Peter Cimino

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 applicant contended that chronic pain removed him from the MIG.

The Tribunal found the applicant's evidence insufficient to establish chronic pain with functional impairment.

Consequently, the applicant was held to the MIG limit and the disputed treatment plans and interest were denied.

The applicant sought reconsideration of a Tribunal decision that found he did not sustain a catastrophic impairment.

The Associate Chair initiated a review and found that the Tribunal committed a material breach of procedural fairness by relying on the respondent's expert report after the expert was not made available for cross-examination.

The Tribunal's failure to allow cross-examination on central evidence, while still relying on the report to support its conclusions, warranted cancelling the original and reconsideration decisions.

A new hearing was ordered.

The court dismissed the defendants’ motion to strike or dismiss the plaintiff’s claim to set aside a settlement of statutory accident benefits on the basis of unconscionability.

The court found that its jurisdiction was not ousted by section 280 of the Insurance Act, as the claim was not about entitlement to benefits but about the unconscionability of the settlement itself.

The court also held that the issue of repayment of settlement funds should not be determined on a motion to strike, and that the plaintiff’s pleadings disclosed a reasonable cause of action.

The claim was not scandalous, frivolous, vexatious, or an abuse of process.

Costs were awarded to the plaintiff.

The appellant appealed a Licence Appeal Tribunal (LAT) decision denying his claim for removal from the Minor Injury Guideline (MIG) following a motor vehicle accident.

The appellant argued the LAT erred in law by disregarding his subjective evidence of psychological impairment, providing inadequate reasons, and demonstrating bias against subjective pain complaints.

The Divisional Court dismissed the appeal, finding the LAT adequately explained its weighing of the evidence and that no error of law or procedural fairness violation occurred.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision finding he had not sustained a catastrophic impairment.

The applicant argued the Tribunal breached procedural fairness by relying on the untested report of the respondent's psychiatric expert, who did not attend the hearing for cross-examination.

The adjudicator dismissed the request, finding no procedural unfairness because the parties knew from the outset the expert would not testify, the report was properly admitted under section 15(1)(b) of the Statutory Powers Procedure Act, and the Tribunal appropriately assigned it less weight.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to several treatment plans beyond the $3,500 Minor Injury Guideline (MIG) limit due to psychological impairments and chronic pain.

The respondent denied the benefits, arguing the injuries were predominantly minor.

The Tribunal found the applicant's psychological and chronic pain assessments unpersuasive, noting they relied heavily on self-reporting and conflicted with other medical evidence showing only soft tissue injuries.

The Tribunal concluded the applicant's injuries remained within the MIG, and dismissed the claims for the disputed treatment plans and interest.

This case conference addressed a dispute arising from a settled personal injury claim where the plaintiff refused to sign a release containing a "no admission of liability" clause.

The settlement agreement was silent on the specific terms of the release.

The court found that, in the context of an insurance claim where liability was denied throughout, a "no admission of liability" clause is objectively implied by a settlement and is standard in the industry.

The plaintiff was therefore required to sign the release with the impugned clause.

No costs were awarded.

The applicant sought a determination of catastrophic impairment and entitlement to attendant care benefits and assessment costs following a motorcycle accident.

The Licence Appeal Tribunal found that the applicant did not meet the threshold for catastrophic impairment under either criterion 7 or 8, preferring the evidence of the respondent's experts over the applicant's expert, whose conclusions relied heavily on inconsistent self-reporting.

The Tribunal also dismissed the claims for attendant care benefits and assessment costs due to a lack of evidence demonstrating incurred expenses or reasonable necessity.

The applicant sought statutory accident benefits following a motor vehicle accident, including a determination of catastrophic impairment, income replacement benefits, and medical benefits.

At the outset of the scheduled five-day videoconference hearing, the parties advised that the issues in dispute had been settled.

The Tribunal closed the file.

The appellant appealed a Licence Appeal Tribunal (LAT) decision denying her post-104-week income replacement benefits following a motor vehicle accident.

The appellant argued the LAT adjudicator erred in law by failing to reference a Functional Capacity Evaluation, ignoring subjective evidence, demonstrating bias, and misapplying the test for suitable alternative employment.

The Divisional Court dismissed the appeal, finding that the adjudicator's failure to mention specific evidence did not constitute an error of law, there was no reasonable apprehension of bias, and the adjudicator's factual findings supported the conclusion regardless of the specific employment factors considered.

The applicant requested a reconsideration of a decision denying her entitlement to post-104-week income replacement benefits (IRB) and interest.

