Monica Chakravarti

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

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

The applicant argued for removal from the MIG based on pre-existing degenerative disc disease, chronic pain, and psychological injuries.

The Tribunal found the applicant failed to prove that his pre-existing condition precluded recovery within the MIG, or that he suffered from accident-related chronic pain or psychological injuries.

As the MIG limits were exhausted, the application for further benefits, interest, and a special award was dismissed.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming physical and psychological injuries prevented him from working.

The Licence Appeal Tribunal found that the applicant's physical complaints, including chronic back pain and suspected radiculopathy, were long-standing pre-existing conditions that were not exacerbated by the minor accident.

While the Tribunal accepted that the applicant sustained psychological injuries, it rejected the applicant's psychiatric expert evidence because it relied on inaccurate self-reporting.

The Tribunal concluded the applicant failed to prove a substantial inability to perform the essential tasks of his employment or any employment, and dismissed the application for IRBs, interest, and an award.

The applicant sought non-earner benefits following a motor vehicle accident.

The respondent insurer raised a preliminary issue that the applicant was barred from proceeding because he failed to attend two scheduled insurer examinations.

The Tribunal found that the applicant failed to attend the examinations without a reasonable explanation and declined to exercise its discretion to allow the application to proceed.

The applicant's claim for non-earner benefits was dismissed.

The respondent's request for costs was denied as the applicant's conduct was not found to be unreasonable, frivolous, vexatious, or in bad faith.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits for assistive devices and laser foot therapy under the Statutory Accident Benefits Schedule.

The respondent denied the benefits, arguing they were not reasonable and necessary and were related to pre-existing conditions rather than the accident.

The Tribunal applied the 'but for' test for causation and found that the applicant failed to prove the requested treatments and devices were required due to accident-related impairments.

The Tribunal concluded the applicant's mobility and balance issues were pre-existing, and the foot numbness was related to prior chemotherapy.

The application was dismissed.

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

The applicant applied to the Licence Appeal Tribunal to dispute the denial of treatment plans for a chronic pain assessment, psychological assessment and services, and chiropractic services.

The adjudicator found that the applicant established he suffered from chronic pain syndrome as a result of a coccyx fracture, making the chronic pain assessment reasonable and necessary.

However, the applicant failed to prove on a balance of probabilities that he sustained accident-related psychological injuries or required further chiropractic treatment.

The application was allowed in part, with the respondent ordered to pay for the chronic pain assessment with interest.

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 Tribunal found that the applicant failed to prove her injuries warranted treatment outside the MIG, as there was insufficient evidence of a pre-existing condition or psychological impairment.

However, the Tribunal awarded $200 for a psychological assessment because the respondent failed to provide a compliant denial notice within the required 10 business days under section 38(8) of the Schedule.

Claims for further physiotherapy and an award under Ontario Regulation 664 were dismissed.

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

The insurer denied the benefits on the basis that the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's diagnostic imaging showed pre-existing degenerative changes rather than accident-related impairments.

The applicant failed to prove that her pre-existing conditions, alleged chronic pain, or psychological impairments warranted treatment outside the MIG.

The application was dismissed.

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

The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued his injuries were outside the MIG due to chronic pain and psychological injuries, and that the respondent failed to provide timely notice of denial for one treatment plan.

The Tribunal found that the applicant did not suffer from chronic pain or psychological injuries, and that the respondent's notice was compliant with the Schedule.

The application was dismissed.

The applicant, injured in a motor vehicle accident, brought a motion to compel the respondent insurer to produce the full accident benefits file, including independent medical examination (IME) files and adjuster log notes, and sought costs.

The Licence Appeal Tribunal ordered the respondent to produce the requested documents, subject to redactions for privilege.

The Tribunal also awarded the applicant $500 in costs, finding that the respondent acted unreasonably and in bad faith by failing to comply with a previous consent order to produce the IME file and by ignoring the applicant's correspondence.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and various medical and rehabilitation benefits.

The Tribunal found that the applicant was not employed at the time of the accident and therefore did not qualify for IRBs.

The Tribunal also dismissed the claims for an orthopedic mattress, chiropractic treatment, and psychological treatment, finding that the impairments were either pre-existing or the treatments were not proven to be reasonable and necessary.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits, including attendant care benefits, following a motor vehicle accident.

The respondent raised a preliminary issue, arguing the applicant should be barred from proceeding because she failed to attend an insurer examination under section 44 of the Schedule.

