Monica Chakravarti

The applicant sought statutory accident benefits following a 2015 motor vehicle accident, including attendant care benefits and funding for three medical assessments.

The Tribunal dismissed the claim for attendant care benefits because the applicant was not catastrophically impaired and the 104-week post-accident period had expired.

The claims for an orthopedic and home site assessment were dismissed due to a lack of supporting medical evidence.

The respondent conceded the neuropsychological assessment was reasonable and necessary, which the Tribunal ordered, but no interest was awarded as the expense had not been incurred.

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

The respondent denied the benefits and raised a preliminary issue that the applicant was barred from proceeding with her appeal because she failed to attend an insurer examination (IE) under section 44 of the Schedule.

The Tribunal found that the respondent's notice requiring the IE was deficient because it failed to provide sufficient medical and other reasons for the denial and the need for the IE, as required by sections 38(8) and 44(5).

Consequently, the applicant was not barred from proceeding with her appeal.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found they sustained predominantly minor injuries and were not entitled to medical benefits for physiotherapy and a psychological assessment.

The applicant argued the Tribunal erred in fact and law regarding the insurer's late response to the treatment plans and whether the expenses were incurred.

The adjudicator dismissed the request, finding no error of law or fact that would have led to a different result, as the expenses were not incurred prior to the proper notice of denial.

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

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

The applicant argued for removal from the MIG due to chronic pain, pre-existing conditions, psychological injuries, and a concussion.

The adjudicator found insufficient evidence to support the applicant's claims, noting a lack of medical follow-up and relying on the respondent's insurer's examination.

The application was dismissed, and the applicant was held to the MIG limits.

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

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

The Licence Appeal Tribunal found that the applicant failed to provide compelling evidence that his injuries were outside the MIG, that his pre-existing osteoarthritis prevented maximal recovery, or that he suffered from chronic pain.

The disputed treatment plan for physiotherapy was deemed not reasonable and necessary.

The application was dismissed.

The applicant sought medical and rehabilitation benefits following a 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 had been exhausted.

The applicant argued her pre-existing conditions, including chronic pelvic pain and a history of surgeries, prevented her from achieving maximal recovery within the MIG, and that she developed chronic pain from the accident.

The Tribunal found the applicant failed to provide compelling medical evidence that her pre-existing conditions prevented maximal recovery from her accident-related soft tissue injuries.

The Tribunal also found insufficient evidence that the applicant suffered chronic pain as a result of the accident.

The application was dismissed.

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

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

The Licence Appeal Tribunal found that the applicant failed to prove his physical or psychological injuries fell outside the MIG definition.

As the $3,500 limit for minor injuries had been exhausted, the disputed treatment plans were denied.

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

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

The respondent denied the benefits, asserting the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG) limits, which had been exhausted.

The Tribunal found the applicant failed to provide compelling medical evidence, such as evidence of a pre-existing condition, psychological injury, or chronic pain, to warrant removal from the MIG.

Consequently, the applicant was not entitled to the disputed treatment plans, and the application was dismissed.

The applicant was injured in a motor vehicle accident and sought payment for 11 treatment plans under the Statutory Accident Benefits Schedule.

The respondent insurer denied the plans as not reasonable and necessary.

The Licence Appeal Tribunal reviewed the medical evidence, including reports from various assessors and treating practitioners.

The Tribunal found that the applicant sustained a mild traumatic brain injury and granted the $7,808.97 treatment plan for occupational therapy, along with interest.

The remaining 10 treatment plans, including those for orthotics, case management, rock climbing therapy, medical cannabis, and various physical therapies, were dismissed for lack of supporting objective medical evidence.

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

The respondent denied the benefits and the applicant filed an appeal with the Licence Appeal Tribunal.

The respondent raised a preliminary issue that the appeal was filed outside the two-year limitation period under section 56 of the Schedule.

The Tribunal found that the respondent's notice of denial was clear and unequivocal, and that a two-day delay in providing the section 44 assessment reports was a minor error that did not invalidate the notice.

The Tribunal further held that the applicant failed to meet the test for an extension of time under section 7 of the Licence Appeal Tribunal Act, as she did not demonstrate a bona fide intention to appeal, failed to explain the delay, and did not show that her claim had sufficient merit to outweigh the prejudice to the respondent.

The application was dismissed as statute-barred.

The applicant sought income replacement benefits following a motor vehicle accident, which the respondent insurer denied.

