Lora Castellucci

The applicant, who sustained a catastrophic impairment in a motor vehicle accident, sought attendant care benefits (ACBs) up to $6,000 per month.

The respondent insurer partially denied the invoices, applying a 'ratio method' and Guideline rates because the applicant failed to provide a detailed breakdown of the time spent on each level of care.

The Tribunal found that the respondent's use of the ratio method was reasonable and approved by the Divisional Court in Malitskiy.

The Tribunal also held that insurers are not required to pay above the Guideline rates.

The application for ACBs, interest, and a special award was dismissed.

The applicant sought a determination that she sustained a catastrophic impairment (CAT) under Criterion 7 of the Statutory Accident Benefits Schedule following a motor vehicle accident.

The applicant relied on expert assessments suggesting a combined whole person impairment (WPI) of 63%, while the respondent's experts assessed her at 38%.

The Tribunal preferred the respondent's experts, finding the applicant's neurological and psychological ratings were largely unsupported by medical evidence and heavily influenced by pre-existing conditions.

The Tribunal concluded the applicant's combined WPI was 41%, falling short of the 55% threshold, and dismissed the application.

The applicant, who was 10 years old at the time of the motor vehicle accident, sought removal from the Minor Injury Guideline (MIG) and entitlement to various psychological treatment plans.

The Tribunal found that the applicant sustained accident-related psychological injuries, including PTSD and vehicular anxiety, warranting removal from the MIG.

The Tribunal approved treatment plans for psychological services and a psychological assessment, finding them reasonable and necessary.

However, a proposed family psychological assessment was denied as duplicative.

The applicant's claim for a special award under s. 10 of Reg. 664 was dismissed, but interest on overdue benefits was granted.

The appellant defendants appealed a motion judge's decision regarding the payment of settlement funds.

The Divisional Court dismissed the appeal, holding that a defendant who pays settlement funds directly to a plaintiff in the face of a Solicitors Act charging order does so at its peril.

Costs of $5,000 were awarded to the responding party solicitors.

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

The respondent insurer denied several treatment plans, asserting the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued the denial notices were defective under s. 38(8) of the Schedule.

The Tribunal found the respondent's denial notices failed to provide sufficient medical and any other reasons, as they were broad, vague, and did not explain how the MIG conclusion was reached.

Consequently, pursuant to s. 38(11), the disputed treatment plans were deemed payable once incurred.

The Tribunal also awarded interest but declined to order a special award, finding no evidence of intentional withholding of benefits.

The applicant sought attendant care benefits (ACBs) following a motor vehicle accident.

The respondent had approved the ACBs up to the non-catastrophic limit but required proof that the expenses were 'incurred' under the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant failed to provide sufficient evidence that the claimed expenses from a hospital, an air ambulance service, his grandmother, and a retired nurse were incurred or resulted in economic loss.

The Tribunal also found no evidence that the respondent unreasonably withheld or delayed payments.

The application for ACBs, interest, and an award was dismissed.

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

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to provide sufficient medical evidence to establish that they sustained a psychological impairment or chronic pain warranting removal from the MIG.

As the $3,500 MIG limit had been exhausted, the disputed treatment plans were denied, and no interest was payable.

Certas Home & Auto Insurance Company appealed an interim arbitration decision which held that Unifund Assurance Company had complied with the notice provisions under s. 3(1) of O. Reg. 283/95 (Disputes Between Insurers) by providing timely notice of a priority dispute for statutory accident benefits.

The core issue was the interpretation of "completed application" and when the 90-day notice period for disputing liability began.

The court dismissed the appeal, finding no error of law or palpable and overriding error in the arbitrator's interpretation or application of the regulation.

The court affirmed that a "completed application" for the purpose of s. 3 means one that provides sufficient information to allow the first insurer to notify another insurer of a dispute, not merely a filled-out and signed OCF-1 form.

Three appeals were heard together to determine whether the Licence Appeal Tribunal (LAT) has jurisdiction under s. 7 of the Licence Appeal Tribunal Act to extend the two-year limitation period for filing appeals set out in s. 56 of the Statutory Accident Benefits Schedule (SABS).

The Divisional Court held that s. 7 does grant the LAT jurisdiction to extend the s. 56 limitation period, as the time limit is fixed 'under an Act' (the Insurance Act).

The Court dismissed the insurers' appeals challenging the LAT's jurisdiction and its exercise of discretion to grant extensions, finding no errors of law.

In the third appeal, where the adjudicator had found no jurisdiction, the Court allowed the appeal and remitted the matter back to the LAT to consider the extension request.

Three appeals were scheduled to be heard regarding whether the Licence Appeal Tribunal (LAT) has jurisdiction under s. 7 of the Licence Appeal Tribunal Act to extend the two-year limitation period for statutory accident benefits applications.

The LAT had previously made conflicting decisions on this issue and indicated it did not intend to appear.

The Divisional Court adjourned the appeals and ordered the LAT to intervene and file materials to assist the court in determining the jurisdictional issue.

The applicant sought to dispute the respondent insurer's denial of a non-earner benefit.

