Amar Mohammed

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

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

The Tribunal found that the applicant failed to prove his injuries, including alleged post-concussion syndrome and degenerative disc disease, warranted removal from the MIG.

The Tribunal also held that the respondent's denial notices contained sufficient medical reasons, meaning the applicant was not entitled to the plans under section 38(11) of the Schedule.

The application was dismissed.

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's injuries were predominantly minor and subject to the $3,500 MIG limit, as the applicant failed to provide compelling medical evidence of a psychological condition or other injuries warranting removal from the MIG.

Consequently, the claim for a $2,200 psychological assessment was dismissed.

The Tribunal also dismissed the claim for a non-earner benefit, finding the applicant failed to establish a complete inability to carry on a normal life.

Claims for an award and interest were also dismissed.

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

The respondent denied a treatment plan for a psychological assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to provide compelling medical evidence to warrant removal from the MIG, giving no weight to an unsigned, undated pre-screen report.

The Tribunal also held that the respondent's denial notice complied with s. 38(8) of the Schedule, as it provided sufficient medical reasons for the denial.

The application was dismissed, with no entitlement to the assessment, interest, or an award.

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

The Tribunal found that the applicant's injuries fell within the Minor Injury Guideline (MIG), as he failed to establish a pre-existing condition or chronic pain with functional impairment that would warrant removal.

The Tribunal also dismissed the claim for an income replacement benefit, finding the applicant did not meet his onus to establish a substantial inability to perform the essential tasks of his employment, and the respondent properly relied on an Insurer Examination to discontinue the benefit.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, which the respondent insurer denied.

The applicant applied to the Licence Appeal Tribunal, arguing that his injuries, including a head laceration and ongoing pain complaints, warranted removal from the Minor Injury Guideline (MIG) due to chronic pain.

The Tribunal found that the applicant's injuries were predominantly minor and that he had not established a diagnosis of chronic pain with functional impairment.

As the applicant was subject to the $3,500 MIG limit, the Tribunal did not assess the reasonableness and necessity of the proposed treatment plans.

The claims for an award and interest were 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 awarded an income replacement benefit (IRB) for the pre-104 week period, finding the applicant suffered a substantial inability to perform the essential tasks of her employment as a general labourer.

The Tribunal also approved treatment plans for psychological services and assessments, but denied plans for chiropractic and massage therapy.

Interest was awarded on overdue benefits.

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 chronic pain with functional impairment or a psychological condition warranting removal from the MIG, noting inconsistencies in his self-reporting and preferring the insurer's psychological assessment.

The Tribunal also dismissed the claim for an income replacement benefit due to a lack of evidence regarding the applicant's employment and functional limitations.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming catastrophic impairment due to mental and behavioural disorders under Criterion 8 of the Schedule.

The Tribunal found that the applicant sustained a marked impairment in three domains of functioning: activities of daily living, adaptation, and social functioning, preferring the evidence of the applicant's psychiatrist over the respondent's.

The Tribunal concluded the applicant was catastrophically impaired.

However, the applicant's claim for a psychological services treatment plan was dismissed as he failed to provide evidence establishing it was reasonable and necessary.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming catastrophic impairment under Criteria 7 and 8 of the Schedule due to vascular dementia and other impairments.

The respondent denied the benefits, noting the applicant had already reached the non-catastrophic funding limit.

The Licence Appeal Tribunal found that the applicant failed to meet the burden of proving catastrophic impairment, as the medical evidence did not establish a 55% whole person impairment under Criterion 7 or a marked impairment in three domains under Criterion 8.

Consequently, the claims for additional medical benefits, interest, and a section 10 award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain.

The Tribunal found the applicant's medical evidence, including a chronic pain assessment, to be internally inconsistent and of limited persuasive value.

Consequently, the applicant's injuries were deemed predominantly minor and subject to the MIG limit, rendering the disputed treatment plans moot.

However, the Tribunal granted a 5% award against the respondent for unreasonably delaying payment of a previously approved and invoiced treatment plan.

The applicant sought payment for two chiropractic treatment plans following a motor vehicle accident.

The respondent denied the plans on the basis that the applicant was subject to the Minor Injury Guideline (MIG) and had exhausted the limit.

The Tribunal found that because the applicant had not been removed from the MIG and did not dispute the MIG issue on this application, an analysis of whether the plans were reasonable and necessary was unwarranted.

The application was dismissed.

The respondent's request for $1,000 in costs was also dismissed, as the applicant's conduct did not meet the threshold for a costs award under Rule 19.

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 for removal from the MIG based on chronic back pain.

