Julian DiBattista

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 for removal from the MIG based on chronic pain.

The Tribunal found that while the applicant had documented pain, there was no evidence of an associated functional impairment, which is required for removal from the MIG.

As the applicant remained in the MIG, the disputed treatment plan was not reviewed.

The applicant made no submissions on the disputed OCF-6 expenses.

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

The applicant argued for removal from the MIG due to chronic pain with functional impairment and a psychological impairment.

The Tribunal preferred the evidence of the respondent's physiatrist over the applicant's orthopaedic surgeon, finding the latter's report relied entirely on self-reported questionnaires without a thorough physical examination or review of medical records.

The Tribunal concluded the applicant suffered soft-tissue injuries within the MIG and failed to prove chronic pain or a psychological impairment warranting removal.

As the applicant remained subject to the MIG, the disputed treatment plans were not considered, and claims for interest and a special award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing their psychological impairments and chronic pain warranted removal from the Minor Injury Guideline (MIG).

The Tribunal found insufficient evidence linking the applicant's psychological diagnoses to the accident, relying on a respondent's psychological assessment that noted symptom magnification.

The Tribunal also accepted the respondent's medical assessment finding no objective functional impairments related to chronic pain.

As the applicant remained subject to the exhausted MIG limits, the disputed treatment plans and claim for interest were dismissed.

The applicant insurer sought repayment of $3,542.86 in income replacement benefits paid to the respondent, alleging wilful misrepresentation because the respondent had driven for Uber.

The Tribunal dismissed the application, finding that the insurer failed to prove the respondent used the insured vehicle for commercial purposes in contravention of the insurance contract or made a material misrepresentation.

The insurer was not entitled to repayment under section 52 of the Schedule.

The applicant sought payment for two physiotherapy treatment plans following a 2015 motor vehicle accident.

The respondent denied the plans, arguing that they included treatment for a right rotator cuff injury that occurred in 2023 due to moving and heavy lifting, not the accident.

The Tribunal agreed, finding that medical evidence, including ultrasound and physiatry reports, confirmed the rotator cuff tear was an intervening, non-accident-related injury.

Because the treatment plans did not differentiate between accident-related and non-accident-related injuries, the applicant failed to prove the plans were reasonable and necessary.

The application was dismissed.

The applicant sought income replacement benefits (IRBs) and a special award following a motor vehicle accident.

Prior to the hearing, the respondent paid the outstanding IRBs with interest up to July 29, 2025, and subsequently terminated the benefit.

The Tribunal found the post-July 2025 termination was not properly in dispute.

The Tribunal dismissed the applicant's claim for a special award under s. 10 of O. Reg. 664, finding the respondent's delay in payment was not unreasonable as it was awaiting necessary Employment Insurance documentation.

Both parties' requests for costs were denied.

The applicant sought entitlement to statutory accident benefits for a rehabilitation assistant, physiotherapy, massage, and a gym membership following a motor vehicle accident.

The Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary.

Medical evidence demonstrated that the applicant's rotator cuff tear pre-dated the accident and that she had reached maximal medical improvement with full range of motion.

The application was dismissed.

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

The applicant argued that the respondent failed to properly deny a treatment plan for a psychological assessment under s. 38(8) of the Schedule, and thus was precluded from relying on the MIG.

The Tribunal found the respondent's denial was compliant, as it clearly cited the MIG as the medical reason for refusal.

The applicant provided no medical evidence to support removal from the MIG or entitlement to the disputed plan.

The application was dismissed.

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

The Tribunal weighed competing psychological assessments and preferred the respondent's expert, who found no accident-related psychological impairment under the DSM-5.

The Tribunal concluded the applicant failed to prove an injury warranting removal from the MIG.

Consequently, the claims for treatment plans beyond the MIG limit and interest were dismissed.

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

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

The Tribunal found that the medical evidence, including clinical notes and a disability certificate, only supported diagnoses of sprains and strains, which fall squarely within the definition of a minor injury.

The applicant failed to prove on a balance of probabilities that his injuries warranted removal from the MIG.

