Monica Ciriello

The applicant was injured in a motor vehicle accident and sought $4,520.00 for catastrophic impairment assessments, representing the denied portion of a treatment plan.

The respondent had approved $10,230.81 for the assessments but denied the $2,000.00 fee for each medical professional to conduct a clinical file review assessment, arguing it exceeded the $2,000.00 cap per assessment under section 25(5)(a) of the Schedule.

The Tribunal agreed with the respondent, finding that a file review is part of the assessment expense and is included within the $2,000.00 limit.

The application was dismissed, and no interest was awarded.

The applicant sought entitlement to statutory accident benefits for chiropractic services and a psychological assessment following a 2018 motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the proposed treatment plans were not reasonable and necessary.

The Tribunal accepted the uncontested medical opinion of the respondent's physiatrist that the applicant had reached maximum medical improvement regarding physical therapy.

Furthermore, the Tribunal found the proposed psychological assessment to be duplicative, as the applicant had already received a funded psychological assessment in 2019 but failed to attend the approved counselling sessions or raise psychological concerns with his family physician.

Claims for an award and interest were also dismissed.

The applicant sought statutory accident 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 based on psychological impairments, pre-existing conditions, and chronic pain.

The Tribunal drew an adverse inference against the applicant for failing to produce required medical records.

The Tribunal found the applicant failed to prove on a balance of probabilities that she suffered a psychological impairment, that her pre-existing conditions prevented maximal recovery within the MIG, or that she developed chronic pain as a result of the accident.

The application was dismissed, and the applicant was found not entitled to the disputed treatment plans or interest.

The applicant sought statutory accident 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 provide sufficient medical evidence of physical or psychological impairments that would warrant removal from the MIG.

Consequently, the disputed treatment plans for psychological services and assessments were denied, along with claims for an award and interest.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that her physical injuries, psychological impairments, and pre-existing diabetes warranted removal from the MIG.

The Tribunal found the applicant's medical evidence, including illegible clinical notes and a virtual psychological assessment, unpersuasive.

Preferring the respondent's in-person medical assessments, the Tribunal concluded the applicant suffered only minor soft tissue injuries and mild psychological symptoms that did not meet the criteria for impairment.

The Tribunal also found no evidence that her diabetes would prevent maximal recovery.

Consequently, the applicant remained subject to the $3,500 MIG limit, and her claims for additional treatment plans and interest were dismissed.

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

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

The applicant argued she suffered from physical injuries and chronic pain that warranted removal from the MIG.

The Tribunal found that the medical evidence, including records from the applicant's family physician and a physiatry assessment, supported a diagnosis of minor soft tissue injuries.

The applicant failed to provide sufficient evidence of chronic pain or functional impairment.

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

The applicant requested a reconsideration of a previous Tribunal decision denying various assessments and a special award.

The applicant argued the Tribunal erred in denying the balance of a catastrophic assessment and that new evidence supported a special award.

The Tribunal found it had erred regarding the catastrophic assessment balance, but noted the respondent had already paid the outstanding HST amount.

The Tribunal also found the alleged new evidence regarding the special award was already before it and would not have changed the outcome.

The request for reconsideration was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and funding for psychological services.

The Licence Appeal Tribunal found that the applicant failed to prove a complete inability to carry on a normal life, as there was insufficient evidence comparing pre- and post-accident activities.

The Tribunal also denied the psychological treatment plan, preferring the insurer's examination which noted the applicant had sold his car and did not want treatment.

The application was dismissed.

The applicant sought statutory accident 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 claimed removal from the MIG based on psychological impairment and chronic pain.

The Tribunal found the applicant failed to prove on a balance of probabilities that he suffered from a psychological impairment or chronic pain with functional impairment caused by the accident.

The medical evidence indicated soft tissue injuries and the applicant maintained an active lifestyle.

The application was dismissed, and the applicant was not entitled to the disputed treatment plans, an award, or interest.

The applicant sought $1,813.83 for a physiotherapy treatment plan following a motor vehicle accident.

