Nathan M. Fabiano

The applicant sought statutory accident benefits following a 2014 motor vehicle accident, including funding for physiatry, chronic pain, and neurological assessments, as well as assistive devices.

The respondent denied the treatment plans on the basis of a lack of contemporaneous medical evidence and the application of the Minor Injury Guideline.

The Tribunal found that the applicant failed to establish on a balance of probabilities that the disputed treatment plans were reasonable and necessary, noting the absence of contemporaneous medical records corroborating the applicant's self-reported chronic pain.

The Tribunal also found that the respondent complied with the notice requirements under s. 38(8) of the Schedule.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a 2014 motor vehicle accident.

The Licence Appeal Tribunal found the applicant was entitled to $1,748.81 for assistive devices and physical therapy, as the occupational therapy assessment supported their necessity for a return to normal life.

However, the Tribunal denied a $3,081.50 chronic pain assessment due to a lack of contemporaneous medical evidence and the applicant's failure to attend a previously approved assessment.

Claims for an award under s. 10 of Regulation 664 were dismissed, but interest was awarded on the overdue benefits.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied his claim for a dental services treatment plan and interest.

The applicant argued that proceeding by way of a written hearing was procedurally unfair because he could not summons the respondent's dental assessor, and that medical issues prevented him from submitting his materials on time.

The Tribunal dismissed the request, finding that the applicant had an opportunity to dispute the hearing format at the case conference and that his medical note post-dated the deadline for his written submissions.

The applicant failed to establish any grounds for reconsideration under Rule 18.2.

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

The respondent insurer denied benefits and scheduled insurer's examinations (IEs) to assess entitlement to medical benefits and non-earner benefits.

The applicant failed to attend the IEs.

The respondent argued the applicant was barred from proceeding with his application under section 55 of the Schedule.

The Tribunal found that the notices of examination for the medical benefits did not comply with section 44(5) as they lacked sufficient medical or other reasons.

However, the notices for the non-earner benefits were compliant.

Therefore, the applicant was permitted to proceed with his claim for medical benefits but barred from proceeding with his claim for non-earner benefits.

The applicant sought judicial review and appealed a Licence Appeal Tribunal decision holding him to a 2004 settlement of his motor vehicle accident claims.

The applicant argued the settlement was invalid because he initialed, rather than signed, the Statutory Disclosure Notice.

The Divisional Court dismissed the appeal, finding that the applicant's failure to sign the specific signature line was a technical and immaterial defect that did not invalidate the notice or allow him to rescind the agreement.

The applicant was struck by a vehicle while crossing the street and sought statutory accident benefits for injuries sustained.

The insurer denied two treatment plans for chiropractic services and assistive devices.

The Licence Appeal Tribunal found both treatment plans to be reasonable and necessary, preferring the applicant's medical evidence over the insurer's examination reports, which were primarily focused on a withdrawn non-earner benefit claim.

The Tribunal awarded interest on the overdue benefits but dismissed the applicant's claim for a special award, finding the insurer had applied proper due diligence.

The Tribunal also dismissed the insurer's request for costs related to the late withdrawal of the non-earner benefit claim.

The applicant sought a $10,000 death benefit under the Statutory Accident Benefits Schedule following the death of her husband in a motor vehicle accident.

The respondent insurer denied the claim on the basis that the applicant was not "principally dependent" on her late husband for financial support.

The Tribunal applied the criteria from Miller v. Safeco, analyzing the applicant's financial situation in the six months prior to the accident.

The Tribunal found that the applicant's own income was sufficient to cover more than 51% of her financial needs, meaning she was not principally dependent on her husband.

The application for the death benefit, along with claims for interest and a special award, was dismissed.

The applicant requested a reconsideration of a decision finding the respondent was not liable to pay an income replacement benefit due to a material misrepresentation.

The applicant argued the Tribunal exceeded its jurisdiction, denied procedural fairness, failed to apply strict statutory interpretation, and erred in declining to apply equitable principles of waiver and estoppel.

The Tribunal dismissed the request, finding no breach of procedural fairness, no ambiguity requiring strict statutory interpretation, and confirming that the Tribunal lacks jurisdiction to apply equitable remedies under the Statutory Accident Benefits Schedule.

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

The respondent determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied income replacement benefits (IRB) and certain treatment plans.

The Tribunal found that the applicant's injuries were predominantly minor and that he failed to prove a pre-existing condition, psychological injury, or chronic pain that would remove him from the MIG.

The Tribunal also found the applicant was not entitled to an IRB as he did not suffer a substantial inability to perform the essential tasks of his pre-accident employment.

However, the Tribunal found the disputed physiotherapy treatment plans were reasonable and necessary, and ordered them payable up to the $3,500 MIG limit, less amounts already paid.

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

The respondent denied certain psychological treatment and assessment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant contended that pre-existing back pain and accident-related psychological impairments and chronic pain removed her from the MIG.

The Tribunal found insufficient medical evidence to support the applicant's claims, noting her family physician's records did not substantiate a pre-existing condition or a psychological diagnosis.

The Tribunal preferred the respondent's psychological expert over the applicant's, concluding the injuries were predominantly minor and the disputed treatment plans were not reasonable and necessary.

The application was dismissed.

The applicant, who sustained a catastrophic brain injury in a motorcycle accident, sought $7,017.40 for the unapproved portion of a home modification assessment treatment plan.

The insurer had partially approved the plan up to the $2,000 cap for assessments.

The Tribunal found that the home modification assessment involved an appraisal of the applicant's health status and functional limitations, and was therefore subject to the $2,000 cap under s. 25(5)(a) of the Schedule.

The application for the unapproved balance and interest was dismissed.

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

The insurer denied the claims between 2015 and 2017.

The applicant filed an application with the Tribunal in August 2019, well beyond the two-year limitation period.

The insurer raised a preliminary issue that the application was statute-barred under s. 56 of the Schedule.

The Tribunal found that the insurer's denial notices were clear and unequivocal, meeting the requirements set out in Smith v. Co-Operators.

The Tribunal also declined to extend the limitation period under s. 7 of the LAT Act, finding no bona fide intention to appeal within the time limit, significant delay, and prejudice to the insurer.

The application was dismissed as statute-barred.