The applicant argued that the adjudicator erred in law and fact by failing to properly analyze the post-104-week IRB test, misapprehending evidence, providing inadequate reasons, and demonstrating bias against subjective pain complaints.

The Tribunal dismissed the request, finding no violation of procedural fairness or significant error of law or fact that would have altered the original decision.

The adjudicator held that the original decision properly considered both objective and subjective evidence and correctly applied the post-104-week IRB test.

The insurer brought a preliminary issue motion to bar the insured from proceeding with a claim for income replacement benefits (IRB) because he failed to submit a Disability Certificate (OCF-3) within 104 weeks of the accident.

The insured argued that O. Reg. 73/20, enacted during the COVID-19 pandemic, extended the deadline by 183 days.

The Tribunal held that O. Reg. 73/20 applies to legal proceedings and limitation periods, not to the specific document submission deadlines within the Statutory Accident Benefits Schedule.

Finding that the OCF-3 was never properly submitted to the insurer within the prescribed timeline, the Tribunal barred the insured from proceeding and dismissed the IRB claim.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing that chronic pain and psychological impairments warranted removal from the Minor Injury Guideline (MIG).

The Tribunal found the applicant's psychological assessment report unreliable as its authorship was unclear and its severe findings were uncorroborated by contemporaneous medical records.

The Tribunal also noted insufficient evidence of chronic pain impacting function.

Concluding the applicant's injuries fell within the MIG, the Tribunal denied the disputed psychological assessment as not reasonable and necessary, and found no interest payable.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) for 104 weeks.

The insurer terminated the benefits at the 104-week mark, arguing the applicant did not suffer a complete inability to engage in any employment for which she was reasonably suited by education, training, or experience.

The Tribunal reviewed the medical evidence, including reports from orthopedic surgeons, a psychologist, and a vocational assessor, and found that the applicant's physical and psychological impairments did not meet the post-104-week IRB test.

The application was dismissed, and no interest was payable.

The applicant sought medical benefits under the Statutory Accident Benefits Schedule following an incident at a taxi-stand involving a vehicle door strike.

The insurer denied the claims for an occupational therapy treatment plan and a chronic pain assessment, arguing they were not reasonable and necessary and that the claims were res judicata due to a prior Tribunal decision.

The Tribunal found that res judicata did not apply, but dismissed the application on the merits, concluding the applicant failed to prove the proposed treatments were reasonable and necessary for the injuries sustained in the accident phase of the incident.

The applicant, a pedestrian struck by a vehicle, sought a non-earner benefit and interest under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal dismissed the application, finding the applicant's testimony regarding her pre- and post-accident employment, medical history, and daily activities to be highly inconsistent and unreliable.

The Tribunal concluded the applicant failed to prove on a balance of probabilities that she suffered a complete inability to carry on a normal life as a result of the accident.

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

The respondent denied certain medical benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG due to a pre-existing condition (Degenerative Disk Disease) and chronic pain.

The Tribunal found that the applicant failed to provide compelling evidence that her pre-existing condition prevented her from reaching maximal recovery within the MIG, noting her family doctor found no change in her condition since before the accident.

The Tribunal also found the applicant did not establish a chronic pain diagnosis meeting the AMA Guides criteria.

As the applicant's injuries were predominantly minor and she had exhausted the $3,500 MIG limit, the application for medical benefits and interest was dismissed.

The applicant sought a loss of earning capacity benefit (LECB) offer from the respondent following a 1994 motor vehicle accident.

The respondent argued the claim was barred under s. 20.1 of the Statutory Accident Benefits Schedule because the applicant had not commenced a mediation, arbitration, or court proceeding prior to March 1, 2006.

The applicant contended that s. 20.1 did not apply because the respondent never issued a proper written denial of her income replacement benefits.

The Tribunal held that regardless of whether a proper denial was issued, the failure to commence a proceeding before the March 1, 2006 deadline meant the applicant was not entitled to an LECB offer.

The preliminary issue was resolved in favour of the respondent.

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.

The applicant was injured in a motor vehicle accident and sought medical benefits from the respondent insurer.

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

The applicant sought removal from the MIG on the basis of chronic pain.

The Licence Appeal Tribunal found that the applicant failed to provide compelling medical evidence of chronic pain or functional impairment, noting limited contemporaneous complaints and no chronic pain diagnosis.

As the MIG limits were exhausted, the disputed treatment plans were deemed not reasonable and necessary, and no interest was payable.