Maciek Piekosz

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including attendant care benefits and funding for a multidisciplinary catastrophic impairment assessment.

The respondent insurer denied the benefits.

The Tribunal found that the applicant failed to prove the attendant care benefits were reasonable and necessary, as insurer's examinations indicated she had returned to her pre-accident functional abilities.

The Tribunal also denied the catastrophic impairment assessment treatment plan, finding insufficient medical evidence to support that it was reasonably possible the applicant sustained a catastrophic impairment.

The application was dismissed.

The applicant, who was injured in a motor vehicle accident while visiting Canada, sought $21,357.00 for catastrophic impairment assessments after his accident benefits were exhausted.

The respondent insurer denied the treatment plan, relying on independent medical examinations that found no objective impairments.

The Tribunal found that the applicant's occupational therapy evidence and medical records established a reasonable basis to investigate a catastrophic impairment, noting his ongoing physical and psychological limitations.

The Tribunal partially approved the treatment plan for $12,400.00, allowing the physiatry, neurology, occupational therapy, and one psychiatry assessment, but denied duplicative assessments and file reviews.

The claim for an award for unreasonable delay was dismissed.

The defendant brought a motion to compel the plaintiff to attend a defence neuropsychological assessment and for an extension of time to serve the resulting expert report.

The plaintiff had increased his damages claim from approximately $1.5 million to $2.1 million based on additional expert reports regarding future care costs delivered between August and October 2024.

The defendant requested the assessment in late October 2024, after the deadline for service of defence expert reports had passed on December 16, 2024.

The court found the defendant had a reasonable explanation for the delayed request, as the plaintiff's expert reports materially changed the damage claim.

The court granted the motion, ordering the plaintiff to attend the assessment on October 21, 2025, and granting leave to serve the report by November 30, 2025.

The court also granted the plaintiff leave to amend the statement of claim to increase the quantum of damages without additional terms.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found she did not sustain a catastrophic impairment.

The applicant alleged the adjudicator committed a material breach of procedural fairness by limiting oral submissions and excluding an Aide Memoire, and made errors of law and fact in assessing her activities of daily living, communication abilities, and expert evidence.

The Tribunal dismissed the request, finding no breach of procedural fairness as the parties were granted ample time for submissions.

The Tribunal also held that the alleged factual errors would not have changed the outcome and that the applicant was improperly attempting to re-litigate the weighing of evidence.

The applicant sought a determination that he sustained a catastrophic impairment under s. 3(2)(f) of the Statutory Accident Benefits Schedule following a 2015 motor vehicle accident.

The sole issue was whether the applicant suffered a Class 4 (marked) impairment in the sphere of adaptation.

The Tribunal found that the applicant's ability to complete occupational therapy tasks, maintain independent activities of daily living, and sustain seasonal employment for five years post-accident demonstrated some useful functioning.

Preferring the respondent's psychiatric evidence, the Tribunal concluded the applicant suffered only a Class 3 (moderate) impairment in adaptation and dismissed the application.

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

The respondent denied the benefits, arguing that an intervening accident broke the chain of causation and relying on its own independent medical examinations.

The Tribunal found that the subject accident was a necessary cause of the applicant's physical injuries, but not her psychological complaints.

The Tribunal awarded partial attendant care benefits for meal preparation and laundry assistance, and approved several treatment plans including occupational therapy, a cognitive assessment, and vestibular physiotherapy.

The Tribunal also ordered a 10 per cent special award against the respondent for unreasonably maintaining the applicant in the Minor Injury Guideline despite knowing she had sustained a concussion.

The court considered whether the plaintiff, Cory McGrath, sustained a permanent serious impairment of an important physical, mental, or psychological function as a result of a motor vehicle collision, as required by the "threshold" in section 267.5(15) of the Insurance Act.

After a jury trial and detailed review of the evidence, including expert and lay testimony, the court found that Ms. McGrath met the threshold, entitling her to recover health care expenses and non-pecuniary loss.

The decision provides a thorough application of the statutory and regulatory framework, and the relevant case law, to the facts of the case.

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

The respondent insurer suspended the IRB based on section 44 assessments but reinstated the benefits just five days before the hearing, after a 686-day delay.

The sole issue at the hearing was whether the respondent was liable for an award under section 10 of Regulation 664 for unreasonably withholding or delaying payments.

The Tribunal found that the respondent failed to adjust the file as new information became available, specifically section 25 rebuttal reports, and that its conduct was inflexible.

The Tribunal ordered the respondent to pay a 25 per cent award on the total IRB payable during the delay period.

The applicant was involved in a motor vehicle accident and sought a non-earner benefit (NEB) under the Statutory Accident Benefits Schedule.

The respondent insurer argued the application was statute-barred because the applicant failed to submit the OCF-1 form within the required timeframe.

The Tribunal found the applicant was not statute-barred, as the respondent failed to prove it sent the blank OCF-1 form to the applicant's correct address, meaning the 30-day time limit was never triggered.

However, on the substantive issue, the Tribunal dismissed the claim for a NEB.

The applicant failed to provide sufficient medical evidence comparing his pre- and post-accident functioning to establish a complete inability to carry on a normal life within 104 weeks of the accident.

