Paul DeLuca

The applicant, a pedestrian involved in a 2010 motor vehicle accident, sought funding for $26,919.25 in catastrophic impairment (CAT) assessments.

The insurer denied the funding after conducting its own assessments and determining the applicant was not catastrophically impaired.

On a reconsideration hearing, the Tribunal found that the applicant failed to prove the proposed assessments were reasonable and necessary.

The Tribunal noted a lack of objective medical evidence supporting a reasonable possibility of catastrophic impairment, significant inconsistencies in the applicant's reporting, and the fact that the applicant had used less than $10,000 in treatment funding over ten years.

The claims for the assessment costs, interest, and an award were dismissed.

The applicant requested a reconsideration of a decision denying an examination expense of $24,400 for catastrophic impairment assessments.

The applicant argued the adjudicator erred in fact by believing the assessments only concerned criterion 8, and erred in law by failing to apply the Saadati principles.

The adjudicator found that while there was an error in fact regarding the scope of the assessments, it would not have changed the outcome as the applicant failed to establish a reasonable need for the assessments under any criteria.

The request for reconsideration was dismissed.

The applicant sought various statutory accident benefits following a motor vehicle accident, including treatment plans for assistive devices, psychological services, hydrotherapy, chiropractic services, and catastrophic impairment assessments.

The insurer denied the benefits, arguing the applicant's ongoing issues were related to a significant pre-existing back condition and opioid dependence, not the accident.

The adjudicator dismissed the application, finding the applicant failed to provide sufficient medical evidence to prove the treatments were reasonable and necessary, and preferred the insurer's medical assessors who concluded the accident did not exacerbate the pre-existing condition.

The defendants brought a motion for summary judgment to dismiss the plaintiff's motor vehicle accident claim, arguing the plaintiff was entirely at fault for failing to yield at an intersection where traffic lights were inoperative.

The court found a genuine issue for trial regarding whether the plaintiff stopped before entering the intersection, which required a credibility assessment.

The court declined to use its expanded fact-finding powers under Rule 20.04 due to evidentiary issues, including the parties' failure to cross-examine witnesses on contradictory evidence as required by the rule in Browne v. Dunn, and problems with the plaintiff's expert evidence.

The motion for summary judgment was dismissed.

The applicant sought entitlement to statutory accident benefits following a motor vehicle accident, including costs for a catastrophic impairment assessment, chiropractic treatment plans, and a psychological assessment.

The Tribunal found that the applicant failed to prove the proposed treatments and assessments were reasonable and necessary, noting the minor nature of the physical injuries, the applicant's return to work and daily activities, and the unreliability of the applicant's medical reports.

The application was dismissed in its entirety, with no interest or special award payable.

The applicant sought medical benefits for physiotherapy, chiropractic treatment, massage, acupuncture, recreation therapy, and aromatherapy following a motor vehicle accident.

The respondent insurer denied the treatment plans, arguing the applicant's soft tissue injuries had resolved and the ongoing symptoms were related to a prior accident.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, as the medical evidence indicated the accident-related injuries were mild soft tissue strains that had resolved, and there was no exacerbation of pre-existing conditions.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought transportation expenses and a special award under s. 10 of O. Reg. 664 for unreasonable delay in paying income replacement benefits.

The Licence Appeal Tribunal found that the transportation expenses were not payable because the round trip was under 50 kilometres and the applicant was not catastrophically impaired.

The Tribunal also dismissed the claim for a special award, finding that the insurer's denials were based on properly scheduled assessments and there was no evidence of unreasonable behaviour.

The applicant sought entitlement to an income replacement benefit and a medical benefit for chiropractic treatment following a motor vehicle accident.

The adjudicator found the applicant was not entitled to the income replacement benefit because he failed to attend properly scheduled insurer's examinations and did not provide a reasonable explanation for his non-attendance.

The claim for chiropractic treatment was also dismissed, as the adjudicator preferred the respondent's expert reports over the applicant's family physician notes, concluding the treatment was not reasonable and necessary.

Claims for interest and an award were consequently dismissed.

The applicant, a pedestrian injured in a 2010 motor vehicle accident, sought payment for a catastrophic impairment assessment totaling $26,919.25.

The respondent denied the claim.

The Licence Appeal Tribunal found that the applicant failed to provide sufficient objective medical evidence to suggest a reasonable possibility of catastrophic impairment.

The Tribunal held that the assessment was not reasonable and necessary, noting evidence of symptom amplification and a lack of support from treating physicians.

The application for the assessment costs, interest, and a special award was dismissed.

The applicant sought statutory accident benefits for physical and psychological injuries allegedly sustained in a motor vehicle accident.

The respondent denied the claims, arguing that the accident was not the cause of the applicant's impairments, pointing to extensive pre-existing medical and psychological issues, including trauma from Syria and family legal troubles.

The Tribunal applied the 'but for' test and found that the applicant failed to prove the accident was a necessary cause of her impairments.

Furthermore, the Tribunal found that the requested medical benefits and catastrophic impairment assessments were not reasonable and necessary, or were duplicative and contrary to the Schedule.

The application was dismissed.

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

The insurer denied funding for physiotherapy, chiropractic treatment, and a psychological assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered from vehicular anxiety, a psychological injury that removed him from the MIG.

However, the physical treatment plans were denied as there was no evidence of physical injury.

The psychological assessment was approved subject to the $2,000 statutory limit.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB), physiotherapy, catastrophic impairment assessments, and a special award.

The Tribunal found the applicant was substantially unable to perform his pre-accident employment due to chronic pain, entitling him to an IRB up to the 104-week mark.

However, the applicant failed to prove a complete inability to engage in any suitable employment, denying him post-104 week IRBs.

The disputed treatment plans for physiotherapy and catastrophic impairment assessments were deemed not reasonable and necessary.

The claim for a special award was dismissed as the insurer reasonably relied on its medical assessments.