Petros Yannakis

The respondent insurer requested a reconsideration of a Tribunal decision that found the applicant entitled to $877.93 for the cost of a psychological assessment.

The insurer argued the Tribunal erred in law and fact by not requiring the cost to be justified by the hourly rates of the service providers and by relying on the cost of the insurer's own examination.

The Vice Chair dismissed the request, finding no errors of law or fact in the original decision that would have likely led to a different result.

The respondent insurer requested a reconsideration of a Tribunal decision that found the applicant was not subject to the Minor Injury Guideline and was entitled to a non-earner benefit and treatment plans.

The insurer argued the adjudicator erred in fact and law regarding causation, ignored medical evidence, and violated procedural fairness by not addressing costs.

The Vice-Chair dismissed the request, finding that while the adjudicator made a minor factual error regarding the withholding of medical records, it would not have changed the outcome.

The adjudicator properly applied the 'but for' test for causation and did not deny procedural fairness in declining to award costs against a successful and credible applicant.

The applicant sought medical benefits for physiotherapy, an orthopedic assessment, and a psychological assessment following a motor vehicle accident.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the funding limit had been exhausted.

The Tribunal found that the applicant failed to prove her injuries, including headaches, chronic pain, and psychological issues, warranted removal from the MIG.

The Tribunal also found insufficient evidence that pre-existing conditions prevented her from achieving maximal recovery within the MIG limit.

The application was dismissed.

The insurer requested a reconsideration of a decision granting the insured partial payment for multidisciplinary catastrophic impairment assessments.

The insurer argued the OCF-18 was invalid because it was completed by a chiropractor recommending assessments outside her scope of practice, and that the assessments were unpayable 'rebuttal' reports.

The Adjudicator dismissed the reconsideration, finding that a chiropractor may recommend assessments by other specialists and that the reports were the insured's first set of assessments, not rebuttals.

Although a procedural error occurred regarding post-hearing submissions, it was remedied on reconsideration.

The insurer's request was dismissed, and the insured's request for costs was denied.

The applicant was injured in a motor vehicle accident in 2000 and sought funding for multidisciplinary catastrophic impairment (CAT) assessments.

The respondent insurer denied the treatment plan, arguing the assessments were not reasonable or necessary and relying on its own insurer's examinations which concluded the applicant did not meet the CAT threshold.

The Tribunal found that the applicant was entitled to explore whether she was catastrophically impaired and that the insurer's completion of its own CAT assessments supported the need for the applicant to obtain her own reports.

The Tribunal awarded $14,000 for seven of the requested assessments, as well as $400 for the completion of the OCF-18 and OCF-19 forms.

Claims for file review and psychometric testing fees were denied as duplicative.

The applicant's claim for a special award under Ontario Regulation 664 was dismissed.

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

The respondent partially approved a psychological assessment plan, reducing the requested fee of $2,267.80 to $1,389.87 based on an insurer's examination.

The Tribunal found that the respondent's assessor failed to provide a rationale for the reduced fee breakdown and that the applicant's assessor was not required to provide an hourly breakdown under the Schedule.

The Tribunal ordered the respondent to pay the outstanding balance of $877.93 plus interest.

The applicant was injured in a motor vehicle accident and sought a non-earner benefit, the cost of a social work assessment, and the cost of three disability certificates from her insurer.

The insurer denied the claims, arguing the applicant did not suffer a complete inability to carry on a normal life and that the assessments were not reasonable and necessary.

The Licence Appeal Tribunal dismissed the application, finding the applicant's self-reported activities and the insurer's medical examinations demonstrated she was not completely prevented from engaging in her pre-accident activities.

The Tribunal also found the social work assessment was not reasonable and necessary, and the disability certificates were not payable as they were duplicative and not requested by the insurer.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to non-earner benefits and medical benefits for physiotherapy and acupuncture.

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

The Tribunal found that the applicant suffered from pre-existing psychological impairments and chronic pain that were worsened by the accident, removing her from the MIG.

The Tribunal preferred the evidence of the applicant's experts and her own sworn affidavit over the insurer's assessor, who had not been provided with the applicant's complete medical history.

The Tribunal awarded the non-earner benefits and the physiotherapy treatment plans as reasonable and necessary, but denied the acupuncture claim because it was not properly submitted via an OCF-18.

The appellant rental car company sued the respondent renter and his insurer for a $10,000 deductible incurred after the rented vehicle was damaged in an accident.

The rental agreement required the renter to pay the deductible regardless of fault.

The Small Claims Court dismissed the action, finding it was barred by s. 263(5)(a.1) of the Insurance Act.

On appeal, the Divisional Court upheld the dismissal, confirming that the statutory first-party payor system prohibits rental companies from suing renters for deductibles incurred under their own direct compensation property damage coverage.

The applicant was injured in a motor vehicle accident and sought payment for an orthopaedic assessment under the Statutory Accident Benefits Schedule.

The insurer denied the claim.

The Licence Appeal Tribunal found that the orthopaedic assessment was not reasonable and necessary, as the referral came from the applicant's legal counsel rather than a medical professional, and there was no objective medical evidence of an orthopaedic injury.

The applicant's claims for interest and an award for unreasonable delay were dismissed.

The insurer's request for costs was also dismissed.

The applicant sought statutory accident benefits for physiotherapy and an orthopedic assessment following a motor vehicle accident.