The applicant filed an appeal with the Licence Appeal Tribunal 20 days after the expiry of the two-year limitation period under section 56 of the Statutory Accident Benefits Schedule.

The applicant sought an extension of time under section 7 of the Licence Appeal Tribunal Act, 1999.

The Tribunal applied the four-factor test from Manuel and found that the applicant failed to demonstrate a bona fide intention to appeal within the limitation period, did not adequately explain the delay, and lacked strong merits for the appeal.

The Tribunal concluded that the justice of the case did not warrant an extension of time, and the applicant was statute-barred from proceeding with her claim.

The applicant sought medical benefits, including chiropractic services, massage services, an attendant care assessment, and a chronic pain assessment, following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide objective medical evidence or the actual treatment plans to prove the treatments and assessments were reasonable and necessary.

Claims for an award under Regulation 664 and interest were also dismissed.

The applicant sought accident benefits following a motor vehicle accident.

The insurer denied a psychological assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained a concussion and psychological injuries, including driving anxiety, which removed him from the MIG.

The Tribunal ordered the insurer to pay for the psychological assessment, finding it reasonable and necessary.

The applicant's claim for an award for unreasonable delay was dismissed because the compelling medical evidence was only provided during the hearing.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, including a neurological assessment, physiotherapy, a dog, medical cannabis, and a dental night guard.

The respondent denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to meet her burden of proving that the claimed expenses were reasonable and necessary as a result of accident-related injuries, noting her pre-existing chronic pain and fibromyalgia.

The applicant was involved in a motor vehicle accident and failed to submit his application for accident benefits (OCF-1) within the 30-day time limit prescribed by section 32(5) of the Statutory Accident Benefits Schedule, submitting it over two years late.

The applicant argued that his delay was reasonable due to emotional distress from an abusive relationship and confusion regarding the insurance system.

The Tribunal found that the applicant failed to provide a reasonable explanation for the delay under section 34, noting a lack of evidence connecting his emotional state to his inability to submit the form, especially given he had filed other insurance claims during the same period.

Consequently, the applicant was found to be statute-barred from proceeding with his application.

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

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

The Tribunal found that the applicant failed to prove her injuries warranted removal from the MIG, as the medical evidence confirmed only minor soft tissue injuries.

The Tribunal rejected the applicant's expert reports diagnosing chronic pain and psychological impairments, finding them unreliable and unsupported by contemporaneous medical records.

As the MIG limits were exhausted, the application for further medical and rehabilitation benefits was dismissed.

The applicant insurer sought repayment of $3,408.40 in medical and rehabilitation benefits paid to the respondent following a motor vehicle accident.

The insurer argued the respondent made a willful misrepresentation by failing to disclose that the accident occurred during the course of her employment, which would have entitled her to WSIB benefits instead.

The respondent also failed to commence a third-party action after electing to do so, which would have exempted her from the WSIB requirement.

The Tribunal found the respondent made willful misrepresentations and ordered her to repay the benefits with interest.

The insurer's request for costs was denied as the respondent's non-participation did not frustrate the proceedings.

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

The insurer denied ongoing entitlement to IRBs on July 11, 2017, and later determined the quantum of IRBs prior to that date was nil on March 16, 2018.

The applicant filed an application with the Licence Appeal Tribunal on January 20, 2020.

The Tribunal held that the applicant was statute-barred from disputing the denial of ongoing IRBs from July 11, 2017 onwards, as the application was filed beyond the two-year limitation period under s. 56 of the Schedule, and the applicant failed to provide reasonable grounds for an extension under s. 7 of the LAT Act.

However, the applicant was not barred from disputing the quantum of IRBs prior to July 11, 2017, as the application was filed within two years of the quantum determination.

The applicant sought statutory accident benefits for a chronic pain assessment and a chronic pain program following a motor vehicle accident.

The respondent insurer denied the treatment plans, arguing a lack of medical evidence.

The Licence Appeal Tribunal found that the applicant failed to meet her burden of proving the treatment plans were reasonable and necessary, as she did not provide post-accident clinical notes and records from her treating physicians.

The expert reports relied upon by the applicant were based solely on self-reporting and pre-accident records.

The application was dismissed in its entirety.

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

The respondent insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant sustained a concussion, which falls outside the Schedule's definition of a minor injury, thereby removing him from the MIG.

The Tribunal further held that the disputed $3,297.08 physiotherapy treatment plan was reasonable and necessary to treat the applicant's accident-related injuries, which had been exacerbated by a subsequent accident.

The treatment plan was ordered payable with interest.