concluded that the applicant's injuries were predominantly minor and subject to the MIG limits.

Because the MIG limits were already exhausted, the disputed treatment plans were not considered, and claims for an award and interest were dismissed.