Kimberly Parish

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

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

The applicant argued she should be removed from the MIG due to pre-existing conditions and chronic pain.

The Tribunal found that the applicant's pre-existing conditions did not preclude her from achieving maximal medical recovery within the MIG limit.

Applying the AMA Guides criteria for chronic pain, the Tribunal concluded the applicant failed to establish that she suffered from chronic pain caused by the accident.

The application was dismissed, and the applicant was not entitled to the treatment plan or interest.

The applicant sought statutory accident benefits following a 2014 motor vehicle accident.

The respondent denied certain 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 chronic pain and a pre-existing psychological condition.

The Tribunal found the applicant sustained predominantly minor soft tissue injuries and failed to prove chronic pain or that her pre-existing depression precluded recovery within the MIG limits.

The Tribunal also denied the cost of an accounting report, finding it was not reasonable and necessary as the applicant's income calculation was straightforward.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs), medical benefits for chiropractic and psychological treatment, and an award for unreasonable delay.

The Tribunal found the applicant was not entitled to IRBs, as medical evidence and surveillance footage showing the applicant performing heavy lifting for his pre-accident employer contradicted his claim of substantial inability to work.

The claim for chiropractic treatment was dismissed as duplicative of an already approved plan.

However, the Tribunal granted the unapproved portion of the psychological treatment plan, preferring the treating providers' recommendation of 1.5-hour sessions over the insurer's examination assessor's unexplained recommendation of 1.0-hour sessions.

The claim for an award was dismissed, but interest was awarded on the overdue psychological benefit.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident.

The respondent insurer denied funding for chiropractic treatment, the unapproved balance of a psychological treatment plan, and an orthopedic assessment.

The Licence Appeal Tribunal found that the applicant's ongoing pain complaints and functional impairments, supported by medical records and an orthopedic assessment diagnosing chronic pain syndrome, justified the disputed treatment plans.

The Tribunal ordered the respondent to pay the full amounts for the chiropractic treatment and orthopedic assessment, a partial amount for the psychological treatment plan, and interest on overdue payments.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claims for an income replacement benefit and a treatment plan for physiotherapy.

The applicant argued that the Tribunal made errors of fact and law, including failing to consider certain medical evidence and misinterpreting employment records.

The adjudicator found that the applicant was attempting to re-litigate issues already decided and had not demonstrated any significant legal or evidentiary mistake.

The adjudicator also declined to admit new evidence that could have been produced at the original hearing.

The request for reconsideration was denied.

The applicant sought income replacement benefits and a physiotherapy treatment plan following a motor vehicle accident.

The Tribunal found that the applicant did not suffer a substantial inability to perform the essential tasks of her pre-accident employment within 104 weeks of the accident, nor a complete inability to engage in any employment thereafter.

The Tribunal preferred the respondent's multidisciplinary insurer examination reports over the applicant's expert reports, noting that the applicant's experts relied heavily on uncorroborated self-reporting and failed to address her pre-accident job duties.

The claim for the physiotherapy treatment plan, an award under Regulation 664, and interest were also dismissed.

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

The insurer initially paid the benefit but terminated it following insurance examinations.

The applicant argued the termination notice was deficient under the Schedule.

The Tribunal found that while the notice lacked medical reasons, this did not automatically entitle the applicant to ongoing benefits.

On the merits, the Tribunal found the applicant failed to prove a complete inability to carry on a normal life, noting inconsistencies in his self-reporting, pre-existing conditions from a prior workplace accident, and evidence that he had returned to work.

The application was dismissed.

The applicant sought statutory accident benefits after tripping over a forklift tine while walking towards her parked vehicle and using her key fob to unlock it.

The respondent denied the claim on the basis that the incident was not an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal found that the incident did not meet the purpose test, as walking towards a vehicle and unlocking it with a key fob does not constitute the use or operation of an automobile.

Furthermore, the Tribunal found that the causation test was not met, as tripping over the forklift tine was an intervening act that broke the chain of causation.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, which the respondent insurer denied.

The Licence Appeal Tribunal found that the applicant suffered from ongoing post-concussion symptoms that caused a substantial inability to perform the essential tasks of her pre-accident employment, entitling her to income replacement benefits.

The Tribunal also approved treatment plans for an attendant care assessment, a functional abilities assessment, and a portion of a psychological treatment plan, finding them reasonable and necessary.

The Tribunal dismissed a claim for physical therapy services.

Finally, the Tribunal ordered a 25% award against the respondent under Ontario Regulation 664, finding that the insurer unreasonably withheld the attendant care and functional abilities assessments by failing to properly investigate the applicant's concussion symptoms and relying on flawed independent medical examinations.

The applicant was injured in a motor vehicle accident and sought $2,200 for an attendant care assessment under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal dismissed the claim, finding the applicant's occupational therapy report unpersuasive due to its reliance on self-reporting and internal contradictions.

The Tribunal preferred the respondent's insurer's examination report, which was based on objective testing and concluded the applicant was independent with her personal care tasks.

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 treatment plans for chiropractic/massage therapy, a psychological assessment, and psychological treatment.

The Tribunal found the chiropractic and massage therapy plan was not reasonable and necessary, preferring the respondent's physiatry assessment which recommended a home exercise program.

