Maciek R. Piekosz

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 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.

The respondent insurer brought a motion for the production of the appellant's medical records and information regarding a subsequent insurance policy.

The appellant opposed the motion, arguing that the only issue in the appeal was whether he had a reasonable explanation for submitting his claim late, making medical records irrelevant.

The Tribunal granted the motion, finding that there was a medical issue in the appeal regarding the cost of a Disability Certificate, and that the requested documents were relevant to assessing the appellant's credibility and his explanation for the delay.

The applicant was injured in two motor vehicle accidents and sought non-earner benefits for both.

The insurer moved to bar the appeals, arguing they were filed beyond the two-year limitation period under s. 56 of the Statutory Accident Benefits Schedule.

The Tribunal found that the appeal for the first accident was statute-barred as the denial notice was clear and unequivocal.

However, the appeal for the second accident was allowed to proceed because the insurer issued multiple, confusing denial notices with changing reasons, which misled the applicant regarding the limitation period.

The applicant's request for costs was denied.

The appellant appealed the dismissal of her action for injuries sustained in a slip and fall on an icy, sloped municipal boulevard connecting to a private driveway.

She argued the municipality owed a higher standard of maintenance because pedestrians occasionally cross there, and that the adjacent property owner was an occupier of the boulevard.

The Court of Appeal dismissed the appeal, finding the municipality's maintenance standard was for vehicles, not pedestrians, and the adjacent owner did not exercise control over the boulevard to qualify as an occupier.