Jesse A. Boyce

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 claimed entitlement to a non-earner benefit, a psychological assessment, and removal from the MIG due to chronic pain and psychological impairments.

The Licence Appeal Tribunal found that the applicant failed to provide sufficient medical evidence to warrant removal from the MIG, noting the absence of a chronic pain diagnosis and preferring the insurer's objective psychological assessments.

Furthermore, the applicant did not demonstrate a complete inability to carry on a normal life, as he continued to work and engage in pre-accident activities.

The application was dismissed.

The applicant insurer sought repayment of $17,830.30 in income replacement and medical benefits paid to the respondent, alleging wilful misrepresentation.

The respondent claimed she was injured in a motor vehicle accident, but medical records revealed her injuries resulted from falling down a flight of stairs while intoxicated.

The respondent failed to participate in the hearing.

The Tribunal found that the respondent wilfully misrepresented the cause of her impairments and ordered her to repay the benefits in full, plus interest, pursuant to section 52 of the Statutory Accident Benefits Schedule.

The applicant sought payment for a chiropractic treatment plan in the amount of $2,822.90 following a motor vehicle accident.

The respondent denied the plan based on an insurer's examination report which concluded the treatment was not reasonable and necessary.

The Tribunal found that the applicant suffered from uncomplicated soft-tissue injuries and had already received a year of similar treatment with limited progress.

The Tribunal preferred the respondent's medical evidence and dismissed the application, finding the treatment plan was not reasonable and necessary.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her physical and psychological impairments warranted removal from the Minor Injury Guideline (MIG).

The adjudicator found that the applicant's physical injuries were uncomplicated sprains and strains treatable within the MIG, and she failed to establish chronic pain with functional impairment.

Furthermore, the applicant did not prove that her psychological impairments were caused by the subject accident rather than other significant life stressors and previous accidents.

As the MIG limits were exhausted, the disputed treatment plans were deemed not reasonable and necessary, and the application was dismissed.

The respondent insurer requested a reconsideration of a preliminary decision which found that the applicant's incident constituted an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The respondent argued the Tribunal erred in its consideration of the evidence, including the applicant's examination under oath and an MRI report.

The Tribunal dismissed the request, finding that the respondent was attempting to re-litigate the weight assigned to the evidence and that no errors of law or fact were made that would have resulted in a different outcome.

The applicant's request for costs was also dismissed.

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

The respondent insurer denied the benefits on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant failed to meet her burden of proving the chiropractic treatment plans were reasonable and necessary, noting a lack of contemporaneous medical evidence and reliance on the treatment plans themselves.

The Tribunal preferred the insurer's s. 44 assessment reports which concluded further facility-based treatment would not provide substantive benefit for the applicant's soft-tissue injuries.

The Tribunal also dismissed the claim for psychological treatment, finding the applicant failed to respond to the insurer's request for further information under s. 33 of the Schedule.

The application was dismissed.

The applicant sought a medical benefit of $2,028.78 for physiotherapy under the Statutory Accident Benefits Schedule.

The applicant claimed he sustained a shoulder injury from providing massage and care to his wife, who was injured in an automobile accident three years prior.

The respondent denied the claim on the basis that the applicant was not involved in an accident and the treatment was not reasonable and necessary.

The Tribunal found that the applicant failed to meet the 'but for' test for causation, as his injury was not directly caused by an automobile accident.

The application was dismissed.

The applicant sought payment for two psychological treatment plans, a special award, and interest following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, noting that the treating psychologist's reports were boilerplate and did not reflect the applicant's reported improvements or lack of functional difficulties.

The Tribunal preferred the respondent's section 44 assessor's report, which recommended a ramp down in treatment.

The application was dismissed, and no interest or award was payable.

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

The respondent denied a treatment plan for physiotherapy, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, claiming her injuries warranted removal from the MIG due to chronic pain and psychological impairments.

The Tribunal found the applicant failed to provide sufficient medical evidence to support removal from the MIG, noting her physical injuries were soft-tissue in nature and her psychological symptoms resolved shortly after the accident.

The application was dismissed, and claims for interest and a section 10 award were denied.

The applicant sought statutory accident benefits for a $1,000 orthopaedic mattress following a motor vehicle accident.

