Steven Arie Glowinsky

The applicant sought statutory accident benefits following a motor vehicle accident, specifically funding for a neuropsychological catastrophic assessment, a neurocognitive catastrophic assessment, and document support expenses.

The adjudicator found that the neuropsychological assessment was reasonable and necessary because the medical evidence raised a question regarding whether the applicant's impairments stemmed from the accident, entitling the applicant to an expert opinion on the issue.

However, the adjudicator denied funding for the neurocognitive assessment, finding it would overlap with the neuropsychological assessment, and denied the document support expenses for lack of supporting evidence.

The applicant was awarded $2,260.00 for the neuropsychological assessment and HST.

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

The insurer partially denied an OCF-18 for catastrophic assessments and issued an Explanation of Benefits.

The applicant filed an application with the Licence Appeal Tribunal more than two years after the denial.

At a preliminary issue hearing, the applicant argued the limitation period was not triggered because the denial notice did not detail the entire dispute resolution process up to the Supreme Court of Canada or address discoverability.

The Tribunal rejected this argument, finding the denial notice was compliant with section 54 of the Schedule and the principles in Smith v. Co-operators, as it provided sufficient information for the applicant to decide whether to dispute the refusal.

As the applicant provided no submissions for an extension under section 7 of the LAT Act, the application was dismissed as statute-barred.

The applicant was injured in a motor vehicle accident and initially received income replacement benefits (IRBs), which were terminated by the insurer in January 2019.

The applicant continued to work at a reduced level until April 2020, when he fully withdrew from self-employment and subsequently claimed post-104 week IRBs.

The insurer argued the claim was barred by the two-year limitation period under s. 56 of the Schedule.

The Tribunal applied the doctrine of discoverability, finding that the post-104 week IRB has a distinct eligibility test that could not have been met or denied until two years post-accident.

Therefore, the limitation period did not bar the applicant from proceeding to a hearing for post-104 week IRBs.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, which the respondent insurer denied.

The Licence Appeal Tribunal found that the applicant was entitled to the cost of a neurological assessment, as his treating physician diagnosed a nerve injury and the insurer's assessors lacked access to those medical records.

However, the Tribunal dismissed the claims for a chronic pain assessment, a Functional Ability Evaluation, psychological treatment, and transportation costs for an orthopaedic assessment, finding them not reasonable and necessary due to pre-existing conditions, lack of contemporaneous evidence, and unpersuasive expert reports.

The claim for a special award under Regulation 664 was also dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The applicant claimed entitlement to a physical treatment balance, an orthopaedic assessment, and a chronic pain assessment, as well as a special award and interest.

The Tribunal dismissed all claims, finding that the applicant failed to prove the proposed treatment and assessments were reasonable and necessary.

Specifically, the Tribunal noted that the applicant had already received two OHIP-funded orthopaedic assessments, which constituted reasonably available medical benefits under another plan or law.

Furthermore, the evidence did not support the necessity of a chronic pain assessment, as the applicant's pain was managed with medication and he had not sought specialized chronic pain treatment.

The applicant sought statutory accident benefits after falling through a gap between her house and back patio.

The gap was created when a motor vehicle struck the patio, detaching it from the house.

The applicant heard the collision, went to investigate, and fell.

The respondent denied benefits, arguing the incident did not meet the definition of an "accident" under section 3(1) of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal found that the incident satisfied both the purpose and causation tests.

The operation of the vehicle was the direct cause of the applicant's injuries, and there was no intervening act breaking the chain of causation.

The Tribunal concluded the incident was an accident.