Claims for interest and an award were consequently dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a catastrophic impairment due to a mental or behavioural disorder under Criterion 8 of the Schedule.

The Tribunal assessed the applicant's functioning across four spheres: activities of daily living, social functioning, concentration, persistence and pace (CPP), and adaptation.

While the Tribunal found a marked impairment in CPP, it concluded the applicant only sustained moderate impairments in the other three spheres.

As the applicant did not demonstrate a marked impairment in three or more spheres, or an extreme impairment in one, the application was dismissed.

The applicant requested reconsideration of a Licence Appeal Tribunal decision that dismissed his application for an income replacement benefit as time-barred.

The applicant argued the Tribunal erred in law by revisiting a prior interlocutory decision, failing to consider the respondent's post-termination conduct, and refusing to order payment of the benefit.

The Vice-Chair dismissed the reconsideration request, finding that the Tribunal properly applied binding appellate jurisprudence regarding the termination of benefits and the limitation period, and made no errors of law or procedural fairness.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident.

The respondent denied the benefits after the applicant returned to full-time work, and later suspended them when the applicant failed to attend insurer examinations (IEs) after his employment was terminated.

The Tribunal found that the applicant was statute-barred from proceeding to a hearing because he failed to apply within two years of the respondent's valid denial.

The Tribunal also held that the applicant was not entitled to the benefits claimed because he failed to attend properly scheduled IEs.

The application was dismissed.

The applicant sought a determination of catastrophic impairment following a motor vehicle accident.

The respondent scheduled psychological and occupational therapy insurer's examinations (IEs).

The applicant attended both, but the psychologist passed away before finalizing his report, and the applicant declined to participate in the situational portion of the occupational therapy IE.

The respondent scheduled a second set of IEs, which the applicant refused to attend.

The Tribunal found that a second in-person psychological IE was not reasonably necessary, as the respondent possessed the draft report and raw data.

However, the Tribunal found the situational occupational therapy assessment was reasonably necessary.

The Tribunal stayed the proceeding until the applicant complied with the situational assessment requirement.

The applicant was injured in a motorcycle accident and sought a determination of catastrophic impairment.

The insurer initially denied the determination pending insurer examinations.

The applicant sought $14,238.00 for the cost of catastrophic examinations obtained to support his application.

The Tribunal found the applicant was not precluded from obtaining examinations before the insurer completed its own, and that the costs were reasonable and necessary.

The Tribunal ordered the insurer to pay the examination costs with interest, but denied the applicant's request for a special award, finding the insurer had not acted unreasonably.

The applicant requested a reconsideration of a preliminary issue decision that found his application for income replacement benefits was statute-barred.

The Vice-Chair granted the reconsideration, applying the recent Divisional Court decision in Varriano v. Allstate, which held that insurers must provide medical and other reasons for discontinuing benefits under s. 37(4) of the Schedule.

Because the insurer's denial cited only a return to work and failed to include a medical reason, it was invalid and did not trigger the limitation period.

The applicant was permitted to proceed with his application.

The moving parties sought leave to appeal an order dated December 17, 2021.

The Divisional Court dismissed the motion for leave to appeal.

As no costs outlines were filed by the parties, the court made no order as to costs.

The applicant sought income replacement and medical benefits following a motor vehicle accident.

The insurer denied the benefits and the applicant applied to the Tribunal more than two years later.

The Tribunal held that the applicant was statute-barred from proceeding under s. 56 of the Schedule because the application was commenced after the two-year limitation period expired, and there were no reasonable grounds to extend it.

Furthermore, the applicant was statute-barred under s. 55(1)2 for failing to attend properly scheduled insurer's examinations.

The plaintiff in a motor vehicle accident case brought a motion to strike the defendants' jury notice due to the COVID-19 pandemic and the resulting backlog of cases in the Southwest Region.

The trial was scheduled for January 2022.

The court noted the unprecedented crisis in the civil justice system and the need to prioritize criminal and family matters.

To prevent the case from becoming stale and to assist the administration of justice, the court provisionally struck the jury notice, allowing the case to proceed as a non-jury trial unless civil jury trials could be accommodated at the time of trial.

The defendants brought a motion for an order compelling the plaintiff to attend an independent medical examination (IME) with a neuropsychologist in Hamilton.

The plaintiff agreed to the IME and the choice of physician but sought accommodation due to childcare responsibilities and ongoing family and criminal proceedings.

The court, while acknowledging the defendants' entitlement to the IME, imposed conditions to accommodate the plaintiff, including covering transportation and childcare expenses, and allowing the assessment to be conducted over multiple days if necessary to respect her childcare commitments.

The applicant sought a determination that she sustained a catastrophic impairment as a result of a motor vehicle accident.

The dispute centered on whether she suffered a class 4 marked impairment in the Adaptation domain due to a mental or behavioural disorder.

The Tribunal applied the three-step test from Pastore and preferred the evidence of the applicant's experts, finding her credible regarding her chronic pain, social withdrawal, and inability to cope with stress.

The Tribunal concluded that the applicant's functioning in adaptation was significantly impeded, meeting the threshold for a catastrophic impairment.