The adjudicator found that the proposed treatments and assessment were not reasonable or necessary, as the medical evidence, including the applicant's own assessor and family physician records, indicated her accident-related injuries had resolved and her ongoing back pain was related to a subsequent pregnancy.

The adjudicator also found the insurer was not liable to pay for the treatment plans under the non-compliance provisions of section 38(11) of the Schedule.

The application was dismissed.

The appellant insurer appealed a License Appeal Tribunal decision finding that its failure to provide compliant notices denying treatment plans under s. 38 of the Statutory Accident Benefits Schedule precluded it from relying on the Minor Injury Guideline limits.

The Divisional Court dismissed the appeal, holding that the Adjudicator reasonably interpreted s. 38(11) to mean that a non-compliant notice requires the insurer to pay for the goods and services in the specific treatment plan without the $3500 limit applying, until a compliant notice is given.

The applicant sought payment for income replacement benefits, psychological treatment, chiropractic treatment, and a driver reintegration program following a motor vehicle accident.

The Tribunal held that the applicant was not entitled to income replacement benefits because she failed to prove she was employed at the time of the accident or for 26 weeks prior.

The claims for psychological treatment and the driver reintegration program were dismissed as the applicant failed to prove they were reasonable and necessary.

The Tribunal granted payment for two chiropractic treatment plans, finding the applicant's preference for facility-based treatment reasonable.

Claims for costs by both parties were dismissed.

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

The respondent insurer denied ongoing non-earner benefits and asserted the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's pre-existing medical conditions, including a severe lung condition, prevented her from achieving maximal recovery within the MIG, thus excluding her from its limits.

The Tribunal also held that the respondent was required to pay non-earner benefits for a closed period because it failed to provide proper notice of an insurer's examination.

However, ongoing non-earner benefits were denied because the applicant's current complete inability to carry on a normal life was caused by her pre-existing lung condition and osteoarthritis, not the accident.

The insurer requested a reconsideration of a Licence Appeal Tribunal decision regarding an insured's entitlement to an income replacement benefit (IRB).

The insurer argued the Tribunal failed to address whether it could rely on s. 37(7) of the Statutory Accident Benefits Schedule to refuse paying the IRB after the insured failed to attend a scheduled physiatric examination.

The Executive Chair granted the reconsideration, finding the Tribunal erred by not determining the issue.

The Tribunal's order was amended to clarify that the insurer is not required to pay the IRB between the date of the missed examination and the date the insured actually attends.

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

The applicant applied for arbitration but withdrew the application the day before the scheduled four-day hearing.

The insurer sought its expenses for preparing for the hearing.

The arbitrator found that the insurer was entitled to prepare for the hearing as there was no clear indication it would not proceed until the day before.

The arbitrator awarded the insurer its expenses in the amount of $12,751.76, reducing some witness preparation fees that exceeded the maximum allowed under the Dispute Resolution Practice Code.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physical therapy and a psychological assessment.

The insurer denied the physical therapy plans, arguing the applicant's impairments were pre-existing and fell within the Minor Injury Guideline.

The arbitrator preferred the evidence of the applicant's orthopaedic surgeon, finding the accident exacerbated pre-existing degenerative conditions in the low back and right knee, warranting further physical therapy outside the Minor Injury Guideline.

Three of the four physical therapy plans were approved, while one was denied because it was retroactively altered.

The arbitrator also denied the unapproved balance for a psychological assessment, finding the services were provided by an unregulated counsellor and billed improperly.

The applicant was awarded interest on overdue benefits, and no costs were ordered.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a chronic pain management program and an orthopaedic assessment.

The respondent insurer denied the treatment plans, arguing they were not reasonable or necessary.

The Licence Appeal Tribunal found the applicant's medical evidence, which included diagnoses of chronic pain syndrome and recommendations for multidisciplinary treatment, to be more persuasive than the insurer's assessments.

The Tribunal ordered the respondent to pay for the chronic pain program and the orthopaedic assessment, along with interest on incurred expenses.

However, the Tribunal dismissed the applicant's claim for a special award under Regulation 664, finding no evidence that the insurer acted unreasonably or in bad faith.

The insurer requested a reconsideration of two Licence Appeal Tribunal decisions which found that its notices denying treatment plans were defective under ss. 38(8) and (9) of the Statutory Accident Benefits Schedule.

The Tribunal had concluded that the defective notices triggered the mandatory consequences of s. 38(11), prohibiting the insurer from ever taking the position that the applicants' impairments fell within the Minor Injury Guideline (MIG) and requiring the insurer to pay for the treatment plans.

On reconsideration, the Executive Chair upheld the Tribunal's interpretation that the MIG prohibition applies to the entire claim and that s. 38(11)2 requires payment without a "reasonable and necessary" analysis.

However, the Executive Chair found an error regarding the quantum awarded to one applicant, as the insurer had subsequently provided a compliant notice that limited its obligation to pay.

The reconsideration was granted in part to reduce the quantum for that applicant, and otherwise denied.

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

The respondent raised preliminary issues regarding the applicant's failure to attend a physiatry insurer examination (IE) and failure to provide information under section 33 of the Schedule.

The Tribunal held that the applicant is barred from proceeding with her IRB claim until she attends the physiatry IE, as the respondent's request was reasonably necessary.

However, the Tribunal found that the applicant had provided sufficient information and documentation to the respondent, meaning her claim was not barred under section 33.

Neither party was awarded costs.