Amar Mohammed

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

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

The Tribunal found the applicant demonstrated chronic pain with functional impairment, warranting removal from the MIG, based on reports from an orthopaedic surgeon and an OHIP-funded specialist.

The Tribunal denied the proposed physiotherapy treatment plans as the applicant failed to establish they were reasonable and necessary.

However, the Tribunal partially approved a chronic pain assessment plan for $2,200.00, finding sufficient grounds to investigate the pain condition.

Interest was awarded on overdue benefits.

The applicant sought entitlement to various chiropractic and psychological treatment plans following a motor vehicle accident, as well as an award for unreasonable delay.

The Tribunal found all disputed treatment plans to be reasonable and necessary, noting consistent medical reporting and rejecting the insurer's credibility concerns.

The Tribunal also granted an award under s. 10 of Regulation 664, finding the insurer unreasonably withheld benefits, particularly by denying psychological services despite agreement between its own assessor and the applicant's assessor.

The award was set at 10% for psychological services and 5% for chiropractic services.

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

The respondent denied various treatment plans and assessments on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG due to alleged concussions, chronic pain, and psychological conditions.

The Tribunal found that the applicant failed to establish an accident-related concussion, chronic pain with functional impairment, or a psychological condition warranting removal from the MIG.

The Tribunal preferred the respondent's medical assessments, which aligned with contemporaneous medical records, over the applicant's self-reported symptoms.

As the applicant remained subject to the MIG, the disputed treatment plans were not analyzed for reasonableness and necessity, and the application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits, psychological treatment, and a chronic pain assessment.

The Tribunal denied the income replacement benefits as the applicant failed to meet her evidentiary burden.

The psychological treatment claims were also denied because the incurred services did not align with the approved plans.

However, the Tribunal approved the chronic pain assessment, finding sufficient medical evidence to warrant an investigation into the applicant's ongoing pain symptoms.

Claims for a special award and costs were dismissed.

The applicant sought entitlement to various statutory accident benefits following a motor vehicle accident, including multiple treatment plans for physiotherapy, psychological, optometric, and chiropractic services, as well as attendant care benefits.

The Licence Appeal Tribunal found that the applicant failed to meet her burden of proving that the majority of the disputed treatment plans were reasonable and necessary.

The Tribunal granted entitlement only to 16 instances of travel costs for a massage therapist, noting the applicant's inability to attend in-facility treatment at the time.

The claims for attendant care benefits and other treatment plans were dismissed.

The applicant was awarded interest on the overdue travel costs.

The applicant was injured in a motor vehicle accident and sought attendant care benefits (ACBs) from the respondent insurer.

The parties had previously executed a settlement agreement fixing the monthly ACB amount at $1,200.00.

The respondent partially denied subsequent invoices, arguing its liability was strictly capped by the maximum hourly rates in the Superintendent's Guideline.

The Tribunal found that the 2018 Guideline uses hourly rates to calculate the monthly benefit but does not strictly cap the insurer's liability on a per-invoice basis once the monthly amount is fixed.

The Tribunal ordered the respondent to pay the incurred ACBs up to the $1,200.00 monthly limit, plus interest, but declined to order an award under s. 10 of Reg. 664.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming for psychological services and catastrophic impairment assessments.

The Tribunal found the applicant was entitled to a reduced amount for psychological services, adjusting the hourly rate to that of an unregulated provider.

The claim for catastrophic impairment assessments was denied as the applicant failed to establish grounds suggesting such an impairment existed.

The Tribunal also awarded interest on overdue benefits but declined to order a special award against the insurer.

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 Tribunal found that the applicant suffered from an accident-related psychological condition, warranting removal from the MIG.

The Tribunal approved treatment plans for a psychological assessment, a chronic pain assessment, and partially approved psychological services, but denied plans for a neurological assessment, driving rehabilitation, and physiotherapy.

The applicant's claim for an award for unreasonable delay was dismissed, but interest on overdue benefits was granted.

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 Tribunal found that the applicant failed to establish a documented pre-existing injury, chronic pain with functional impairment, or a psychological condition that would warrant removal from the MIG.

As the applicant was subject to the MIG, the disputed treatment plans were not analyzed for reasonableness and necessity, and the claim for interest was dismissed.

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

The parties resolved the catastrophic impairment and attendant care benefits issues prior to the written hearing.

The remaining issues were entitlement to guardianship application fees, interest, and an award for unreasonable delay.

The respondent agreed to pay the guardianship fees.

The Tribunal found the respondent unreasonably delayed payment of enhanced attendant care benefits and the guardianship fees, ordering an award of 25% and 18% respectively, plus interest.

