Melody Maleki-Yazdi

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to a treatment plan for chiropractic, massage therapy, and acupuncture, as well as a psychological assessment.

The Licence Appeal Tribunal dismissed the application, finding that the physical treatment plan was not reasonable and necessary because the applicant had reached maximum medical improvement and had not reported physical complaints to her family physician for over a year.

The Tribunal also denied the psychological assessment, concluding it would be duplicative of an already completed and comprehensive driver rehabilitation evaluation that adequately addressed her primary psychological complaint of driving anxiety.

Claims for interest and an award for unreasonable delay were consequently dismissed.

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

The respondent denied the claim, arguing the applicant failed to comply with section 33 requests for information regarding a potential address misrepresentation, and alternatively, that the applicant did not meet the disability test.

The Tribunal found the applicant did not have a reasonable explanation for failing to provide most of the requested documents, justifying the respondent's withholding of benefits.

Substantively, relying on the respondent's insurer's examinations, the Tribunal concluded the applicant did not suffer a substantial inability to perform the essential tasks of his pre-accident employment as a cleaner.

The claims for IRBs, an award, interest, and costs were dismissed.

The applicant sought post-104-week Income Replacement Benefits (IRBs) following a motor vehicle accident.

The Licence Appeal Tribunal considered whether the applicant suffered a complete inability to engage in any employment or self-employment for which he was reasonably suited by education, training, or experience.

The Tribunal preferred the respondent's medical and vocational assessments, which found the applicant capable of working in alternative occupations such as a retail salesclerk, over the applicant's tort-focused expert reports.

The application was dismissed, as the applicant failed to meet the post-104-week IRB test, and no interest was payable.

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

The respondent denied certain medical benefits and assessment costs on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that pre-existing conditions, including neck and back pain, ankylosing spondylitis, and chronic pain, prevented maximal medical recovery under the MIG.

The Tribunal found that the applicant's pre-existing conditions were not exacerbated by the accident and did not prevent maximal medical recovery.

The Tribunal concluded that the applicant's injuries were predominantly minor and subject to the $3,500 MIG limit, which had already been exhausted.

The claims for additional benefits and an award for unreasonable delay were dismissed.

The applicant sought statutory accident benefits following an alleged motor vehicle collision.

The respondent insurer denied the claim, arguing the collision did not occur as reported and the applicant was not involved in an 'accident' under s. 3(1) of the Schedule.

The Tribunal found significant inconsistencies in the applicant's evidence and accepted the respondent's expert accident reconstruction evidence, concluding the applicant failed to prove she was in an accident.

The Tribunal further found the applicant wilfully misrepresented material facts regarding the collision and her injuries.

Consequently, the respondent was entitled to terminate benefits and was awarded repayment of $1,757.24 in previously paid benefits, though costs were denied.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and a medical benefit for physiotherapy.

The Licence Appeal Tribunal found that the applicant suffered a substantial inability to perform the essential tasks of his pre-accident employment as a janitorial cleaner due to physical and psychological impairments, entitling him to pre-104-week IRBs.

However, the applicant failed to establish a complete inability to engage in any suitable employment, and was therefore denied post-104-week IRBs.

The Tribunal also denied the proposed physiotherapy treatment plan, noting the applicant had an unexhausted, previously approved treatment plan and had provided inconsistent evidence regarding the benefits of physiotherapy.

The applicant sought statutory accident benefits after allegedly falling off the back of an ATV.

The respondent insurer denied the claim, arguing the incident did not involve an automobile and was therefore not an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

Following a preliminary issue hearing, the adjudicator weighed conflicting witness testimony and first responder records.

The adjudicator found the testimony of an independent neighbour, who saw the applicant on the ATV shortly before the incident, to be credible and determinative.

The tribunal concluded the applicant was involved in an accident and is entitled to statutory accident benefits.

The respondent insurer requested a reconsideration of a previous Tribunal decision that found the applicant entitled to various treatment plans, including chiropractic treatment, an attendant care assessment, a chronic pain assessment, and a psychological assessment.

The insurer argued that the Tribunal erred in law by applying incorrect tests to determine whether the treatment plans were reasonable and necessary, relying too heavily on the applicant's subjective reporting.

The adjudicator dismissed the request for reconsideration, finding that the Tribunal had properly applied the Statutory Accident Benefits Schedule, considered the evidence in its totality (including objective medical evidence), and made no errors of law or fact that would have changed the outcome.

The applicant sought payment for a psychological assessment and a chronic pain assessment following a motor vehicle accident.

The Tribunal denied the psychological assessment because the applicant incurred the cost before the treatment plan was properly submitted to the respondent, violating s. 38(2) of the Schedule.

However, the Tribunal granted the chronic pain assessment, finding it reasonable and necessary given the applicant's exacerbation of pre-existing pain and functional limitations.

The claim for an award under s. 10 of O. Reg. 664 was dismissed as the insurer's denials were not unreasonable.

