Leo Demarce

The applicant was injured in an all-terrain vehicle rollover and sought a determination of catastrophic impairment under Criteria 6, 7, and 8 of the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant did not meet the 55% whole person impairment threshold under Criteria 6 or 7, preferring the respondent's medical assessments over the applicant's, noting that the applicant's chiropractor improperly assigned ratings outside his scope of practice and without conducting in-person assessments.

The Tribunal also found the applicant did not suffer marked impairments in the spheres of function under Criterion 8.

Additionally, the Tribunal ordered the applicant to repay $9,977.20 in overpaid income replacement benefits to the respondent, plus interest.

The applicant was catastrophically injured in a motor vehicle accident and sought Income Replacement Benefits (IRB).

Prior to the accident, the applicant was participating in a Work Transition Program through the WSIB, which included a work placement.

The insurer denied IRB, arguing the applicant was not employed but receiving disability benefits.

The Tribunal found that the work placement created an employer/employee relationship, as the applicant was required to perform specific duties and report to a supervisor.

The Tribunal concluded the applicant was employed at the time of the accident and entitled to IRB.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing her injuries warranted removal from the Minor Injury Guideline (MIG) due to a pre-existing degenerative thoracic spondylosis, chronic pain, and psychological impairments.

The Licence Appeal Tribunal found the applicant failed to provide compelling medical evidence of a pre-existing condition that precluded recovery within the MIG.

Applying the AMA Guides, the Tribunal concluded the applicant met only one of the required three criteria for chronic pain.

As the applicant's injuries were predominantly minor and the $3,500 MIG limit was exhausted, the claims for a $2,681.69 treatment plan and interest were dismissed.

The applicant sought various statutory accident benefits following a motor vehicle accident, which were denied by the respondent insurer.

The Tribunal found that the applicant had been removed from the Minor Injury Guideline (MIG) and that the insurer's reliance on assessments limited to the MIG was flawed.

The Tribunal approved treatment plans for chiropractic services, a neurological assessment, a driving evaluation, a chronic pain assessment, and a biopsychosocial assessment as reasonable and necessary.

Claims for cognitive devices, ergonomic devices, and an MRI screening were dismissed for lack of supporting evidence or failure to demonstrate necessity over OHIP-covered services.

Interest was awarded on overdue payments.

The applicant sought $16,712.81 for catastrophic impairment determination assessments following a 2013 motor vehicle accident.

The insurer denied the treatment plan, stating the recommendation did not fit the loss details.

The applicant argued the denial notice was invalid under s. 38(8) of the SABS for failing to provide meaningful medical reasons, triggering s. 38(11).

The Tribunal found the applicant failed to meet their burden of proof, noting the OCF-18 provided no explanation for the assessments or how they related to the accident.

The Tribunal held the insurer's denial was adequate and dismissed the claim for the assessment costs and interest.