The Tribunal previously found that the application was filed beyond the two-year limitation period under s. 56 of the Statutory Accident Benefits Schedule.

The applicant argued that the Tribunal had discretion to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act, 1999.

The Tribunal held that s. 7 applies only to limitation periods fixed by an Act, not those in regulations like the Schedule.

In the alternative, applying the Manuel test, the Tribunal found that the justice of the case did not favour extending the limitation period due to the lack of a bona fide intention to appeal, the length of the delay, and prejudice to the insurer.

The application was dismissed as time-barred.

The applicant was injured in a motor vehicle accident and sought an income replacement benefit (IRB) more than three years later, after her condition deteriorated.

The insurer denied the claim on the basis that she did not suffer a substantial inability to perform the essential tasks of her employment within 104 weeks of the accident, as required by s. 5(1) of the Statutory Accident Benefits Schedule, and that the claim was statute-barred under s. 56 because she failed to dispute a valid denial within the two-year limitation period.

The Tribunal agreed with the insurer, finding that the discoverability rule did not apply to save the claim where the substantive right to an IRB was not established within the initial 104-week period.

The application was dismissed as statute-barred.

The applicant was injured in a motor vehicle accident and initially continued to work, not meeting the test for an income replacement benefit (IRB).

Over three years later, her condition deteriorated, and she applied for an IRB.

The insurer denied the claim on the basis that she did not establish eligibility within 104 weeks of the accident and that the two-year limitation period had expired since the initial denial.

The Tribunal found that the applicant was statute-barred under s. 56 of the Schedule because she failed to appeal the valid initial denial within two years.

Furthermore, the Tribunal held that the discoverability doctrine did not apply to save the claim, as she failed to demonstrate substantive entitlement to an IRB within 104 weeks post-accident under s. 5(1).

The applicant, who was catastrophically impaired in a 2013 motor vehicle accident, sought payment for an in-home occupational therapy assessment to determine ongoing attendant care and housekeeping needs.

The respondent insurer denied the claim, arguing it was statute-barred under s. 56 of the Schedule because a previous denial was not disputed within two years, and that the assessment was not reasonable and necessary.

The Tribunal found that a 2016 partial settlement agreement did not permanently end the applicant's entitlement to these benefits and no settlement disclosure notice was provided.

The Tribunal concluded the claim was not statute-barred and that the assessment was reasonable and necessary given evidence of changes in the applicant's circumstances.

The applicant sought an extension of the two-year limitation period under section 7 of the Licence Appeal Tribunal Act to dispute the termination of his income replacement benefits.

The Tribunal applied the four-part test from Manuel v. Registrar, considering the applicant's intention to appeal, the length of the delay, prejudice to the insurer, and the merits of the appeal.

Finding that the applicant failed to demonstrate a clear intention to appeal within the limitation period and provided little evidence on the merits, the Tribunal declined to extend the time.

The claim for income replacement benefits was dismissed as out of time.

The applicant sought a non-earner benefit following a motor vehicle accident.

The insurer denied the benefit on May 18, 2016, because the applicant failed to submit a Disability Certificate (OCF-3).

The applicant applied to the Tribunal on August 10, 2018.

The insurer argued the application was statute-barred by the two-year limitation period.

The Tribunal found the May 18, 2016 denial letter was clear and unequivocal, triggering the limitation period.

The Tribunal held the application was filed late but allowed the parties to make written submissions on whether an extension of time should be granted under section 7 of the Licence Appeal Tribunal Act, 1999.

Following the dismissal of the applicant's proceeding, the respondent sought costs.

The court awarded the respondent costs on a partial indemnity basis, finding the hours and billable rates claimed to be reasonable.

The applicant was ordered to pay the respondent's costs fixed at $7,788.37.

The applicant sought a preliminary order deeming him catastrophically impaired under Criterion 7 of the Statutory Accident Benefits Schedule, relying on a section 44 insurer examination by Dr. Waseem that concluded he met the 55% Whole Person Impairment threshold.

The respondent insurer opposed the motion, relying on conflicting section 44 assessments and an executive summary that concluded the applicant's wheelchair dependency was caused by pre-existing diabetes complications rather than the accident.

The Tribunal dismissed the applicant's request, holding that an insurer is not bound by the opinion of a single section 44 assessor and that a full hearing was required to weigh the complex medical evidence regarding causation.

The Tribunal also ordered the applicant to attend a section 44 psychiatric examination before proceeding with the application.

The applicant sought judicial review of an Ontario Labour Relations Board decision dismissing her complaint that her former employer, a housing cooperative, engaged in reprisals against her for enforcing her rights under the Occupational Health and Safety Act.

The Tribunal found no evidence that the employer's actions, including extending her probation and terminating her employment, were motivated by her health and safety complaints.

The Divisional Court applied the reasonableness standard of review and found the Tribunal's findings of fact and legal analysis were justified, transparent, and intelligible.

The application for judicial review was dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits for physiotherapy.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered an accident-related psychological impairment, removing her from the MIG.

The Tribunal further held that the proposed physiotherapy treatment plans were reasonable and necessary for her recovery, and awarded the disputed benefits along with interest.