Miryam Gorelashvili

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

The adjudicator found that the applicant failed to prove on a balance of probabilities that his injuries fell outside the MIG.

The medical evidence indicated large gaps in treatment and an intervening fall that caused significant injuries, breaking the causal link to the accident.

Furthermore, the adjudicator preferred the respondent's psychological assessment, which found no accident-related psychological disorder.

As the applicant remained within the MIG, the disputed treatment plans and claim for interest were dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic services, physiotherapy services, and an attendant care assessment.

The respondent denied the benefits.

The Tribunal found that the applicant failed to prove the chiropractic and physiotherapy treatment plans were reasonable and necessary due to a lack of contemporaneous medical evidence.

However, the Tribunal approved the attendant care assessment, noting that the respondent's own subsequent request for a functional abilities evaluation contradicted its position that an assessment was not warranted.

The applicant was also awarded interest on the overdue payment for the assessment.

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

The insurer denied benefits, arguing the applicant was subject to the Minor Injury Guideline (MIG) and ineligible for an Income Replacement Benefit (IRB).

The Tribunal found the applicant did not meet the employment or self-employment criteria for an IRB.

However, the Tribunal removed the applicant from the MIG based on a documented concussion diagnosis from a treating emergency physician, rejecting the insurer's s. 44 assessor who failed to address the hospital records.

The Tribunal approved several treatment plans for occupational therapy, psychological assessment, massage therapy, and social rehabilitation counselling as reasonable and necessary.

The Tribunal also ordered the insurer to pay for an accounting report used to calculate the IRB claim, noting the Schedule only requires the applicant to be applying for the benefit, not entitled to it.

The claim for a special award under s. 10 of Reg. 664 was dismissed because the insurer reasonably relied on a s. 44 assessment.

The Director of the Motor Vehicle Accident Claims Fund sought to stay the proceeding on the basis that the plaintiff, Gerald Heron McKee, was mentally incapable of commencing the action, or in the alternative, to have a litigation guardian appointed or to require a capacity assessment.

The court found that the presumption of capacity had not been rebutted by compelling evidence and dismissed the motion, emphasizing the importance of autonomy and privacy for litigants and the high threshold for court intervention in counsel's assessment of client capacity.

The applicant was injured in a bus accident and sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The respondent denied several treatment plans, including a catastrophic impairment assessment, assistive devices, and various therapies.

The Tribunal found that the applicant proved the OT CAT assessment and related forms were reasonable and necessary, noting the respondent's own assessor had recommended them.

However, the Tribunal dismissed the claims for the other treatment plans due to a lack of contemporaneous medical evidence.

The Tribunal also ordered the respondent to pay a special award of $440 under s. 10 of O. Reg. 664, finding that the respondent unreasonably delayed the OT CAT assessment for over four years despite its own assessor's recommendation.

The respondent insurer requested a reconsideration of a Tribunal decision awarding the applicant attendant care benefits.

The insurer argued the Tribunal erred in finding it had not properly denied the benefits and in awarding benefits despite finding no functional limitations caused by the accident.

The Vice-Chair dismissed these grounds, finding no error of fact or law.

However, the Vice-Chair granted the reconsideration in part, finding the Tribunal erred by failing to apply section 42(5) of the Schedule, which governs retroactive attendant care benefits before a Form 1 is submitted.

The decision was varied to award attendant care benefits only from the date the Form 1 was received.

The applicant, who sustained a catastrophic impairment including a traumatic brain injury in a motor vehicle accident, sought various statutory accident benefits.

The Licence Appeal Tribunal found the applicant was entitled to a non-earner benefit for a limited period, as she demonstrated a complete inability to carry on a normal life.

The Tribunal also approved a treatment plan for psychological services, finding it reasonable and necessary given her ongoing psychological impairments.

However, claims for a rehabilitation support worker, occupational therapy, kinesiology, and life skills training were dismissed due to insufficient evidence or because similar previously approved funds remained unutilized.

The claim for a special award was dismissed as the insurer did not act in bad faith.

The applicant, a resident of China injured in a tour bus crash in Ontario, sought various statutory accident benefits including non-earner benefits, attendant care, and multiple treatment plans.

The Licence Appeal Tribunal denied the non-earner benefits due to the applicant's failure to provide an updated disability certificate as reasonably requested by the insurer.

The Tribunal also denied the attendant care benefits and most of the treatment plans, finding the applicant failed to meet her burden of proving they were reasonable and necessary.

However, the Tribunal approved a treatment plan for psychological services, finding the applicant continued to experience significant psychological symptoms that warranted further treatment.

The claim for a bad faith award was dismissed.

The applicant requested a reconsideration of a decision finding her subject to the Minor Injury Guideline (MIG) and denying her disputed treatment plans.

The applicant argued the Tribunal erred in law by failing to address the reasonableness and necessity of the treatment plans up to the MIG limits.

The Tribunal granted the reconsideration, finding that under section 40(8) of the Schedule, benefits incurred under the MIG are deemed reasonable and necessary once the MIG is found to apply.

The decision was varied to entitle the applicant to the incurred benefits up to the MIG limits, plus interest.

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

The respondent insurer determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied treatment plans for physiotherapy and psychological services.

The Tribunal found that the applicant sustained a concussion and post-concussion symptoms, which fall outside the definition of a minor injury, thereby removing him from the MIG.

