Leo Demarce

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 her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG due to psychological impairments and chronic pain with functional impairment.

The Tribunal found that the applicant failed to provide sufficient medical evidence linking her psychological complaints or ongoing pain to a functional impairment caused by the accident.

As the $3,500 MIG limit was exhausted, the disputed treatment plans were denied.

The Tribunal also found the insurer complied with the notice requirements under s. 38(8) of the Schedule and dismissed the claims for an award and interest.

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

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

The Tribunal found that the applicant suffered from an accident-related psychological impairment, specifically an Adjustment Disorder, which removed him from the MIG.

The Tribunal preferred the evidence of the applicant's treating professionals over the insurer's assessors.

Consequently, the Tribunal concluded that the disputed physiotherapy treatments, psychological services, and various assessments were reasonable and necessary.

The respondent was ordered to pay the disputed plans along with interest on overdue benefits.

The applicant sought entitlement to three physiotherapy treatment plans following a motor vehicle accident.

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

The sole issue raised by the applicant was whether the respondent failed to provide adequate medical reasons for the denials under s. 38(8) of the Schedule.

The Tribunal found that the respondent complied with s. 38(8), as the denial letters clearly stated the injuries were considered minor and relied on Insurer Examination reports from a physiatrist and a psychologist.

The application was dismissed.

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

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

The Tribunal found the applicant suffered from a psychological impairment and chronic pain, removing her from the MIG.

The Tribunal approved treatment plans for an attendant care assessment, psychological services, physiotherapy, and a lumbar back brace, finding them reasonable and necessary.

A psychological assessment was denied as redundant.

The Tribunal also awarded interest on overdue benefits but dismissed the applicant's claim for a special award, finding the respondent relied on expert opinions and did not unreasonably withhold payments.

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

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

The applicant sought removal from the MIG based on psychological impairment and chronic pain.

The Tribunal found that the applicant failed to provide compelling medical evidence linking his psychological complaints or ongoing back pain to the accident.

The Tribunal concluded the applicant's injuries were minor and confined him to the MIG.

Consequently, the disputed treatment plans, interest, an award for unreasonable delay, and costs were all denied.

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

The respondent denied various treatment plans and assessments, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant suffered a concussion and should be removed from the MIG.

The Tribunal ordered the respondent to pay for the disputed chiropractic, physiotherapy, psychological, and chronic pain assessments, finding them reasonable and necessary.

Furthermore, the Tribunal granted an award under s. 10 of Reg. 664, finding the respondent unreasonably withheld benefits despite having evidence of the concussion diagnosis, and ordered interest on overdue payments.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy, a concussion assessment, and a psychological assessment.

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

The Tribunal found the applicant proved the physiotherapy and concussion assessment were reasonable and necessary based on clinical notes documenting pain and headaches.

The Tribunal partially approved the concussion assessment and fully approved the physiotherapy plans.

The claim for a psychological assessment balance was dismissed for lack of submissions.

The Tribunal denied the applicant's request for a special award under s. 10 of Reg. 664, finding the insurer's reliance on its medical assessors was reasonable, but awarded interest on overdue payments.

The applicant sought $7,776.00 for hearing aids following a 2017 motor vehicle accident.

The insurer denied the treatment plan because it was submitted beyond the 260-week limit for medical benefits under section 20(1)(a) of the Statutory Accident Benefits Schedule.

Although the adjudicator found the treatment plan reasonable, necessary, and the result absurd, the Tribunal held it had no authority to set aside the strict 260-week legislative limit.

The application for benefits and interest was dismissed.

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.

The Tribunal scheduled a written hearing, but the applicant failed to file any written submissions.

Pursuant to section 7(2) of the Statutory Powers Procedure Act, the Tribunal proceeded without the applicant's participation.

The application was dismissed as the applicant failed to meet his evidentiary burden.

The applicant was injured in a motor vehicle accident and sought $3,000.22 for a physiotherapy treatment plan under the Statutory Accident Benefits Schedule.

The insurer denied the benefit.

The Licence Appeal Tribunal found the treatment plan reasonable and necessary to assist in relieving the applicant's chronic pain, preferring the evidence of the applicant's treating family doctor and physiotherapist over the insurer's paper review.

The Tribunal ordered the insurer to pay the treatment plan amount plus interest.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits, chiropractic services, and a psychological assessment.

The Licence Appeal Tribunal denied the non-earner benefits, finding the applicant was able to carry on a normal life and had pre-existing conditions.

The psychological assessment was also denied based on a section 44 assessment showing no psychological impairment.

However, the Tribunal approved the chiropractic services treatment plan, finding it reasonable and necessary.