The applicant argued the respondent failed to respond to the treatment plan within 10 business days under s. 38(8) of the Schedule, and was therefore prohibited from relying on the Minor Injury Guideline (MIG) limit.

The Tribunal found the respondent responded within 10 days of receiving the plan via HCAI, and provided sufficient medical reasons for denial.

As the MIG limit was exhausted, the treatment plan was denied.

Claims for interest and a special award were also dismissed.

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

The Tribunal found that the applicant's psychological impairments, including anxiety and specific phobias, warranted removal from the Minor Injury Guideline (MIG).

However, the Tribunal dismissed the claims for outstanding balances on psychological treatment plans, finding that the provider was a qualifying psychotherapist and not entitled to the higher hourly rate reserved for psychologists under the Professional Services Guideline.

The application was dismissed.

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

The Tribunal found that the applicant was not entitled to $2,200.00 for minor injury guideline (MIG) treatment and supplementary goods because the MIG limit had already been exhausted prior to changing clinics.

However, the Tribunal found that a treatment plan for physical therapy in the amount of $3,622.73 was reasonable and necessary based on the medical evidence.

The applicant's claim for a special award was dismissed as there was no evidence the insurer unreasonably withheld benefits.

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

The respondent denied various treatment plans 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 for removal from the MIG due to a concussion, psychological impairments, and pre-existing conditions.

The Tribunal found insufficient evidence of a concussion or accident-related psychological impairment, preferring the respondent's psychological assessment.

The Tribunal also found that the applicant failed to prove her pre-existing conditions would prevent maximal recovery within the MIG limits.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her physical and pre-existing psychological injuries warranted removal from the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's physical injuries were minor soft tissue injuries falling within the MIG.

Furthermore, the Tribunal held that the applicant failed to provide compelling medical evidence that her pre-existing psychological condition was exacerbated by the accident or would prevent maximal medical recovery within the MIG limits.

The application for disputed treatment plans and interest was dismissed.

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

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

The Licence Appeal Tribunal found that the applicant failed to meet his burden of providing medical evidence to demonstrate his injuries warranted removal from the MIG.

Consequently, the applicant was not entitled to the disputed treatment plan or interest, and the application was dismissed.

The applicant sought statutory accident 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 Tribunal drew a negative inference against the applicant for failing to produce relevant medical records as ordered in a Case Conference Report and Order.

The Tribunal found the applicant failed to provide sufficient medical evidence to demonstrate that his physical, psychological, or chronic pain injuries warranted removal from the MIG.

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

The applicant sought statutory accident 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 provide sufficient evidence of physical, psychological, or pre-existing injuries that would warrant removal from the MIG.

The Tribunal preferred the respondent's medical evidence, which concluded the applicant sustained minor soft tissue injuries.

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

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to several treatment plans beyond the $3,500 Minor Injury Guideline (MIG) limit due to psychological impairments and chronic pain.

The respondent denied the benefits, arguing the injuries were predominantly minor.

The Tribunal found the applicant's psychological and chronic pain assessments unpersuasive, noting they relied heavily on self-reporting and conflicted with other medical evidence showing only soft tissue injuries.

The Tribunal concluded the applicant's injuries remained within the MIG, and dismissed the claims for the disputed treatment plans and interest.

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

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

The applicant claimed chronic pain and psychological impairments warranted removal from the MIG.

The Tribunal found insufficient evidence of chronic pain syndrome or psychological impairment, concluding the injuries were predominantly minor.

The application for a chiropractic treatment plan and interest was dismissed.

The applicant sought statutory accident 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 contended he suffered from chronic pain, psychological impairments, and a concussion, which would warrant removal from the MIG.

The Tribunal found insufficient medical evidence to support the applicant's claims of chronic pain, psychological impairment, or concussion.

Consequently, the Tribunal held that the applicant's injuries were predominantly minor and subject to the MIG limit.

The application for disputed treatment plans, an award, and interest was dismissed.