Pavlos Achlioptas

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRB) and a psychological treatment plan.

The respondent insurer delayed paying the IRB for over a year, demanding documentation that was not required to determine eligibility, despite having received the necessary OCF-2 and OCF-3 forms.

The Tribunal found the respondent's conduct in withholding the IRB to be imprudent, stubborn, and inflexible, and ordered an award of 50% of the delayed IRB amount under s. 10 of Regulation 664.

The Tribunal also found the disputed psychological treatment plan to be reasonable and necessary, noting it was not duplicative of the applicant's psychiatric consultations, and ordered it payable with interest.

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

The insurer initially deemed her catastrophically impaired but later reversed its decision based on an addendum report.

The applicant disputed the denial of several treatment plans submitted during the period she was deemed catastrophically impaired.

The Licence Appeal Tribunal held that the insurer could not retroactively apply its decision to revoke the catastrophic impairment designation, as the Schedule is consumer protection legislation.

The Tribunal found the applicant was entitled to apply for enhanced catastrophic policy coverage during that period.

The Tribunal partially approved two psychological treatment plans and two physical therapy treatment plans, finding them reasonable and necessary, but denied the remaining treatment plans and the request for an award.

The applicant, an international student, was injured in a motor vehicle accident and sought visitor's expenses for her mother's travel from China to Canada, claiming the visits were necessary for her recovery.

The respondent denied the benefits.

The Licence Appeal Tribunal found numerous inconsistencies in the applicant's evidence regarding her injuries, employment, and when she informed her family about the accident.

The Tribunal concluded that the applicant failed to prove on a balance of probabilities that the visitor's expenses were reasonable, necessary, or incurred as a result of the accident.

The application was dismissed.

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

The parties participated in a case conference and subsequently advised the Tribunal that the disputed issues had been resolved.

The Tribunal ordered the file closed.

The appellant insurer appealed a License Appeal Tribunal decision finding that its failure to provide compliant notices denying treatment plans under s. 38 of the Statutory Accident Benefits Schedule precluded it from relying on the Minor Injury Guideline limits.

The Divisional Court dismissed the appeal, holding that the Adjudicator reasonably interpreted s. 38(11) to mean that a non-compliant notice requires the insurer to pay for the goods and services in the specific treatment plan without the $3500 limit applying, until a compliant notice is given.

Following a successful arbitration for statutory accident benefits, the applicant sought an award for expenses.

The arbitrator found the applicant was entitled to expenses based on his success at the hearing.

Applying a 4:1 ratio for preparation to hearing time, the arbitrator awarded counsel fees at the legal aid rate, partial paralegal fees, and disbursements, totaling $17,023.43.

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

At the scheduled arbitration hearing, the applicant failed to attend.

The applicant's legal representative brought a motion to be removed from the record due to a breakdown in the solicitor-client relationship, which was granted.

The insurer brought an oral motion to dismiss the application for arbitration due to the applicant's non-attendance.

The arbitrator dismissed the application and awarded costs of $6,221.42 to the insurer, noting the applicant's failure to attend insurer's examinations, failure to provide income documentation, and failure to attend the hearing.

The applicant sought accident benefits following a motor vehicle accident.

The parties settled the substantive issues immediately prior to the scheduled arbitration, leaving only the issue of expenses in dispute.

The applicant sought $12,532.83 in costs, while the insurer sought $17,220.24.

The arbitrator found that because the matter did not proceed to a hearing and both parties achieved a mixed result, neither party was entitled to its expenses.

The applicant was injured in a T-bone collision and received income replacement benefits (IRBs) for two years.

The insurer terminated IRBs at the 104-week mark, arguing the applicant could return to suitable employment.

The Tribunal found that the applicant's accident-related soft tissue injuries aggravated pre-existing arthritis in his hand, resulting in chronic pain and functional limitations.

Given his physical restrictions, limited education, and lack of transferable skills, the Tribunal concluded he suffered a complete inability to engage in suitable employment and was entitled to ongoing IRBs.

Claims for further chiropractic and massage treatments were dismissed as not reasonable or necessary.

The applicant sought an income replacement benefit and the cost of a psychological assessment following a motor vehicle accident.

The adjudicator found that the applicant failed to prove a substantial inability to perform the essential tasks of his pre-accident employment as an articling student, noting contradictions in his evidence and a lack of supporting medical documentation.

The adjudicator also denied the psychological assessment, accepting the respondent's expert evidence that the applicant did not suffer from a clinically significant, accident-related psychological impairment.

Both parties' requests for costs were dismissed.

The insurer raised a preliminary issue arguing that the insured was barred from proceeding to mediation and arbitration because he failed to attend a scheduled insurer's examination under section 44 of the Statutory Accident Benefits Schedule.

The arbitrator found that the examination had been cancelled by mutual consent because the insured had travelled to China, and the insurer made no subsequent attempts to reschedule it.

As there was no active examination for the insured to attend, he did not fail to comply with the Notice of Examination.

The insurer's motion was dismissed, and the insured was permitted to proceed to arbitration.