Aric Bhargava

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

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

The Licence Appeal Tribunal found that the applicant failed to establish a psychological impairment warranting removal from the MIG, as the evidence lacked independent medical assessments or clinical notes.

However, the Tribunal found that the insurer failed to provide a timely denial for one psychological assessment under section 38(8) of the Schedule.

Consequently, the applicant was entitled to the incurred costs for that assessment for the period of non-compliance, plus interest.

The remaining claims for treatment plans were dismissed.

The applicant sought payment for a psychological services treatment plan and an award for unreasonable delay under the Statutory Accident Benefits Schedule following a 2016 motor vehicle accident.

The Tribunal found the psychological services were not reasonable and necessary, relying on an insurer's examination that concluded the applicant did not meet the diagnostic threshold for a psychological disorder.

However, the Tribunal granted a 20% award under section 10 of Regulation 664, finding the respondent unreasonably delayed approval of a previously submitted occupational therapy treatment plan for nearly two years without explanation.

The applicant sought attendant care benefits and funding for dog walking services following a motor vehicle accident.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to establish entitlement to attendant care benefits, as the medical evidence, including a section 44 occupational therapy assessment, indicated she was independent in her self-care and had returned to work.

The Tribunal also denied the treatment plan for dog walking services, finding it was not essential for her rehabilitation and did not meet the requirements of section 16(3)(l) of the Schedule.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit and various medical and rehabilitation treatment plans outside the Minor Injury Guideline (MIG).

The Tribunal found the applicant failed to prove that her injuries, including alleged chronic pain, psychological impairments, and pre-existing conditions, warranted removal from the MIG.

Furthermore, the applicant did not meet the test for a non-earner benefit, as she failed to demonstrate a complete inability to carry on a normal life.

The application was dismissed.

The applicant sought a non-earner benefit, various chiropractic treatment plans, an orthopaedic assessment, interest, and an award under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to demonstrate a complete inability to carry on a normal life, as medical evidence indicated she continued to substantially engage in her pre-accident activities.

The Tribunal also found the applicant did not meet her burden to prove the disputed treatment plans were reasonable and necessary.

Claims for interest and an award were consequently dismissed.

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

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

The Tribunal found the applicant did not meet her burden to prove chronic pain with functional impairment or a psychological injury warranting removal from the MIG.

However, because the respondent failed to provide compliant denial notices within the required 10-day period under section 38(8) of the Schedule, the Tribunal ordered the respondent to pay for the incurred treatment plans from the 11th day after submission until the date the defective notices were cured.

The applicant's claim for an award for unreasonable delay was dismissed.

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

The Licence Appeal Tribunal found the applicant did not meet her burden to prove a functional impairment from chronic pain or a psychological impairment, placing weight on the respondent's independent medical and psychological evaluations which included objective testing.

As the applicant remained subject to the MIG, her claims for various treatment plans, interest, and an award for unreasonable delay were dismissed.

The applicant sought a determination of catastrophic impairment under Criterion 8 (mental or behavioural disorder) following a 2015 motor vehicle accident.

The Tribunal reviewed expert evidence and the applicant's self-reported functioning.

The Tribunal found the applicant's self-reports unreliable and inconsistent with his academic, employment, and social history.

The Tribunal concluded the applicant did not sustain a marked impairment in social functioning or adaptation, and therefore did not meet the threshold for a catastrophic impairment.

The applicant sought statutory accident benefits for hearing aids costing $5,620.00 following a motor vehicle accident.

The respondent denied the expense.

The Tribunal found that the hearing aids were not reasonable and necessary, as medical records indicated the hearing loss was primarily due to guitar playing noise exposure rather than the accident.

Furthermore, the applicant failed to submit a treatment plan prior to incurring the expense, contrary to section 38(2) of the Schedule, and no exceptions applied.

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 applicant argued she should be removed from the MIG due to chronic pain with functional impairment and psychological impairments.

The Tribunal found the applicant did not meet her burden to prove her injuries fell outside the MIG, noting inconsistencies in her expert reports and a lack of documented functional impairment in her primary care records.

As the MIG applied, the disputed treatment plans were not payable.

Claims for interest, a special award, and costs were also 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 applicant argued she should be removed from the MIG due to pre-existing right knee and psychological conditions, as well as accident-related psychological impairments.

