Anita Goela

The applicant sought a medical benefit of $2,000 for an attendant care assessment following a motor vehicle accident.

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

The Tribunal found that the insurer's denial notice was deficient under section 38(8) of the Schedule because it misstated the insurer's examination report and failed to reassess the treatment plan after the applicant was removed from the MIG.

Consequently, under section 38(11), the insurer was liable to pay for the disputed benefit.

The Tribunal ordered the insurer to pay the $2,000 benefit plus interest.

The applicant was injured in a motor vehicle accident and sought a determination of catastrophic impairment.

The respondent insurer requested that the applicant attend section 44 multidisciplinary examinations.

The applicant refused to attend, arguing the requests were unreasonable and untimely.

The Tribunal applied the six-factor test for reasonableness and found the insurer's requests were reasonable and timely, as they were made after the two-year anniversary of the accident to assess specific criteria.

The Tribunal ordered that the applicant is barred from proceeding with his application until he attends the requested physiatry, psychology, and otolaryngology examinations, and directed the insurer to schedule them within 35 days.

The applicant was injured in a motorcycle accident and sought a medical benefit for physiotherapy services under the Statutory Accident Benefits Schedule.

The respondent insurer denied the treatment plan, arguing that the applicant had improved and could perform exercises independently.

The Tribunal found that the treatment plan's goals of pain reduction and improved function were reasonable and necessary given the applicant's injuries, which included post-concussion syndrome.

The Tribunal ordered the respondent to pay the $3,003.85 treatment plan and interest on any incurred expenses.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain, fibromyalgia, depression, and PTSD.

The Tribunal found the applicant's injuries were predominantly minor, noting a lack of objective medical evidence and rejecting expert opinions that were outside their scope of expertise or unsupported by evidence.

The Tribunal also found no compelling evidence of a pre-existing condition that would prevent maximal recovery under the MIG.

Consequently, the applicant was subject to the $3,500 MIG limit and was not entitled to the disputed costs of examinations or interest.

The applicant, who was injured in a motor vehicle accident while a passenger on a motorcycle, sought a medical benefit of $2,200 for a psychological assessment.

The respondent insurer denied the claim.

The Tribunal found that the applicant failed to prove on a balance of probabilities that the assessment was reasonable and necessary.

The Tribunal preferred the evidence of the respondent's psychological assessor, who found only mild symptoms and no identifiable impairment, over the applicant's evidence, which included an inappropriate diagnosis of acute stress disorder 18 months post-accident.

The application was dismissed.

The applicant, a cyclist injured in a motor vehicle accident, sought the cost of an orthopedic assessment under the Statutory Accident Benefits Schedule.

The respondent denied the treatment plan, suggesting alternative treatment (cortisone injections) based on a physiatrist's report.

The Tribunal found that the respondent failed to provide a proper medical reason for denying the assessment as required by section 38(8) of the Schedule, meaning the benefit was payable under section 38(11).

Furthermore, the Tribunal found the assessment was reasonable and necessary given the nature of the collision and the applicant's injuries.

The applicant was awarded the cost of the examination up to the $2,000 limit, plus $200 for the preparation of the treatment plan, HST, and interest.

The applicant sought medical benefits for physiotherapy services following a 2011 motor vehicle accident.

The respondent denied the treatment plans, arguing the injuries were related to a prior 2010 accident.

The Tribunal struck the applicant's reply submissions for improperly introducing new arguments.

On the substantive issue, the Tribunal found the applicant failed to prove the treatment plans were reasonable and necessary in relation to the 2011 accident, noting significant factual inaccuracies in the applicant's medical evidence and a failure to distinguish the impairments from the 2010 accident.

The application was dismissed.