Brian Norris

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

The respondent insurer determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and refused to pay for certain physiotherapy treatment plans.

The applicant applied to the Licence Appeal Tribunal, arguing that chronic pain removed them from the MIG.

The adjudicator found that the applicant's pain was intermittent and did not meet the criteria for chronic pain syndrome, preferring the evidence of the respondent's independent medical examiner over the applicant's family physician.

The adjudicator concluded the injuries were predominantly minor and subject to the $3,500 funding limit.

One treatment plan was denied as it proposed treatment outside the MIG, while another was approved subject to the funding limit.

No interest was awarded.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision.

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

The Tribunal found that the applicant's diagnosed psychological injury (Adjustment Disorder) removed them from the MIG, despite the applicant's reported disinterest in psychological treatment.

While the Tribunal approved the psychological assessment and treatment plans, it denied the physiotherapy, assistive devices, and chronic pain plans, finding them not reasonable and necessary based on the medical evidence.

The Tribunal also ordered the respondent to pay an award of $1,110.95 under O. Reg. 664 for unreasonably withholding the psychological benefits by misinterpreting the Schedule.

The respondent insurer requested a reconsideration of a Tribunal decision that found the applicant was entitled to the costs of a psychological assessment.

The insurer argued the Tribunal referred to evidence not before it, mischaracterized the dispute as one regarding hourly rates, improperly placed the onus on the respondent, and failed to adhere to case law.

The Adjudicator dismissed the request, finding that while the original decision used imprecise language regarding invoices, it did not constitute an error of fact.

The Adjudicator also found no error in the weighing of evidence regarding the time required to complete the assessment and report, and distinguished the case law relied upon by the insurer.

The request for reconsideration was denied.

The applicant sought an award under Ontario Regulation 664, alleging the respondent unreasonably delayed payment for two 2016 chiropractic treatment plans.

The respondent argued the delay was justified because the applicant failed to comply with a section 33 request for information made by the prior adjusting insurer.

The Tribunal found the applicant did not dispute the validity of the section 33 request and only provided the requested documents two days before the case conference, after which the respondent promptly paid the accounts.

The Tribunal concluded the respondent's refusal to pay was not unreasonable under section 33(6) of the Schedule and dismissed the claim for an award.

The applicant sought statutory accident benefits following a 2010 motor vehicle accident.

The respondent insurer denied caregiver and housekeeping benefits in 2011.

The applicant filed an application to dispute the denial more than two years later, arguing the limitation period should not apply because the denial notice was deficient.

The Tribunal found the denial notice was proper, as it included the required reasons within the enclosed medical reports and complied with the Schedule's requirements.

The Tribunal also declined to extend the limitation period under section 7 of the LAT Act, finding no bona fide intention to dispute the denial within the limitation period.

The application was dismissed as statute-barred.

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

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

The Tribunal found that the applicant failed to prove their psychological and chronic pain symptoms warranted removal from the MIG.

Furthermore, the applicant failed to establish that the disputed treatment and assessment plans were reasonable and necessary, and failed to exhaust collateral benefits for ambulance services.

The application was dismissed.

During an in-person hearing regarding a catastrophic impairment claim, the applicant sought to admit the full neuropsychological report of Dr. Gilman, which had not been fully disclosed prior to the hearing.

The respondent objected on the basis of late disclosure and prejudice.

The Tribunal allowed the full report to be admitted, finding that its relevance and probative value outweighed any prejudice to the respondent.

The Tribunal ordered the applicant to provide the complete report to the respondent's expert and directed a case conference to address any necessary rebuttal reports.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for physical and psychological treatment.

The respondent insurer denied two treatment plans on the basis of an insurer's examination that concluded the injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the treatment plans reasonable and necessary, preferring the evidence of the treating psychologist and other insurer's examiners who noted ongoing pain and psychological disturbance over the physician who erroneously applied the MIG.

The applicant was awarded the claimed medical benefits plus interest.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits, attendant care benefits, and medical benefits.

The Licence Appeal Tribunal found the applicant was not entitled to ongoing income replacement benefits or attendant care benefits, as the medical evidence did not support a substantial inability to perform essential tasks or a need for ongoing care.

The Tribunal also denied requests for psychological and chronic pain assessments.

However, the Tribunal found that orthotic devices were reasonable and necessary, ordering the respondent to pay for them.

Claims for an award and costs were dismissed.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, as well as the costs of several assessments, which the respondent insurer denied.

The Licence Appeal Tribunal found that the proposed chiropractic and psychological treatment plans, along with a chronic pain assessment, were reasonable and necessary given the applicant's ongoing pain and psychological symptoms.

However, the Tribunal concluded that a cognitive assessment and a driver's reintegration assessment were not reasonable and necessary, as the applicant did not exhibit cognitive impairment and the driving phobia could be addressed through the approved psychological treatment.