However, the Tribunal dismissed the claims for the specific physiotherapy and psychological treatment plans, finding the applicant failed to demonstrate they were reasonable and necessary.

No interest was awarded.

The applicant, a Chinese tourist, was involved in a single-vehicle bus accident in Ontario and sought statutory accident benefits, claiming she sustained a catastrophic impairment including a traumatic brain injury and severe psychological impairments.

The respondent denied the benefits, arguing her ongoing impairments were related to pre-existing conditions and post-accident falls in China.

The Licence Appeal Tribunal found that the applicant failed to prove she sustained a traumatic brain injury in the accident, attributing her cognitive and physical decline to a probable cerebrovascular event and subsequent falls.

The Tribunal dismissed the claims for catastrophic impairment, non-earner benefits, and most medical and rehabilitation benefits.

However, the Tribunal awarded CN ¥159,705 yuan for incurred attendant care services and CN ¥612.32 yuan for specific prescription medications, finding the respondent had sufficient information to adjust those claims and the applicant had proven they were incurred.

The applicant, a tourist from China, was injured in a motorcoach accident and sought statutory accident benefits, including attendant care benefits (ACB) and various medical and rehabilitation benefits.

The respondent denied the benefits.

The Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, preferring the respondent's section 44 assessors who found normal range of motion and negative response bias over the applicant's outdated and self-report-based assessments.

The Tribunal also found the applicant was not entitled to ACB due to inconsistent evidence regarding incurred expenses and non-compliance with section 33 of the Schedule.

The application was dismissed.

The applicant was injured in a motor vehicle accident while visiting Canada and sought statutory accident benefits.

The respondent denied several treatment plans (OCF-18s) for massage therapy, occupational therapy, assistive devices, transportation, a rehabilitation support worker, physiotherapy, and an attendant care assessment.

The Tribunal found that the treatment plans proposing services in Shanghai were not feasible due to the applicant's severe travel anxiety.

The Tribunal also found the assistive devices and rehabilitation support worker plans were not reasonable and necessary.

However, the Tribunal allowed the occupational therapy plan to address sleep and pain management related to psychological impairments, as well as the attendant care assessment.

The applicant's claim for an award under Regulation 664 was dismissed.

The applicant sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent insurer denied the treatment plans.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the disputed treatment plans were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's assessors, noting credibility issues and a lack of contemporaneous medical evidence supporting the applicant's assessors.

Claims for interest and an award for unreasonable delay were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits and several treatment plans.

The Licence Appeal Tribunal denied the attendant care benefits, finding the applicant failed to prove the expenses were incurred, noting contradictory evidence and a lack of detailed invoices.

The Tribunal also denied treatment plans for physiotherapy, occupational therapy, and life skills training, as the applicant failed to establish they were reasonable and necessary or payable due to insurer non-compliance.

However, the Tribunal granted the treatment plan for psychological services, finding it reasonable and necessary based on the applicant's progress and ongoing symptoms.

The claim for a special award was dismissed.

The Applicant sought statutory accident benefits following a motor vehicle accident, claiming physical and psychological impairments that fell outside the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the Applicant failed to meet her burden of proving her injuries warranted treatment beyond the $3,500 MIG cap.

The Tribunal preferred the respondent's medical evidence, noting symptom magnification and a lack of validity testing in the applicant's psychological assessment.

All claims for medical benefits, assessments, interest, and an award were dismissed.

The applicant sought statutory accident benefits after an altercation with a motorcyclist.

The applicant walked into the street to confront the motorcyclist about noise, grabbed the motorcycle's handlebars, and was subsequently assaulted by the motorcyclist.

The respondent denied benefits on the basis that the incident was not an 'accident' under the Schedule.

The Tribunal agreed, finding that the incident was an assault that broke the chain of causation and did not arise out of the ordinary and well-known activities for which motorcycles are used.

The application was dismissed.

The applicant, a minor who was injured in a motor vehicle accident, sought court approval of a $100,000 settlement of her Statutory Accident Benefits claim.

The court declined to approve the settlement due to significant procedural and evidentiary deficiencies in the application record.

The deficiencies included a lack of notice to the respondent, absence of consent or minutes of settlement, incomplete draft order terms, and insufficient medical and financial evidence to determine if the settlement amount was reasonable.

The court remained seized of the matter and directed the applicant to file additional materials.

The defendant moved for summary judgment, arguing the plaintiff's motor vehicle accident claim was statute-barred as it was commenced more than two years after the accident.

The court found that due to the statutory threshold requirements, the limitation period did not begin to run until the plaintiff knew or ought to have known she had a viable tort claim.

The court concluded there was a genuine issue requiring a trial regarding when the cause of action was discovered, and dismissed the motion for summary judgment.

The applicant insurer sought an order compelling seven respondents to attend examinations under oath regarding their statutory accident benefits claims, specifically attendant care benefits, due to concerns about validity.

The respondents refused, citing insufficient notice of the reasons for examination and their medical conditions.

The court dismissed the motion, holding that the insurer's generic notice ("determining whether State Farm is liable to pay benefits") was inadequate under s. 33(4)3 of the Statutory Accident Benefits Schedule.

The court emphasized that specific reasons for the examination are a condition precedent to the obligation to attend, allowing insureds to prepare adequately.