Tessie Kalogeras

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

The respondent denied the claim for catastrophic impairment and scheduled insurer's examinations (IEs).

The respondent alleged the applicant failed to attend rescheduled IEs and sought to dismiss the application as a preliminary issue.

The Tribunal found the respondent's allegation was pre-emptive and speculative, as there was no evidence the applicant failed to attend the most recently scheduled IEs.

The Tribunal held the respondent did not meet its burden to show non-attendance, and ordered the parties to proceed to the substantive hearing.

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

The respondent denied the claim and scheduled insurer's examinations (IEs) to assess catastrophic impairment.

The respondent raised a preliminary issue arguing the application should be barred because the applicant failed to attend the IEs.

The Tribunal found that the respondent failed to meet its burden to show the applicant did not attend the rescheduled IEs, as the allegation was pre-emptive and speculative.

The Tribunal ordered the parties to proceed to the substantive hearing.

The applicant sought statutory accident benefits after falling near her vehicle while preparing to transport her father.

The respondent denied benefits and raised preliminary issues regarding whether the incident was an "accident" and whether the application was statute-barred due to late notification.

The Tribunal found that the incident met the purpose and causation tests for an "accident" under the Schedule.

However, the applicant failed to notify the respondent within the prescribed time limits and did not provide a reasonable explanation for the four-year delay.

The Tribunal denied the applicant's request for relief from forfeiture, finding willful blindness and ongoing negligence.

The application was dismissed as statute-barred.

The appellant appealed a Licence Appeal Tribunal (LAT) decision denying his claim for catastrophic impairment benefits.

The LAT had found that the appellant's physician, Dr. Ofokansi, provided only a conclusory opinion on the OCF-19 form without supporting analysis or medical data.

The appellant argued the LAT should have considered the evidence of his psychologist, Dr. Reesor.

The Divisional Court dismissed the appeal, holding that section 45 of the Statutory Accident Benefits Schedule requires a catastrophic impairment assessment to be conducted by a physician.

Since the physician's assessment was entirely conclusory and entitled to no weight, the psychologist's evidence alone was insufficient to establish the claim.

The applicant sought payment for a catastrophic impairment assessment and an ENT assessment under the Statutory Accident Benefits Schedule.

The respondent denied the treatment plans.

The applicant argued the denials were non-compliant with s. 38(8) for failing to provide medical reasons.

The Tribunal found the denials were compliant as they were based on non-medical reasons (duplication of services and inclusive fees), applying the Court of Appeal's reasoning in Varriano.

The Tribunal further found the applicant failed to establish the assessments were reasonable and necessary.

The application was dismissed.

The applicant sought a determination that she sustained a catastrophic impairment under criterion 8 (mental and behavioural impairments) of the Statutory Accident Benefits Schedule following a 2019 motor vehicle accident.

The Tribunal preferred the evidence of the applicant's psychiatric expert over the respondent's expert, finding the applicant suffered marked impairments in all four spheres of functioning: activities of daily living, social functioning, concentration, persistence and pace, and adaptation.

The Tribunal concluded the applicant was catastrophically impaired.

However, the Tribunal dismissed the applicant's claim for a special award under s. 10 of Regulation 664, finding the respondent's adjusting conduct was not unreasonable, excessive, or imprudent.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found he was not catastrophically impaired.

The applicant argued the Tribunal violated procedural fairness by providing inadequate reasons and made errors of law and fact by misapprehending expert evidence and relying solely on the OCF-19 application.

The Vice-Chair dismissed the request, finding the original decision's reasons were adequate, the Tribunal properly weighed the evidence in accordance with the Statutory Accident Benefits Schedule, and the applicant was merely attempting to re-litigate the case.

The applicant sought a determination of catastrophic impairment following a 2013 motor vehicle accident, claiming impairments under Criteria 7 and 8 of the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant's medical evidence, primarily from a psychiatrist and a psychologist, was insufficient to establish either a 55% whole person impairment or a marked/extreme impairment in any domain of functioning.