The Tribunal found that the respondent's notice of examination was not compliant with section 42(7) of the Schedule because it was issued without requesting a new Form 1.

Consequently, the applicant was not barred from proceeding, and the respondent was not entitled to the costs of the missed examination.

However, to ensure procedural fairness, the Tribunal ordered a timeline for the respondent to properly request an assessment and for the parties to exchange reports prior to the hearing.

The applicant sought a special award under section 10 of Regulation 664, alleging the respondent unreasonably withheld or delayed payment of income replacement benefits (IRBs) following a motor vehicle accident.

The Tribunal found that the initial delay was due to the applicant's failure to provide necessary financial documentation, particularly given her self-employment status.

The Tribunal also found that the respondent's subsequent error in calculating the IRBs based on net rather than gross income, which was later corrected with interest, did not amount to excessive, imprudent, or stubborn conduct.

Both parties' requests for costs were dismissed.

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

The respondent insurer argued that the applicant was statute-barred from disputing the denial of social worker fees, HST expenses, and catastrophic impairment assessments because the application was not commenced within two years of the refusal.

The Tribunal found that the denial of the social worker fees was clear and unequivocal, rendering that claim statute-barred.

However, the Tribunal held that the denials for the HST expenses and the catastrophic impairment assessments were ambiguous and indeterminate, meaning the limitation period had not been triggered.

The application was permitted to proceed on those issues.

The applicant sought non-earner benefits following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide any evidence that she sustained an impairment as a result of the accident.

Consequently, she could not establish a complete inability to carry on a normal life.

Claims for interest were also dismissed as no benefits were owing.

The applicant sought statutory accident benefits for physiotherapy and a psychological assessment 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) and were not reasonable or necessary.

The Tribunal found that the applicant did not suffer from a psychological impairment, pre-existing condition, or chronic pain that would remove him from the MIG.

The Tribunal further held that the requested treatment plans were not reasonable or necessary.

The application was dismissed.

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

The respondent insurer withheld the benefits because the applicant failed to provide requested pre- and post-accident financial records and subsequently revoked consent for a paper-based insurer examination.

The Tribunal found that the respondent's requests for bank records were reasonable to determine the applicant's self-employment income and verify post-accident earnings.

The Tribunal also held that the request for a paper review was reasonable given new medical information and a change in the applicant's employment status.

Because the applicant failed to comply with section 33(1) and section 44(9) of the Statutory Accident Benefits Schedule, the respondent was entitled to withhold the IRBs.

The application was dismissed.

The applicant sought attendant care benefits following a motor vehicle accident.

The respondent insurer denied the benefits and scheduled an insurer's examination with an otolaryngologist under section 44 of the Statutory Accident Benefits Schedule.

The applicant did not attend the examination, arguing the respondent's notices were deficient.

On a preliminary issue, the Tribunal found that the respondent failed to provide meaningful medical and other reasons for the examination as required by section 44(5)(a).

The boilerplate reasons provided were insufficient.

Consequently, the applicant was not held in non-compliance and his claim was not statute-barred under section 55(1)2.

The applicant sought interest on income replacement benefits (IRBs) and an award for unreasonable delay following a motor vehicle accident.

The Tribunal found that the issue of interest for the period of April to December 2017 was not properly before it, as it was not raised in the application or case conference order.

The Tribunal also denied interest on IRBs from January 22, 2018, because the applicant failed to provide requested information in a timely manner, justifying the insurer's suspension of benefits under section 33 of the Schedule.

The claim for an award under O. Reg. 664 was dismissed as the applicant made no submissions on the issue.

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

The respondent denied the treatment plan on the basis that the applicant's injuries fell within the Minor Injury Guideline, relying on an insurer's examination.

However, a prior binding arbitration decision had already determined that the applicant suffered from chronic pain syndrome and did not have minor injuries.

The Tribunal found the treatment plan reasonable and necessary.

Furthermore, the Tribunal awarded a 50% special award under section 10 of O. Reg. 664, finding that the respondent acted unreasonably and in bad faith by stubbornly maintaining that the injuries were minor despite the binding arbitration decision to the contrary.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, medical benefits for chiropractic treatment, and the cost of an attendant care assessment.

The insurer 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, noting a lack of corroborating medical evidence and inconsistencies in his testimony.

Consequently, the Tribunal dismissed the claims for medical benefits and the assessment cost.

The Tribunal also dismissed the claim for a non-earner benefit, finding no evidence that accident-related impairments prevented the applicant from engaging in substantially all of his pre-accident activities.