Jeff Chatterton

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, which the respondent insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's injuries warranted removal from the MIG due to chronic pain with functional limitations and psychological injuries, preferring the evidence of the applicant's treating professionals over the insurer's assessors.

The Tribunal ordered the respondent to pay for the disputed chiropractic services, psychological assessment, and psychological treatment, finding them reasonable and necessary.

The claims for physiatry and orthopedic assessments were dismissed as the applicant had already been diagnosed with chronic pain and failed to prove their necessity.

Interest was awarded on overdue payments.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically a $3,861.20 physiotherapy treatment plan.

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

The applicant argued the respondent's denial notice violated s. 38(8) of the Schedule.

The Tribunal found the denial notice was compliant, as referencing the MIG is a valid medical reason for denial.

The applicant failed to provide substantive evidence to warrant removal from the MIG.

The application was dismissed.

The applicant sought payment for three physiotherapy treatment plans following a motor vehicle accident.

The adjudicator found that the applicant failed to prove the treatments were reasonable and necessary, noting that the applicant's own family physician recorded that physiotherapy was not helping, and neither the applicant's nor the respondent's medical assessors recommended ongoing physiotherapy.

The applicant also argued entitlement based on the insurer's failure to provide timely notice under section 38(8) of the Schedule.

The adjudicator agreed the insurer was non-compliant but dismissed the claim because the applicant provided no evidence that the expenses were actually incurred during the period of non-compliance.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to two physiotherapy treatment plans and a chronic pain assessment.

The adjudicator found that the applicant failed to provide sufficient objective medical evidence to demonstrate that the proposed treatments and assessment were reasonable and necessary.

The adjudicator also rejected the applicant's argument that the respondent's denial letters violated section 38(8) of the Schedule, finding that the insurer had clearly identified the medical reasons for the denials.

The application was dismissed in its entirety.

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 that the respondent's denial notices were procedurally defective under s. 38(8) of the Schedule.

The Tribunal found that the applicant failed to provide medical evidence to establish removal from the MIG.

Furthermore, the Tribunal held that the respondent's denial notices were compliant with the Schedule, as they clearly identified the treatment plans and provided valid medical reasons for the denials.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming costs for medical cannabis and a social work assessment.

The Tribunal denied the claims for medical cannabis, finding it was not reasonable and necessary as the applicant reported deriving little benefit from it compared to other pharmaceuticals.

However, the Tribunal ordered the respondent to pay for the social work assessment because the respondent's denial letter relied on boilerplate language and failed to provide sufficient medical reasons, violating s. 38(8) of the Schedule.

Claims for an award under s. 10 of Reg. 664 were dismissed, but interest was awarded on the overdue payment for the social work assessment.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing that his injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain.

The adjudicator found that the applicant failed to provide sufficient objective medical evidence of a functional limitation or a pre-existing condition that would preclude recovery within the MIG.

Relying on the respondent's independent medical examination, the adjudicator concluded the injuries were predominantly minor.

Consequently, the claims for physiotherapy treatment plans, interest, and an award for unreasonable delay were dismissed.

The applicant sought statutory accident benefits for chiropractic treatment, an orthopedic assessment, and a psychological assessment following a motor vehicle accident.

The respondent denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the treatments and assessments were reasonable and necessary.

The Tribunal drew an adverse inference from the applicant's failure to produce medical records, noted a lack of contemporaneous medical evidence supporting the chiropractic plans, found the orthopedic assessment unnecessary as the applicant had missed prior OHIP-covered assessments, and deemed the psychological assessment a duplication of services.

The applicant sought statutory accident benefits following a motor vehicle accident but was denied by the respondent on the basis that her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG due to a psychological condition, relying on a psychological assessment conducted via video call.

The Tribunal preferred the respondent's in-person psychological assessment, which found no psychological condition, noting it included validity testing and was conducted directly by a psychologist.

The Tribunal held the applicant to the MIG limit and dismissed the claims for disputed treatment plans and interest.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on an alleged psychological condition and pre-existing chronic back pain.

The Licence Appeal Tribunal found the medical evidence insufficient to establish an accident-related psychological condition or that the pre-existing condition precluded recovery within the MIG.