The Tribunal found the applicant failed to prove her pre-existing conditions precluded recovery within the MIG or that she suffered an accident-related psychological impairment, noting a lack of corroborating clinical notes from her family doctor.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a chronic pain assessment and removal from the Minor Injury Guideline (MIG) due to chronic pain and psychological impairments.

The Licence Appeal Tribunal found that the applicant failed to establish chronic pain with functional impairment or a psychological condition warranting removal from the MIG, preferring the respondent's section 44 multidisciplinary assessments over the applicant's expert reports.

As the applicant remained subject to the MIG, the disputed treatment plan was not considered, and claims for interest and a section 10 award were 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 a concussion, psychological impairment, and chronic pain.

The Tribunal found insufficient medical evidence to support these diagnoses, concluding the applicant's injuries were predominantly minor.

The Tribunal also found the respondent's denial notices complied with section 38(8) of the Schedule.

As the applicant was subject to the MIG and the limit was exhausted, the treatment plans were not payable.

Claims for interest and a section 10 award were dismissed.

The applicant, who was deemed catastrophically impaired following a 2015 motor vehicle accident, sought payment for several treatment plans denied by the respondent insurer.

The Licence Appeal Tribunal found that the proposed physiotherapy services were not reasonable and necessary, as the applicant had reached maximum medical recovery and previous treatment yielded no functional gains.

The Tribunal partially approved the psychological services plan for the OCF-18 completion fee but denied administrative and planning costs.

The Tribunal approved the occupational therapy and case management plans, finding the requested hours for documentation and planning to be reasonable.

The applicant's claim for a special award was dismissed, as the insurer's conduct was not found to be unreasonable.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit (NEB), a functional abilities assessment, and a chronic pain assessment.

The Tribunal found the respondent failed to comply with a production order regarding the NEB denial letter and drew an adverse inference, concluding the respondent failed to provide proper notice under s. 36(4) of the Schedule.

Consequently, the NEB was payable under s. 36(6).

The Tribunal denied the functional abilities assessment, finding the applicant's physical condition did not limit his daily tasks or employment.

However, the Tribunal approved the chronic pain assessment based on consistent reports of ongoing pain.

Claims for an award and costs were dismissed.

The applicant, who was deemed catastrophically impaired following a motor vehicle accident, sought various statutory accident benefits including assistive devices, a hot tub, a family gym membership, and physiotherapy services.

The Tribunal found the applicant was barred from proceeding with two treatment plans because she failed to attend scheduled insurer examinations without a reasonable explanation.

For the remaining substantive issues, the Tribunal dismissed the claims, finding the applicant failed to meet her burden to demonstrate that the proposed treatments and devices were reasonable and necessary.

Claims for interest and a special award were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, chiropractic treatment plans, and a psychological assessment.

The respondent denied the benefits based on section 44 insurer examinations.

The Tribunal found that the applicant failed to prove a complete inability to carry on a normal life, as medical evidence showed she could perform personal care, grocery shop, and swim.

The Tribunal also dismissed the claims for medical benefits, preferring the respondent's expert evidence that the treatments were not reasonable and necessary.

The application was dismissed in its entirety.

The applicant sought $3,697.14 for a psychological services treatment plan involving virtual drive counselling following a motor vehicle accident.

The insurer denied the plan and requested additional information under section 33 of the Schedule, which the applicant failed to provide.

The Tribunal found the applicant did not meet her burden to prove the treatment was reasonable and necessary, preferring the insurer's section 44 psychological assessment over the applicant's evidence.

Claims for interest and an award for unreasonable delay were also dismissed.

The applicant sought entitlement to statutory accident benefits for an endocrinology CAT assessment and various other CAT assessments following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to establish on a balance of probabilities that the proposed assessments were reasonable and necessary.

The Tribunal noted that the applicant's diabetes and pancreatitis pre-dated the accident and lacked a causal connection to it.

Furthermore, the applicant failed to justify the need for multiple psychiatric and occupational therapy assessments beyond the statutory caps.

Claims for interest and an award for unreasonable delay were also dismissed.

The applicant sought a determination that she sustained a catastrophic impairment (Criterion 8) following a motor vehicle accident.

The respondent argued the application was barred by res judicata, as the Tribunal had previously dismissed an identical claim by the applicant.

The applicant contended that res judicata should be waived based on fresh evidence, including updated medical and occupational therapy reports, and an ODSP approval.

The Tribunal found that the three preconditions for res judicata were met and that the new reports did not constitute fresh evidence that would conclusively impeach the prior decision.

The application was dismissed.