The respondent insurer requested a reconsideration of a decision finding that the applicant was not precluded from applying to the Tribunal for failing to attend scheduled insurer's examinations.

The insurer argued the Tribunal applied an inappropriately stringent standard to the reasons provided in the examination notices and failed to consider the applicant's lack of medical evidence.

The Tribunal dismissed the request, finding no error of law or fact, and affirmed that an insurer must provide sufficient medical reasons in its notice before relying on section 55(2) of the Schedule to bar an application.

The applicant sought a special award under section 10 of Ontario Regulation 664, alleging the respondent insurer unreasonably delayed payment of income replacement benefits.

The insurer argued the delay was justified because the applicant was late in submitting the required application forms and medical records.

The Tribunal found that the insurer unreasonably delayed payment from January 4, 2019, to April 5, 2019, as it was aware the applicant was self-represented and had already provided a statement to its Special Investigations Unit.

The Tribunal awarded the applicant a 15% special award on the benefits paid during that period, plus interest.

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

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

The Tribunal found that the respondent's initial notices denying the treatment plans were defective under s. 38(8) of the Schedule, as they failed to provide adequate medical reasons.

Furthermore, the Tribunal determined that the applicant's injuries fell outside the MIG due to her accident-related psychological impairments, preferring the evidence of the applicant's psychological expert over the insurer's examiner.

The Tribunal concluded that all three disputed treatment plans were reasonable and necessary, and ordered the respondent to pay for them along with interest on overdue payments.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming two treatment plans for physiotherapy (Pilates and massage therapy) and one for an occupational therapy assessment.

The adjudicator found the physiotherapy treatment plans reasonable and necessary to alleviate pain and improve function, preferring the evidence of the applicant's treating and assessing practitioners over the insurer's examination assessor.

However, the hourly rate for the Pilates instructor was reduced to the unregulated provider rate, and the second plan was subject to deduction for available collateral benefits.

The claim for an occupational therapy assessment was dismissed as the adjudicator found it was not reasonable and necessary, relying on a recent comprehensive functional capacity evaluation.

The applicant requested a reconsideration of a Tribunal decision that found her statute-barred from applying for dispute resolution due to her failure to attend an insurer's psychological examination.

The applicant argued the Tribunal erred in law and failed to exercise its discretion to allow the application despite the non-attendance.

The Tribunal dismissed the reconsideration request, finding no error of law or fact, as the applicant provided no reasonable explanation for missing the examination and no evidence that she attempted to reschedule it.

The applicant was injured in a motor vehicle accident and sought dispute resolution at the Licence Appeal Tribunal after the respondent insurer denied a treatment plan for a chronic pain assessment.

The adjudicator found that the assessment was reasonable and necessary, given compelling evidence from the applicant's treating physicians of constant and severe pain.

However, the adjudicator dismissed the applicant's claim for a special award under Ontario Regulation 664, finding no evidence that the insurer unreasonably withheld or delayed payments.

The applicant was awarded the cost of the assessment and applicable interest.

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

The applicant applied to the Licence Appeal Tribunal for dispute resolution.

The adjudicator found that the applicant was entitled to a comprehensive chiropractic treatment plan, an attendant care assessment, a chronic pain assessment, and a psychological assessment, as they were reasonable and necessary given the applicant's ongoing pain and psychological impairments.

However, two duplicative chiropractic treatment plans were denied.

The adjudicator also awarded interest on overdue payments but denied the applicant's requests for a special award and costs, finding no evidence of unreasonable conduct by the respondent.

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 Tribunal found that the applicant's injuries were predominantly minor and did not meet the threshold for chronic pain that would remove him from the MIG.

However, because the respondent failed to provide proper notice under s. 38(8) of the Schedule for a chiropractic treatment plan, it was ordered to pay any incurred expenses for that plan.

The respondent also conceded payment for a chronic pain assessment due to late notice.

The applicant's claim for a special award under O. Reg. 664 was dismissed.

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

The Licence Appeal Tribunal found that the insurer failed to provide adequate medical reasons in its notices denying certain treatment plans under s. 38(8) of the Schedule, entitling the applicant to incurred costs until proper notice is given.

The Tribunal also found three chiropractic treatment plans and one psychological treatment plan to be reasonable and necessary.

However, a second psychological treatment plan, a chronic pain assessment, and a cognitive assessment were deemed not reasonable and necessary.

The applicant's claim for an award under Regulation 664 was dismissed.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits for chiropractic treatment.

The respondent denied the claims on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that pre-existing lower back pain and other injuries, including a partial rotator cuff tear and a labral tear, warranted removal from the MIG.

The Tribunal found that the applicant's injuries were predominantly minor and that his pre-existing conditions did not prevent maximal medical recovery.

The application for benefits and interest was dismissed.

The applicant sought statutory accident benefits following an alleged motor vehicle collision.

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

The adjudicator found the applicant's evidence unreliable due to significant inconsistencies with accident reconstruction expert evidence, surveillance video, and cell phone records.

The adjudicator concluded the collision was staged and dismissed the appeal.