The respondent denied the benefit, relying on an insurer's examination report which concluded the mattress was unlikely to assist in managing pain.

The Tribunal found the mattress to be reasonable and necessary, noting that multiple treating practitioners and assessors documented the applicant's ongoing sleep disturbances and fatigue.

The Tribunal afforded less weight to the respondent's expert, whose opinion was inconsistent with other medical evidence.

The applicant was awarded the cost of the mattress plus interest.

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's physical injuries were uncomplicated soft tissue injuries and that he failed to provide sufficient medical evidence of a psychological impairment or pre-existing condition to warrant removal from the MIG.

As the MIG limits were exhausted, the disputed treatment plans were not payable, and claims for interest and a section 10 award were dismissed.

The applicant requested a reconsideration of a decision finding his application for Non-Earner Benefits statute-barred due to an expired limitation period.

The applicant argued the Tribunal erred in its findings regarding the respondent's duty to re-adjust the file when he reached the age of majority, its reliance on early medical records, and its conclusion that three valid denials triggered the limitation period.

The Tribunal dismissed the request, finding no errors of law or fact that would have led to a different result, noting the preliminary hearing focused solely on the limitation period and formal documentation rather than the substantive merits of the claim.

The applicant sought an income replacement benefit (IRB) and funding for psychological treatment following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove a substantial inability to perform the essential tasks of his employment, as he provided no job description or details of his essential tasks.

The Tribunal also denied the psychological treatment plans, concluding they were not reasonable and necessary because they duplicated OHIP-funded psychiatric services the applicant was already receiving.

The applicant sought statutory accident benefits for chiropractic treatment and a chronic pain assessment following a 2017 motor vehicle accident.

The insurer denied the treatment plans on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant failed to meet her burden of proving the treatments were reasonable and necessary, noting a lack of objective musculoskeletal impairment and evidence that the applicant had returned to normal activities.

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 for removal from the MIG based on chronic pain.

The Tribunal found the applicant failed to prove their injuries warranted removal from the MIG, noting the lack of a chronic pain diagnosis, no prescription medication, and a return to full-time pre-accident employment.

The application for an orthopaedic assessment, interest, and an award under O. Reg. 664 was dismissed.

The applicant requested a reconsideration of a previous decision that denied a treatment plan for physiotherapy services.

The Tribunal found that it had committed a clear error of fact and law by relying on incorrect submissions that addressed a psychological treatment plan not in dispute.

Upon reviewing the correct submissions, the Tribunal found that the applicant had demonstrated on a balance of probabilities that the $2,486.45 physiotherapy treatment plan was reasonable and necessary to address her chronic pain and functional limitations.

The Tribunal preferred the evidence of the applicant's experts over the respondent's section 44 assessor, noting the latter failed to contemplate a chronic pain diagnosis.

The request for reconsideration was granted and the treatment plan was approved.

The applicant requested a reconsideration of a decision that denied payment for various medical expenses under the Statutory Accident Benefits Schedule.

The applicant argued the adjudicator erred in law and fact by failing to consider his unique circumstances.

The Licence Appeal Tribunal dismissed the request, finding that the applicant was attempting to re-litigate unsuccessful arguments and failed to identify an articulable error of law or fact that would have changed the outcome.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit and a treatment plan for massage and physiotherapy.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that he failed to provide sufficient information to support his IRB claim.

The Licence Appeal Tribunal found that the applicant failed to meet his burden of proof to warrant removal from the MIG, failed to prove the treatment plan was reasonable and necessary, and failed to demonstrate a substantial inability to perform the essential tasks of his employment for the IRB.

The application was dismissed.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident.

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

The Tribunal found that the applicant failed to provide sufficient objective medical evidence to demonstrate that his physical or psychological impairments warranted removal from the MIG.

As the MIG limits had been exhausted, the disputed treatment plans were not reasonable and necessary, and no interest was payable.

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

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

The Tribunal found that the applicant failed to demonstrate that her physical or psychological impairments warranted removal from the MIG, noting a lack of objective evidence and preferring the respondent's medical assessments.

Consequently, the disputed treatment plan was deemed not reasonable and necessary, and the application was dismissed.