Chris Sewrattan

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

The insurer denied payment, arguing the injuries were predominantly minor and subject to the $3,500 treatment limit under the Minor Injury Guideline, or alternatively, that the injuries were caused by a subsequent accident.

The Licence Appeal Tribunal found that the applicant suffered from a concussion with post-concussive symptoms caused by the first accident, which is not a predominantly minor injury.

The Tribunal ordered the insurer to pay for a driving rehabilitation assessment and an occupational therapy assessment, finding them reasonable and necessary.

The applicant was awarded interest on overdue payments but denied an award for unreasonable denial, as the insurer's belief regarding the cause of the injuries was reasonable.

The applicant sought payment for statutory accident benefits following a motor vehicle accident, specifically four treatment plans for chiropractic services and a functional abilities assessment, which the insurer denied.

The Licence Appeal Tribunal found that two of the treatment plans for passive, facility-based chiropractic services were reasonable and necessary because they relieved the applicant's physical pain, which in turn prevented his psychological injuries from worsening.

However, the Tribunal denied a third treatment plan involving active home-based exercise as it would aggravate his pain, and denied a second functional abilities assessment as duplicative.

The applicant was awarded interest on the approved plans but denied an award for unreasonable delay, as the insurer did not have the critical evidence linking the physical treatment to the psychological injuries until the hearing.

The applicant sought an income replacement benefit (IRB) following a 2011 motor vehicle accident.

The insurer denied the claim in March 2012.

The applicant did not dispute the denial until December 2017, after exhausting collateral benefits.

The Tribunal held that the two-year limitation period began running with the clear and unequivocal 2012 denial.

The Tribunal declined to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act or apply estoppel, finding no bona fide intention to appeal within the time limit and no prejudice caused by the insurer's subsequent conduct.

The application was dismissed as time-barred, and the applicant's request for costs was denied.

The applicant was injured in a motor vehicle accident and sought payment for physiotherapy services.

The insurer initially denied the treatment plan but approved and paid the $1,168.02 prior to the written hearing.

The only remaining issue was whether the applicant was entitled to interest on the overdue payment.

The adjudicator found that the applicant was entitled to interest under section 51 of the Schedule.

Other issues raised by the self-represented applicant were not properly before the Tribunal.

The applicant sought payment for income replacement benefits, psychological treatment, chiropractic treatment, and a driver reintegration program following a motor vehicle accident.

The Tribunal held that the applicant was not entitled to income replacement benefits because she failed to prove she was employed at the time of the accident or for 26 weeks prior.

The claims for psychological treatment and the driver reintegration program were dismissed as the applicant failed to prove they were reasonable and necessary.

The Tribunal granted payment for two chiropractic treatment plans, finding the applicant's preference for facility-based treatment reasonable.

Claims for costs by both parties were dismissed.

The applicant sought a non-earner benefit following a motor vehicle accident.

The adjudicator found that the applicant was not continuously prevented from engaging in substantially all of her pre-accident activities, as she had reported to the respondent's medical assessors that she could still perform self-care, housekeeping, and caregiving tasks, albeit with pain.

The application for the non-earner benefit was dismissed, and neither party was awarded costs.

The applicant sought payment for an income replacement benefit, chiropractic services, psychological services, and custom orthotics following a motor vehicle accident.

The Licence Appeal Tribunal dismissed all claims.

The applicant failed to prove a substantial inability to perform the essential tasks of his pre-accident employment after May 2017.

The chiropractic treatment plans were not shown to be reasonable and necessary, the psychological services were duplicative, and the custom orthotics expense was incurred before submitting a treatment plan, contrary to section 38(2) of the Schedule.

The applicant sought an order from the Licence Appeal Tribunal to allow him to record an insurer's medical examination under s. 44 of the Statutory Accident Benefits Schedule.

The Tribunal held that it does not have the jurisdiction to order the use of a recording device during an insurer's examination, as its powers are strictly statutory and neither the Insurance Act nor the Schedule confers such authority.

The preliminary issue was resolved in favour of the insurer.

The applicant sought payment for attendant care benefits following a motor vehicle accident, claiming her son resigned from his employment to provide the care.

The Licence Appeal Tribunal dismissed the application, finding insufficient evidence that the son actually provided the specific attendant care services recommended by the occupational therapist.

The Tribunal noted credibility issues with the son's bank statements and paystubs, and concluded the applicant failed to prove on a balance of probabilities that the services were incurred.

Claims for interest and a special award were consequently dismissed.

The applicant sought payment for various medical treatments, assessments, disability certificates, and Income Replacement Benefits (IRBs) following a motor vehicle accident.

The insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The adjudicator found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain or a psychological impairment that would remove him from the MIG.

Consequently, the claims for medical benefits and assessments were denied.

Furthermore, while the applicant may have been entitled to IRBs, he failed to provide sufficient financial records to calculate the quantum, resulting in an award of $0 per week.