The applicant was awarded interest on overdue payments, and no costs were awarded to either party.

The applicant sought medical benefits for occupational therapy and chiropractic treatment following a motor vehicle accident where they were struck as a pedestrian.

The Licence Appeal Tribunal found that the occupational therapy plan was not reasonable and necessary as it proposed case management services to which the applicant was not entitled, and there was no evidence of cognitive issues.

The Tribunal also dismissed the claims for chiropractic treatment, finding no supporting medical evidence and noting that the applicant had mostly recovered.

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

The applicant was injured in a motor vehicle accident and sought funding for neuropsychological assessments.

The respondent insurer denied the treatment plans and requested the applicant attend insurer's examinations under section 44 of the Statutory Accident Benefits Schedule.

The applicant refused to attend and applied to the Licence Appeal Tribunal.

The Tribunal found that the respondent provided a valid medical reason for the examinations and that the requests were reasonably necessary.

Because the applicant failed to attend the properly scheduled section 44 assessments, the Tribunal held that the applicant was statute-barred from bringing the application under section 55 of the Schedule.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought funding for chiropractic and massage therapy treatment plans outside the Minor Injury Guideline due to pre-existing conditions.

The respondent denied the plans as not reasonable and necessary.

The Licence Appeal Tribunal found that while the applicant was not bound by the MIG limits, they failed to provide contemporaneous medical evidence supporting the necessity of the treatments.

Relying on the respondent's insurer's examination, which found no ongoing impairment, the Tribunal dismissed the application and denied the applicant's request for costs.

The applicant was injured in a motor vehicle accident and sought accident benefits for chiropractic treatment.

The respondent denied the treatment plan on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been exhausted.

The applicant argued that previous neck and back fractures from a 2008 accident constituted a pre-existing condition precluding recovery within the MIG.

The Tribunal found that while the applicant had a documented pre-existing condition, there was no compelling medical evidence that it prevented maximal recovery within the MIG limit.

The application was dismissed.

The applicant sought statutory accident benefits for physical and psychological treatment plans following a motor vehicle accident.

The respondent denied the plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) or were not accident-related.

The Tribunal found the respondent validly denied one physiotherapy plan submitted while the applicant was still subject to the MIG.

However, the Tribunal approved the remaining physical and psychological treatment plans, finding them reasonable and necessary to treat the applicant's ongoing accident-related chronic pain and psychological impairments.

Interest was awarded on overdue payments.

The applicant was injured in a motor vehicle accident and sought non-earner benefits, which the respondent denied.

The applicant filed an application with the Licence Appeal Tribunal more than two years after the denial.

The respondent raised a preliminary issue that the claim was statute-barred.

The Tribunal applied the four-factor test under section 7 of the Licence Appeal Tribunal Act and found the applicant did not provide reasonable grounds to extend the limitation period, noting the significant delay and lack of a bona fide intention to appeal within the time limit.

The applicant is barred from proceeding with the claim for non-earner benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including non-earner benefits and medical benefits for various treatments.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been exhausted.

The Tribunal found the applicant was not entitled to non-earner benefits because they returned to work two days after the accident and did not suffer a complete inability to carry on a normal life.

The Tribunal also held the applicant failed to prove their injuries, including alleged chronic pain and pre-existing conditions, warranted removal from the MIG.

As the MIG funding limit was exhausted, the disputed treatment plans and examination costs were not payable.

The applicant was injured in a rear-end motor vehicle accident and sought funding for four physiotherapy treatment plans beyond the $3,500 limit of the Minor Injury Guideline (MIG).

The applicant argued that pre-existing back pain and chronic pain removed the injuries from the MIG.

The adjudicator found insufficient evidence of an exacerbation of a pre-existing condition or a chronic pain condition, noting the applicant's continued high level of functionality and lack of reliance on prescription medication.

The application was dismissed as the injuries fell within the MIG and the funding limit had been exhausted.

The applicant sought a determination of catastrophic impairment following a motor vehicle accident.

The respondent insurer requested in-person section 44 assessments to evaluate the claim, which the applicant refused to attend.

The respondent raised a preliminary issue regarding the applicant's failure to attend.

The Tribunal found that the requested assessments were reasonably necessary as catastrophic impairment was a new issue not addressed by previous assessments.

Consequently, the Tribunal ordered the applicant to attend the assessments and procedurally dismissed the application to dispute catastrophic impairment pursuant to section 55(1)2 of the Schedule.

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

The respondent denied funding for various 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's physical injuries, including ongoing pain, did not warrant removal from the MIG, as range of motion was normal and the applicant had returned to pre-accident activities.

The Tribunal also preferred the respondent's psychological assessment, finding no psychological injury.

As the applicant had exhausted the $3,500 MIG limit, the claims for further medical benefits and examinations were dismissed, along with claims for an award and interest.