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

The respondent denied several treatment plans and assessments, often imposing hourly rates on services proposed as block fees.

The Licence Appeal Tribunal found that the Schedule and Guidelines do not mandate the application of hourly rates to block fees for assessments and form completion.

The Tribunal ordered the respondent to pay the disputed amounts for the occupational therapy assessment, physiotherapy, chiropractic treatment, orthopaedic assessment, and psychological assessment.

The claim for medical services was dismissed due to a lack of submissions.

The Tribunal also awarded a 25% special award under s. 10 of Regulation 664, finding the respondent unreasonably withheld or delayed benefits by arbitrarily imposing hourly rates and maintaining denials based on misinterpretations.

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 argued that a recent MRI finding of a disc bulge and a referral for spine surgery warranted removal from the MIG, explaining that a lack of OHIP coverage delayed his medical evidence.

The Tribunal found that the applicant failed to establish causation linking the disc bulge to the accident.

Consequently, the applicant's injuries were deemed predominantly minor, and the claims for a chiropractic treatment plan and interest were dismissed.

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

The respondent denied various physiotherapy and psychological treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to establish that a pre-existing knee condition or a psychological impairment warranted removal from the MIG.

As the applicant's injuries were predominantly minor, the disputed treatment plans were not reasonable and necessary, and no interest was payable.

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

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

As a preliminary issue, the Tribunal found the applicant was barred from disputing three treatment plans because the application was filed beyond the two-year limitation period and no grounds for an extension were established.

On the substantive issues, the Tribunal held that the applicant's injuries were predominantly minor.

The applicant failed to establish chronic pain or a psychological condition that would warrant removal from the MIG, noting long gaps in medical records and a lack of corroborating evidence.

Because the applicant was subject to the MIG, the Tribunal declined to analyze whether the remaining treatment plans were reasonable and necessary.

The application was dismissed.

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

The respondent denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG due to pre-existing knee and back conditions, as well as an accident-related psychological condition.

The Tribunal found insufficient medical evidence to establish that the pre-existing conditions precluded recovery within the MIG, noting a lack of contemporaneous accident-related complaints.

The Tribunal also preferred the respondent's psychological assessment over the applicant's, finding no clinically significant psychological impairment.

Consequently, the applicant's injuries were deemed predominantly minor, and the disputed treatment plans were not analyzed.

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

The respondent denied several treatment plans and an IRB report, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found the applicant's injuries were predominantly minor, as the medical evidence only supported conditions like sprains, strains, and whiplash-associated disorders.

The applicant failed to provide compelling medical evidence of a concussion or psychological condition warranting removal from the MIG.

Consequently, the treatment plans were not payable.

The Tribunal also denied the cost of an IRB report, finding it was not reasonable and necessary.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits, various treatment plans, and attendant care benefits.

The Tribunal found that the applicant failed to meet her burden of proof for the non-earner benefits, as she did not provide sufficient evidence comparing her pre- and post-accident activities.

The Tribunal also dismissed the claims for the disputed treatment plans and attendant care benefits due to a lack of supporting evidence and submissions.

The respondent conceded entitlement to one psychotherapy treatment plan.

The claim for an award under s. 10 of Reg. 664 was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on a pre-existing psychological condition, relying on a late-filed psychological assessment.

The Tribunal gave no weight to the assessment, finding it unreliable and unsupported by contemporaneous medical records.

The Tribunal held the applicant's injuries were predominantly minor and subject to the MIG limit.

Claims for a non-earner benefit and an assistive device were dismissed.

However, the Tribunal found the insurer provided a late denial notice for a chiropractic treatment plan, entitling the applicant to the portion of the plan incurred between the 11th business day and the date of the denial notice.

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

The Tribunal found that the applicant's injuries were predominantly minor and subject to the $3,500 Minor Injury Guideline (MIG) limit, as the applicant failed to provide compelling medical evidence of a pre-existing condition or psychological impairment warranting removal.

The applicant's claim for a non-earner benefit was dismissed due to a lack of evidence comparing pre- and post-accident activities.

One treatment plan was deemed payable because the insurer's denial notice failed to comply with s. 38(8) of the Schedule, while the remaining plans were denied.

The claim for an award was also dismissed.

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

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

The Tribunal found the applicant suffered from chronic pain with functional impairment, warranting removal from the MIG.

The Tribunal granted the applicant's requests for chronic pain and psychological assessments, as well as chiropractic and massage treatment, finding them reasonable and necessary.

A psychological treatment plan was partially approved, while a duplicative psychotherapy plan was denied.

The Tribunal declined to order a special award under s. 10 of Regulation 664, finding the respondent reasonably relied on its assessors' opinions, but awarded interest on overdue benefits.