The Tribunal found the applicant failed to establish chronic pain with functional impairment, relying on contemporaneous medical records showing resolved muscle pain and minimal medication use.

The Tribunal concluded the injuries were predominantly minor, dismissing the claims for treatment plans and interest.

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

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor and subject to the $3,500 Minor Injury Guideline (MIG) limit, as there was no compelling medical evidence of chronic pain or functional impairment to warrant removal.

The claim for a non-earner benefit was dismissed due to a lack of corroborating evidence regarding a complete inability to carry on a normal life, and because the application was time-barred under the Schedule.

Claims for medical benefits, interest, and a special award were consequently dismissed.

The applicant sought payment for a psychological assessment and a functional abilities evaluation following a motor vehicle accident.

The applicant argued that the insurer's denials were procedurally defective under s. 38(8) of the Schedule, triggering the 'shall pay' provision of s. 38(11).

The Tribunal found that the insurer's denials provided a principled rationale based fairly on the applicant's file, relying on insurer examination reports that concluded the applicant had no accident-related psychological impairment and that his physical injuries had resolved.

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

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

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

The applicant argued that a pre-existing condition warranted removal from the MIG under s. 18(2) of the Schedule.

However, the applicant failed to file any evidence or authorities for the written hearing.

The Tribunal found that the applicant did not meet the burden of proof to establish that a pre-existing condition precluded recovery within the MIG.

Consequently, the injuries were deemed predominantly minor, the treatment plans were not considered, and the application was dismissed.

The applicant sought entitlement to post-104-week income replacement benefits (IRBs), various medical and rehabilitation benefits, and a chronic pain assessment following a motor vehicle accident.

The respondent insurer denied the benefits and sought repayment of $14,381.91 in previously paid IRBs, alleging wilful misrepresentation.

The Licence Appeal Tribunal dismissed the claim for post-104-week IRBs, finding the applicant failed to establish a complete inability to engage in any employment.

The Tribunal also dismissed the respondent's claim for repayment, ruling that the repayment notice was defective because it failed to specify the period for which repayment was sought.

The applicant was granted entitlement to a chronic pain assessment, as evidence showed it was warranted and not reasonably available through OHIP, but the remaining treatment plans were denied.

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

The Tribunal found 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.

A treatment plan for physical therapy was denied because the MIG limit was exhausted.

However, the Tribunal ordered the respondent to pay for a $2,200 psychological assessment once incurred, finding the respondent's denial was defective under s. 38(8) of the Schedule because it relied on an unrelated, previously settled claim, thereby triggering the 'shall pay' provision.

Claims for a special award under s. 10 of Reg. 664 were dismissed as the respondent's error was not highhanded or unreasonable.

The applicant sought a determination that he sustained a catastrophic impairment under Criterion 8 (mental or behavioural disorder) of the Statutory Accident Benefits Schedule following a motor vehicle accident.

The adjudicator found that the applicant's limitations in activities of daily living were predominantly caused by his physical impairments rather than a mental or behavioural disorder.

The applicant failed to establish a Class 4 (marked) impairment in activities of daily living, and thus could not meet the requirement of three Class 4 impairments.

Claims for various treatment plans were dismissed as the applicant's funding limits were exhausted.

However, the adjudicator granted an award of 25% under s. 10 of O. Reg. 664, finding that the respondent unreasonably delayed the payment of two invoices that it had previously agreed to pay.

Both the applicant and the respondent requested reconsideration of a Licence Appeal Tribunal decision regarding statutory accident benefits.

The respondent argued the adjudicator erred in law by not including language about post-accident income deductions in the income replacement benefit order.

The applicant argued the adjudicator breached procedural fairness and erred in law by admitting a medical report without the author being available for cross-examination, refusing to issue summonses, and failing to provide adequate reasons regarding catastrophic impairment.

The Tribunal dismissed both requests, finding no errors of law, fact, or breaches of procedural fairness that would have changed the outcome.

The respondent's request for costs was also dismissed.

The applicant sought various statutory accident benefits following a 2017 motor vehicle accident.

The Tribunal dismissed the claims for increased income replacement benefits, finding that 100% of the applicant's CPP-D benefits were properly deducted from the base amount.

Claims for treatment plans and housekeeping were also dismissed for lack of evidence.

However, the Tribunal found the applicant was entitled to attendant care benefits at the rates set out in the approved Form-1, despite the submitted invoices claiming higher rates.

The Tribunal also ordered a 10% award under s. 10 of Regulation 664, finding the insurer unreasonably withheld payment of the approved attendant care benefits after receiving sufficient documentation.