However, the Tribunal found the psychological assessment and treatment plans were reasonable and necessary, concluding that the accident exacerbated the applicant's pre-existing anxiety and depression.

The Tribunal rejected the respondent's psychiatric assessment because it failed to address the applicant's in-vehicle anxiety and lacked objective testing.

The applicant's claim for a special award under Ontario Regulation 664 was dismissed as the respondent had relied on its own medical assessments.

The applicant was injured in a motor vehicle accident and sought a medical benefit for an occupational therapy treatment plan, which the respondent insurer denied.

The Tribunal found that the accident exacerbated the applicant's pre-existing chronic low back pain and caused new impairments, including neck pain and psychological symptoms.

Relying on the medical evidence, including the applicant's treating professionals and several independent assessments, the Tribunal concluded the treatment plan was reasonable and necessary to address her physical and psychological impairments.

The applicant was awarded the medical benefit and interest on overdue payments.

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

The respondent insurer suspended the IRBs after receiving medical assessment reports indicating the applicant had returned to work, and requested further documentation regarding post-accident income pursuant to section 33 of the Statutory Accident Benefits Schedule.

The applicant failed to produce the requested bank statements and maintained he had not returned to work.

The Tribunal found the respondent's request for documentation was justified, relying on surveillance evidence and assessors' reports that contradicted the applicant's claims.

Due to the applicant's non-compliance with section 33, the Tribunal dismissed the claim for IRBs and interest.

The applicant sought various statutory accident benefits following a motor vehicle accident, including treatment plans for chiropractic, massage, and physiotherapy, a social work assessment, an in-home assessment, transportation expenses, and the cost of a disability certificate.

The Licence Appeal Tribunal dismissed the application in its entirety.

The adjudicator found that the proposed treatment plans were not reasonable and necessary, preferring the evidence of the respondent's independent medical examiners who concluded that the applicant's soft tissue injuries had resolved and that further passive treatment was not warranted.

The transportation expenses were denied due to the 50-kilometre deductible, and the cost of the disability certificate was denied because it was not requested by the insurer or required under the Schedule.

The applicant sought a determination of catastrophic impairment and entitlement to attendant care benefits, cost of examinations, interest, and an award following a 2007 motor vehicle accident.

The Licence Appeal Tribunal found the applicant sustained a catastrophic impairment under Criterion 8, specifically a Class 4 Marked impairment in the domain of Activities of Daily Living due to chronic pain and psychological impairments.

The Tribunal awarded attendant care benefits at $507.03 per month for feeding, along with the costs of an occupational therapy situational assessment and an in-home attendant care assessment.

Claims for a triage assessment, an award under Regulation 664, and costs were dismissed.

The applicant sought medical benefits for physiotherapy, chiropractic treatment, massage, acupuncture, recreation therapy, and aromatherapy following a motor vehicle accident.

The respondent insurer denied the treatment plans, arguing the applicant's soft tissue injuries had resolved and the ongoing symptoms were related to a prior accident.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, as the medical evidence indicated the accident-related injuries were mild soft tissue strains that had resolved, and there was no exacerbation of pre-existing conditions.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for psychological services and rehabilitative driving lessons.

The insurer denied the psychological treatment plan because it was proposed at a psychologist's hourly rate, but the treatment was to be provided by a psychotherapist under supervision, and the applicant failed to provide requested information under s. 33 of the Schedule.

The insurer partially approved the driving lessons at a standard rate but denied the premium rate sought for specialized rehabilitative instruction.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the psychological treatment would be provided by the listed practitioner or that the premium rate for driving lessons was reasonable and necessary.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule for post-concussion syndrome and physical injuries.

The respondent insurer denied several treatment plans.

The Licence Appeal Tribunal found that the applicant was entitled to an in-home assessment, occupational therapy, a portion of a neuropsychological assessment, and assistive devices, as these were reasonable and necessary to address her cognitive and emotional symptoms.

However, claims for massage therapy, physiotherapy, and a rehabilitation support worker were dismissed because the applicant had reached maximum medical improvement from an orthopedic perspective and passive treatments provided only temporary relief.

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

The respondent insurer raised a preliminary issue, arguing the applicant was barred from claiming IRBs under s. 31(1)(b) of the Statutory Accident Benefits Schedule because she intentionally failed to notify the insurer of a material change in risk.

Specifically, the insurer alleged the applicant moved from Quebec to Ontario prior to the accident but maintained her Quebec-based insurance policy, which carried a significantly lower premium.

The Tribunal found that the applicant had been residing and working in Ontario since February 2016, prior to the April 2017 accident, and failed to disclose this change to the insurer.

The Tribunal concluded this was a material misrepresentation that prejudiced the insurer.

The applicant's claim for IRBs was barred, and her request for relief from forfeiture and costs were dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision regarding her entitlement to attendant care benefits following a motor vehicle accident.

The applicant argued the adjudicator made significant errors of fact and law regarding the amounts payable for feeding, bathroom cleaning, basic supervisory care, and the date interest became payable.

The Tribunal granted the reconsideration in part, finding a significant error of fact was made regarding the calculation of time required for lunch and dinner preparation.

The attendant care benefit for feeding was increased to $845.06 per month.

The remainder of the reconsideration request was denied, as the applicant failed to establish errors of fact or law on the other issues.