The application was dismissed, and claims for housekeeping benefits, an award, and interest were consequently denied.

The applicant sought entitlement to four treatment plans for injuries sustained in a motor vehicle accident.

The Tribunal found that the applicant failed to prove the reasonableness and necessity of the treatment plans for driving instructor travel time, physiotherapy, and chiropractic services, noting a lack of compelling contemporaneous evidence and that driving instructor travel time is not an authorized transportation expense.

However, the Tribunal approved the treatment plan for psychological services, finding it reasonable and necessary based on the unrefuted opinion of the applicant's psychologist and corroborating neuropsychological assessments.

The applicant was also awarded interest on the approved psychological treatment plan.

The applicant sought statutory accident benefits following a 2013 motor vehicle accident.

The insurer denied the claims, and the applicant appealed to the Licence Appeal Tribunal.

The insurer raised a preliminary issue that the claims were barred by res judicata, as the applicant had previously appealed the same claims, resulting in a final decision that her injuries fell within the Minor Injury Guideline and she was not entitled to income replacement benefits.

The Tribunal agreed, finding that the applicant's new medical reports did not constitute fresh, new, and previously unavailable evidence that would impeach the prior decision.

The appeal was dismissed as barred by res judicata, and costs were denied.

The applicant sought statutory accident benefits after slipping and falling on black ice immediately after parking and exiting his vehicle at a hospital.

The respondent denied the benefits on the basis that the incident did not meet the definition of an 'accident' under section 3 of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal applied the two-part purpose and causation test.

While the Tribunal found that parking the vehicle satisfied the purpose test, it concluded that the black ice was an intervening cause.

Therefore, the use or operation of the vehicle was not a direct cause of the applicant's injuries.

The application was dismissed.

The plaintiff, Adam Gardner, sued John Doe Driver, John Doe Owner, and TD General Insurance after an automobile accident, alleging an unknown vehicle was the sole cause.

TD General Insurance, Gardner's insurer, brought a summary judgment motion to dismiss the action against it, arguing that an identified vehicle (Mr. Curtis's) was involved, which would preclude coverage under s. 265(1) of the Insurance Act.

The court granted TD Insurance's motion, finding on a balance of probabilities that the accident was not caused solely by an unknown vehicle, but rather by Gardner's vehicle striking Curtis's vehicle.

The appellant appealed a Licence Appeal Tribunal decision denying her income replacement benefits and a treatment plan.

She argued procedural fairness was breached because the hearing was held by telephone rather than in person, minor injury guidelines were added without notice, medical records were not fairly evaluated, and the rule in Browne v. Dunn was not followed.

The Divisional Court dismissed the appeal, finding no procedural unfairness in the telephone hearing, noting the appellant should have been aware of the MIG issue, and concluding the adjudicator reasonably evaluated the medical evidence.

The applicant sought reconsideration of a Licence Appeal Tribunal decision denying her claims for an income replacement benefit and medical benefits following a motor vehicle accident.

The applicant argued the Tribunal ignored medical evidence of pre-existing conditions that would take her outside the Minor Injury Guideline (MIG), improperly admitted surveillance evidence, and breached procedural fairness by denying an in-person hearing and a request to record the proceedings.

The Executive Chair dismissed the request for reconsideration, finding no error in the Tribunal's conclusion that there was no compelling evidence the pre-existing conditions prevented maximal recovery under the MIG, and no breach of procedural fairness.

The applicant sought income replacement benefits (IRBs) and various medical benefits following a motor vehicle accident.

The insurer terminated IRBs and denied further medical benefits on the basis that the applicant's injuries were predominantly minor and the $3,500 Minor Injury Guideline (MIG) limit had been exhausted.

The Tribunal found that the applicant did not suffer a substantial inability to perform the essential tasks of her pre-accident employment, relying on insurer examinations that showed her impairment was temporary and self-limited.

The Tribunal also held that the applicant failed to provide compelling medical evidence that her pre-existing conditions prevented her from achieving maximal recovery under the MIG.

The application was dismissed.