The applicant was injured in a motor vehicle accident and sought payment for statutory accident benefits.

The insurer denied payment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant suffers from Chronic Post Traumatic Pain Syndrome, removing her from the MIG.

The Tribunal ordered the insurer to pay for the disputed physiotherapy treatments, psychological assessment, and chronic pain assessment, finding them reasonable and necessary.

The applicant's claims for a special award and costs were dismissed, but interest on overdue payments was granted.

The applicant sought payment for statutory accident benefits following a motor vehicle accident, including attendant care benefits, a non-earner benefit, and the cost of various assessments.

The Licence Appeal Tribunal found the applicant was not entitled to attendant care benefits or a non-earner benefit, as she failed to prove the expenses were reasonable and necessary or that she suffered a complete inability to carry on a normal life.

However, the Tribunal ordered the respondent to pay for a chronic pain assessment and two Assessments of Attendant Care Needs, finding them to be reasonable and necessary expenses, along with applicable interest.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove substantive entitlement to an IRB under s. 5(1) of the Statutory Accident Benefits Schedule.

However, because the insurer failed to respond to the application within ten business days, the applicant was procedurally entitled to an IRB of $400 weekly for the period between October 21, 2015, and May 1, 2017, pursuant to s. 36(6) of the Schedule.

Claims for a special award and costs were dismissed.

The applicant was injured in a motor vehicle accident and sought payment for assessments in preparation for a Catastrophic Impairment Assessment.

The insurer partially approved the Treatment Plan but denied payment for a physiatry assessment, file review, Whole Person Impairment Analysis, x-rays, and the completion of an OCF-19.

The Tribunal found the physiatry assessment and OCF-19 completion were reasonable and necessary, ordering payment with interest.

However, the Tribunal denied payment for the file review and WPI Analysis as duplicitous, and denied the x-rays because the applicant failed to prove OHIP coverage was not reasonably available.

The applicant, who suffered a psychiatric impairment following a motor vehicle accident, sought funding for a $25,425 Catastrophic Impairment Assessment.

The insurer denied the claim, arguing the psychiatric condition was not caused by the accident and relying on multiple insurer examinations.

The Licence Appeal Tribunal found that while causation was questionable, it was reasonable and necessary for the applicant to explore the possibility of catastrophic impairment using his own assessors.

The Tribunal capped the funding at $12,200 pursuant to the Schedule's limits.

Claims for a special award and costs were dismissed.

The applicant sought payment for a non-earner benefit following a motor vehicle accident.

The insurer denied the benefit, arguing the applicant failed to submit a completed disability certificate within the required timeframe under section 36(2) of the Statutory Accident Benefits Schedule.

In a preliminary issue hearing, the adjudicator found that the applicant had submitted the certificate, noting the insurer had paid the invoice for its completion and likely misplaced the document.

The adjudicator ruled the applicant was not precluded from claiming the benefit.

The applicant's request for costs was denied as the insurer's actions did not amount to bad faith.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident, claiming an inability to perform his pre-accident employment as a factory worker.

The adjudicator dismissed the claim, finding that the applicant failed to prove what his essential pre-accident employment tasks were, which tasks he was unable to perform, and the extent of his inability.

The applicant's claim for costs was also dismissed due to a lack of evidentiary basis.

The applicant sought payment for a general practitioner's assessment and psychological services following a motor vehicle accident.

The insurer 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 she suffered from a psychological impairment or chronic pain syndrome that would remove her from the MIG.

The Tribunal preferred the insurer's expert evidence, which included psychometric testing, over the applicant's evidence.

The claims for the assessment, psychological services, and interest were dismissed.

The applicant sought payment for various medical benefits, an in-home assessment, and a chronic pain assessment following a motor vehicle accident.

The Licence Appeal Tribunal dismissed all claims.

The claims for pharmacotherapy and physiotherapy were denied because the expenses were not incurred, the applicant failed to disclose potential collateral benefits, and the treatments were not proven to be reasonable and necessary.

The claim for the in-home assessment was barred by the two-year limitation period.

The remaining dispute over the chronic pain assessment related to transportation costs, which the applicant failed to prove were authorized expenses.

The applicant sought various statutory accident benefits following a motor vehicle accident, including an income replacement benefit and several medical benefits.

The Licence Appeal Tribunal found that the applicant was not entitled to an income replacement benefit because he was substantially able to perform essential tasks of his pre-accident employment, such as driving and carrying window samples.

The Tribunal approved two treatment plans for chiropractic services, finding them reasonable and necessary for pain management, and awarded interest on those amounts.

The claims for psychological services, an orthopaedic assessment, and an attendant care assessment were dismissed for lack of evidence demonstrating they were reasonable and necessary.

The respondent's request for costs due to the applicant's procedural non-compliance was denied.