Consequently, the disputed treatment plan was not considered for reasonableness and necessity, and the application was dismissed.

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

The Tribunal found that the applicant's medical evidence, including a pain report and an MRI, failed to connect his current pain to the accident or establish chronic pain syndrome with functional impairment.

Conversely, the respondent's medical examination diagnosing a minor thoracolumbar myofascial strain was accepted.

The Tribunal concluded the applicant's injuries were minor and subject to the $3,500 MIG limit.

Claims for specific treatment plans outside the MIG, interest, and an award for unreasonable delay were dismissed.

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 and psychological impairment.

The Tribunal found that the applicant failed to prove a psychological impairment, giving little weight to his psychological assessment as it was unsupported by contemporaneous clinical history or psychometric testing.

The Tribunal also found that the applicant did not meet the criteria for chronic pain syndrome under the AMA Guides.

Consequently, the applicant remained subject to the MIG, and his claims for treatment plans outside the MIG limit, as well as for interest and an award, 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 claimed chronic pain and psychological impairments warranted removal from the MIG.

The Tribunal found the applicant's medical evidence, consisting of a single clinical note and a disability certificate, insufficient to prove impairments outside the MIG.

The Tribunal accepted the respondent's section 44 assessments, which found no impairments warranting removal.

The application was dismissed, and the applicant remained subject to the MIG limits.

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 that the respondent's denial notices were non-compliant with s. 38(8) of the Schedule, which should preclude the respondent from relying on the MIG.

The Tribunal found that the denial notices were compliant because citing the MIG constitutes a valid medical reason.

As the applicant provided no medical evidence to establish injuries outside the MIG, the Tribunal held that the applicant remains subject to the MIG limits and dismissed the claims for the disputed treatment plans, interest, and an award.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing for removal from the Minor Injury Guideline (MIG) due to chronic pain and psychological impairment.

The Tribunal found the applicant's medical evidence insufficient, giving no weight to a telephone-only orthopaedic assessment and negligible weight to a psychological assessment that contradicted its own psychometric testing.

The Tribunal concluded the applicant's injuries remained within the MIG, dismissing the claims for disputed treatment plans, interest, and a special award.

The respondent insurer requested reconsideration of a Tribunal decision which found that the insurer incorrectly applied s. 4(5) of the Statutory Accident Benefits Schedule in calculating the applicant's income replacement benefit.

The insurer argued the Tribunal erred in finding the applicant had complied with a s. 33(1) request for financial documentation.

The Tribunal dismissed the reconsideration request, finding that by communicating he had not filed his pre-accident income taxes, the applicant provided the totality of information required for the insurer to correctly calculate the quantum of his benefit at $0.00, thereby fulfilling the s. 33(1) request.

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 claimed chronic pain warranted removal from the MIG.

The Tribunal found the medical evidence, including clinical notes and an insurer's examination, did not support the presence of an accident-related chronic pain syndrome with functional impairment.

As the policy limits within the MIG were exhausted, the claims for physiotherapy and a chronic pain assessment were dismissed, along with claims for interest and an award.

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

The respondent denied various 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 meet the burden of proving his injuries fell outside the MIG.

The Tribunal also rejected the applicant's argument that the respondent's denial letters were non-compliant with s. 38(8) of the Schedule, finding that citing the MIG constitutes a valid medical reason for denial.

The application was dismissed.

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

The applicant argued for removal from the MIG due to a psychological impairment, a pre-existing anxiety disorder, and chronic pain.

The Licence Appeal Tribunal found that the applicant failed to prove a psychological impairment, as the psychological reports relied on self-reporting and ignored his pre-existing history.

The Tribunal also found insufficient evidence that his pre-existing anxiety precluded recovery within the MIG or that he suffered from chronic pain with functional impairment.

The application was dismissed, and the applicant was denied the disputed treatment plans and interest.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to psychological services and a chronic pain assessment.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary.

The psychological treatment plan lacked properly identified goals, and there was no evidence supporting the need for a follow-up chronic pain assessment two years after the initial one.

The application was dismissed, with no entitlement to interest or an award for unreasonable delay.