Caley Howard

The applicant sought entitlement to statutory accident benefits for physiotherapy, massage therapy, and osteopathy following a motor vehicle accident.

The respondent denied the benefits based on an insurer's examination report which concluded further facility-based treatment would not provide improvement.

The Tribunal found the treatment plans reasonable and necessary, preferring the evidence of the applicant's treating practitioners who noted the treatments provided pain relief and functional maintenance.

The Tribunal granted entitlement to the treatment plans and certain incurred expenses, along with interest, but dismissed the claim for an award under s. 10 of Reg. 664, finding the respondent's reliance on its medical assessment was not unreasonable.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming funding for driving therapy, physiotherapy, and a neurological assessment.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that the proposed treatment plans were reasonable and necessary.

The driving therapy claim lacked sufficient supporting evidence, the physiotherapy claim was unsupported by clinical notes demonstrating benefit, and the neurological assessment was deemed unnecessary as the applicant was already being treated by a neurologist covered by OHIP.

The application was dismissed in its entirety.

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

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

The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain or an accident-related psychological condition that would warrant removal from the MIG.

As the injuries were predominantly minor, the applicant remained subject to the $3,500 MIG limit.

Claims for additional treatment plans, interest, and a section 10 award were 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 applicant argued she should be removed from the MIG due to an accident-related psychological condition and chronic pain.

The Tribunal found the applicant failed to prove on a balance of probabilities that her psychological symptoms or chronic pain were caused by the accident, noting significant delays in reporting symptoms and alternative causes documented in her medical records.

The Tribunal concluded the applicant remains subject to the MIG limit, dismissed the claims for interest and a section 10 award, and held she is entitled to the disputed assessments only up to the remaining MIG limit.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a cognitive communication assessment and psychological services.

The respondent denied the assessment and partially approved the psychological services at a lower hourly rate.

The Tribunal found the cognitive communication assessment was reasonable and necessary based on contemporaneous medical evidence of cognitive symptoms.

For the psychological services, the Tribunal found an hourly rate of $130.00 was reasonable for a registered psychotherapist providing cognitive behavioural therapy under the supervision of a psychologist.

The Tribunal also approved preparation fees but denied brokerage and documentation support fees.

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

The respondent denied 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 prove on a balance of probabilities that he suffered from a psychological condition, chronic pain with functional impairment, or a pre-existing condition that would warrant removal from the MIG.

However, the Tribunal found that the respondent's denial of a $4,675.12 physiotherapy treatment plan did not comply with the notice requirements under s. 38(8) of the Schedule, rendering it payable despite the MIG limits being exhausted.

The denial of a psychological assessment was found to be compliant and was dismissed.

The applicant's claim for a special award under s. 10 of Reg. 664 was denied.

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) and the $3,500 limit had been exhausted.

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

The adjudicator preferred the respondent's medical evidence, finding the applicant's expert report lacked objective corroboration and relied on vague subjective reports.

The adjudicator concluded the applicant failed to prove chronic pain with functional impairment, meaning she remained subject to the MIG.

As the MIG limits were exhausted, the claims for treatment plans and interest were 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 psychological impairments, chronic pain with functional impairment, and a pre-existing chronic pain condition.

The Tribunal found that the applicant failed to prove on a balance of probabilities that her psychological impairments or chronic pain with functional impairment were caused by the subject accident, or that she had a documented pre-existing condition precluding her recovery within the MIG.

As the $3,500 MIG limit had been exhausted, the disputed treatment plans and claim for interest were dismissed.