The Tribunal also granted a section 10 award of 50% of the chiropractic benefits, finding the insurer unreasonably withheld payment by relying on a section 44 assessment that it knew would deny the claim based on minor injury guidelines, despite the applicant not being confined to those guidelines.

The applicant sought accident benefits following a motor vehicle accident, claiming removal from the Minor Injury Guideline (MIG) on the basis of chronic pain and psychological impairment.

The respondent denied the benefits, arguing that the applicant's ongoing complaints were not caused by the subject accident, as she had been involved in multiple subsequent incidents, including a bus accident, a slip and fall, and being crushed by subway doors.

The Tribunal applied the 'but for' test for causation and found that the applicant failed to prove her chronic pain and psychological impairments were caused by the subject accident.

The Tribunal concluded the applicant's injuries were predominantly minor and dismissed the claims for treatment plans, interest, and an award.

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

The insurer denied various treatment plans for physiotherapy, psychological services, and assessments on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on chronic pain and psychological impairments.

The Tribunal found insufficient medical evidence to support a diagnosis of chronic pain with functional impairment or a psychological condition caused by the accident.

The application was dismissed, and the applicant was limited to the $3,500 MIG cap.

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

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the chronic pain assessment was reasonable and necessary as he did not meet the AMA Guides criteria.

The Tribunal also denied the psychological services claim because the applicant provided no meaningful submissions to support the unapproved portion of the treatment plan.

Claims for an award and interest were consequently dismissed.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit was exhausted.

The applicant argued for removal from the MIG based on chronic pain and psychological impairments.

The Tribunal found insufficient evidence of chronic pain, noting the lack of a diagnosis or evidence meeting the AMA Guides criteria.

The Tribunal also gave no weight to the applicant's psychological assessment, as it was conducted by a social worker rather than the signing psychologist.

Relying on the respondent's section 44 assessments, the Tribunal concluded the applicant did not suffer a clinically significant psychological impairment.

The application was dismissed, and claims for treatment plans, an award, and interest were denied.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found he was not entitled to removal from the Minor Injury Guideline (MIG) and denied disputed treatment plans.

The applicant argued the Tribunal made errors of law and fact, including failing to consider chronic pain, ignoring the consumer protection nature of the Schedule, and improperly weighing psychological evidence.

The adjudicator granted the reconsideration in part, acknowledging an error of law in failing to address the chronic pain argument in the original decision.

However, upon reviewing the evidence, the adjudicator concluded the applicant still failed to prove chronic pain with functional impairment, as there was no formal diagnosis.

The remainder of the reconsideration request was dismissed, as the other arguments amounted to an attempt to re-litigate the weighing of evidence.

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

The respondent insurer determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied several treatment plans.

The applicant argued for removal from the MIG based on chronic pain and psychological impairment.

The Tribunal found the applicant failed to meet the burden of proof for chronic pain under the AMA Guides criteria and did not provide sufficient evidence of a psychological impairment.

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

The disputed treatment plans were deemed reasonable and necessary up to the remaining MIG limit pursuant to s. 40(8) of the Schedule.

The application was otherwise dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to various medical and rehabilitation treatment plans outside the Minor Injury Guideline (MIG).

The applicant argued that a pre-existing shoulder dislocation and a psychological impairment warranted removal from the MIG.

The Tribunal found that the pre-existing condition was not worsened by the accident and did not preclude recovery within the MIG.

Furthermore, the Tribunal preferred the respondent's psychiatric assessments over the applicant's psychological report, noting the lack of psychological treatment sought by the applicant.

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

The respondent insurer requested a reconsideration of a previous Tribunal decision that found the applicant was entitled to several treatment plans for chiropractic services and various assessments.

The insurer argued the Tribunal made errors of law and fact, including misinterpreting the basis for the applicant's removal from the Minor Injury Guideline (MIG).

The adjudicator dismissed the request, finding that any factual error regarding the MIG removal would not have changed the outcome, as the Tribunal had properly weighed the totality of the evidence.

The adjudicator concluded the insurer was effectively attempting to re-litigate arguments that were unsuccessful at the original hearing.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to physical rehabilitation and a psychological assessment outside the Minor Injury Guideline (MIG).

The applicant argued that she suffered from a psychological impairment and chronic pain with functional impairment.

The Tribunal found that the applicant failed to meet the burden of proof for either condition, noting her continued ability to work, attend university, and participate in sports post-accident.

Applying the AMA Guides criteria for chronic pain, the Tribunal concluded the applicant did not meet the threshold.

The claims for benefits, interest, and an award were dismissed.

The respondent's request for costs was also dismissed, as the applicant's conduct did not rise to the level of bad faith.