The application was dismissed, and the applicant remained subject to the $3,500 MIG limit, rendering the disputed treatment plans moot.

The applicant sought entitlement to statutory accident benefits for chiropractic services and a chronic pain assessment following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide corroborating medical evidence of accident-related pain or evidence that the proposed chiropractic treatments would relieve such pain.

The Tribunal also found insufficient evidence to warrant a chronic pain assessment, noting the applicant's continued full-time employment and lack of physical deconditioning or social withdrawal.

As no benefits were payable, the claim for interest was 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 sought removal from the MIG on the basis of chronic pain and psychological injury.

The Tribunal found insufficient evidence of chronic pain with functional impairment and preferred the respondent's psychological assessment over the applicant's.

The application was dismissed, and the applicant was held to the $3,500 MIG limit.

The applicant sought accident benefits following a motor vehicle accident, claiming entitlement to chiropractic treatment plans and removal from the Minor Injury Guideline (MIG) due to chronic pain.

The adjudicator found that the applicant failed to meet her burden of proving chronic pain with functional impairment, noting a lack of medical evidence and infrequent visits to her primary care physician.

Relying in part on an insurer's examination which found full range of motion, the adjudicator held the applicant to the MIG.

Consequently, the claims for chiropractic services and interest were dismissed.

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

The respondent denied a treatment plan for psychological services, arguing the applicant was subject to the Minor Injury Guideline (MIG) and that the application was barred by the two-year limitation period.

The Tribunal found the application was filed in time because the deadline fell on a weekend and statutory holiday.

However, the Tribunal held the applicant to the MIG because she failed to provide submissions or evidence to warrant removal.

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

As the treatment plan exceeded the MIG limits, it was denied.

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

The insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that she failed to provide requested medical evidence.

The Tribunal found the applicant failed to meet her burden of proof to be removed from the MIG or to establish entitlement to a non-earner benefit, as she provided no medical evidence to support her claims.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including psychological services, a catastrophic impairment assessment, and a special award.

The Tribunal found the applicant was entitled to the higher psychologist rate for services provided by a supervised psychotherapist, awarding $598.32.

However, further psychological services were denied as the applicant had reached maximal improvement and was independent in daily living.

The catastrophic impairment assessment was also denied due to insufficient evidence of impairment.

The claim for a special award was dismissed.

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

The respondent insurer denied two physiotherapy treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered a concussion, supported by emergency room records and a family physician's diagnosis, which warranted removal from the MIG.

The Tribunal ordered the respondent to pay the disputed treatment plans and awarded a 50% penalty under s. 10 of Regulation 664, finding the insurer's refusal to accept the concussion diagnosis and reliance on a flawed independent medical examination constituted stubborn and unreasonable conduct.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to meet his onus to demonstrate injuries warranting removal from the MIG, noting a lack of supporting medical evidence from his family physician or treatment plans.

Relying in part on an insurer's examination report, the Tribunal concluded the injuries were predominantly minor.

As the applicant was held to the MIG, the disputed treatment plans were dismissed without further analysis.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and an orthopaedic assessment.

The respondent denied the benefits, initially relying on the Minor Injury Guideline (MIG), though the MIG was later conceded.

The Tribunal found the applicant entitled to the first physiotherapy treatment plan based on supportive clinical notes from his family physician.

However, the Tribunal dismissed the claims for subsequent physiotherapy plans and the orthopaedic assessment due to a lack of medical evidence demonstrating they were reasonable and necessary.

The claim for a special award under s. 10 of O. Reg. 664 was dismissed as the insurer's conduct did not rise to the level of being unreasonable, given the applicant's failure to provide requested medical documentation.

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 applicant argued for removal from the MIG due to psychological injury, chronic pain, and physical injuries including a fractured rib and radiculopathy.

The Tribunal found that the applicant failed to provide sufficient medical evidence linking the psychological symptoms, chronic pain, or physical injuries to the accident.

The Tribunal also found the respondent's denial letters complied with the Schedule.

The application was dismissed, and the applicant was held to the MIG.