Lisa Holland

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

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

The applicant argued that a pre-existing back condition warranted removal from the MIG.

The Tribunal found insufficient medical evidence that the pre-existing condition would prevent maximal recovery under the MIG limits.

The Tribunal also found the insurer's denial notices complied with s. 38(8) of the Schedule.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of several treatment plans and invoices, including a catastrophic impairment assessment.

The adjudicator found that the applicant failed to provide submissions for several of the disputed invoices and treatment plans, failing to meet the burden of proof.

For the catastrophic impairment assessment, the adjudicator determined that the requested comprehensive file review, hearing and vestibular testing, and a second mental/behavioural assessment were duplicative or not proven to be reasonable and necessary.

The application was dismissed in its entirety, and no interest was payable.

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

The respondent raised a preliminary issue, arguing the applicant was barred from proceeding with his application before the Tribunal under section 55 of the Schedule for failing to fully participate in neuropsychological and psychological insurer's examinations under section 44.

The Tribunal found that the applicant had attended the examinations, though he did not complete all tasks.

Crucially, the Tribunal held that the respondent's notices for further psychological examinations were deficient because they failed to provide adequate medical or other reasons for the repetitive assessments.

Consequently, the respondent could not rely on section 55 to bar the application, and the applicant was permitted to proceed.

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

The respondent insurer denied the treatment plans on the basis that the injuries fell within the Minor Injury Guideline and requested insurer's examinations.

The applicant argued that the respondent's denial notices were procedurally defective under s. 38(8) of the Statutory Accident Benefits Schedule, but made no submissions on the substantive reasonableness or necessity of the treatment.

The Tribunal found that the respondent's denial notices provided adequate medical and other reasons, complying with the Schedule.

As the applicant failed to establish substantive entitlement to the benefits, the application was dismissed.

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

The respondent denied a treatment plan for physiotherapy and an ambulance expense on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from accident-related chronic pain or other injuries warranting removal from the MIG.

As the MIG limits were exhausted, the disputed treatment and expenses were not payable, and no interest was owed.

The application was dismissed.

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

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the proposed treatment plans were reasonable and necessary.

The medical evidence indicated that the applicant's psychological and physical complaints were largely pre-existing or unrelated to the accident, and several specialists noted that chiropractic treatments were contraindicated as they caused incontinence.

Claims for interest and a section 10 award were also dismissed.

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

The respondent denied the 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, concussion, and psychological impairments.

The Tribunal found that the applicant failed to provide sufficient medical evidence to support diagnoses that would warrant removal from the MIG.

The Tribunal also found that the respondent's denial notices were proper under section 38(8) of the Schedule.

The application was dismissed.

The applicant sought medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a 2017 motor vehicle accident.

The respondent insurer denied treatment plans for psychological services, a gym membership, a Weight Watchers program, and physiotherapy.

The Tribunal found that the applicant failed to demonstrate the proposed treatments were reasonable and necessary as a result of the accident.

The medical evidence, including clinical notes from treating physicians, indicated that the applicant's accident-related injuries had resolved and that her ongoing complaints, including weight gain and soft tissue pain, were attributable to an unrelated endocrine disorder.

The application was dismissed in its entirety.

The applicant was involved in a motor vehicle accident and sought medical and rehabilitation benefits.

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

The applicant applied to the Licence Appeal Tribunal, arguing for removal from the MIG due to chronic pain, concussion, and psychological impairments.

The Tribunal found no medical evidence supporting the applicant's diagnoses of chronic pain or psychological conditions, noting she had returned to her pre-accident activities.

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

The applicant sought $3,067.84 for an occupational therapy treatment plan following a motor vehicle accident.

The respondent denied the claim on the basis that it was not reasonable and necessary.

The adjudicator found that the applicant failed to provide corroborating medical evidence to support the need for further occupational therapy, noting that the respondent's psychiatric assessment concluded the applicant had reached maximum psychological improvement.

The application was dismissed.

The applicant, a minor, sought payment for a treatment plan for speech language pathology services in the amount of $2,556.61 following a motor vehicle accident.

The respondent denied the treatment plan on the basis that it was not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant failed to provide independent medical evidence to support the treatment plan, noting a lack of clinical notes, school records, or assessment reports.

The application was dismissed, and no interest was awarded.

The applicant, a minor, sought payment for a $2,000 treatment plan for tutoring following a motor vehicle accident.

The respondent insurer denied the plan on the basis that it was not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant's academic struggles were related to a pre-existing learning disability and that she was functioning well within her school's Individual Education Plan.

The Tribunal concluded that the proposed tutoring would not address her accident-related emotional and behavioural issues, which required cognitive behavioural therapy instead.

The application for the treatment plan and associated interest was dismissed.

The applicant sought statutory accident benefits for optometry services following a motor vehicle accident.

The respondent denied the treatment plan because the applicant failed to attend scheduled insurer's examinations (IEs) in Toronto and Brampton, citing the inconvenience of travelling from London.

The Tribunal found that the respondent made reasonable efforts to schedule the IEs at a convenient location, as there were no available specialists in the London area.

Because the applicant failed to attend the IEs without a reasonable excuse, she was barred from proceeding with her claim under s. 55 of the Statutory Accident Benefits Schedule.

The application was dismissed.

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

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

The Tribunal found that while the applicant's physical injuries initially met the definition of a minor injury, she subsequently developed chronic pain and psychological impairments, including adjustment disorder and somatic symptom disorder, which warranted removal from the MIG.

The Tribunal concluded that the proposed psychological services were reasonable and necessary to address her chronic pain and emotional issues, approving the treatment plan at a reduced rate.

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

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

The applicant argued that pre-existing conditions, including a skin condition and fibromyalgia, warranted removal from the MIG.

The Tribunal found no compelling medical evidence that the pre-existing conditions prevented maximal recovery under the MIG.

As the MIG limit was exhausted, the treatment plans were not payable, and claims for interest and an award were dismissed.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits beyond the $3,500 Minor Injury Guideline (MIG) limit, claiming chronic pain and psychological impairments.

The respondent denied the treatment plans on the basis that the injuries were predominantly minor.

The Licence Appeal Tribunal found that the applicant sustained uncomplicated soft tissue injuries and failed to provide medical evidence of chronic pain or psychological impairment warranting removal from the MIG.

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

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, arguing his physical and psychological injuries warranted removal from the Minor Injury Guideline (MIG).

The Tribunal found no medical evidence linking his subsequent diagnoses of anxiety, depression, and bipolar disorder to the accident, noting they arose from personal and pandemic-related stressors.

Relying on insurer examinations that found no residual physical impairment or accident-related psychological injury, the Tribunal concluded the applicant failed to prove his injuries fell outside the MIG.

The application for treatment plans and interest was dismissed.