Monica Ciriello

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming $4,948.16 for a chiropractic treatment plan.

The respondent had partially approved the plan but denied the remainder.

The Tribunal found that the applicant failed to prove the denied portions of the treatment plan were reasonable and necessary, preferring the insurer examiner's opinion that further passive modalities were unlikely to provide benefit.

The application was dismissed, and no interest was awarded.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The insurer denied treatment plans for a catastrophic impairment assessment balance, case management assessment, psychological assessment, dietetic assessment, and attendant care assessment.

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

Specifically, the catastrophic assessment balance exceeded the $2,000 limit per assessment, case management services were not available without a catastrophic designation, and the other assessments lacked persuasive medical evidence to support their necessity.

Claims for interest and a special award were also dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for psychological treatment, driving rehabilitation, and an orthopaedic assessment.

The respondent insurer partially approved the psychological and driving rehabilitation treatment plans but denied the remaining balances, and fully denied the orthopaedic assessment.

The Licence Appeal Tribunal found that the applicant failed to meet her onus to prove that the denied portions of the treatment plans and the orthopaedic assessment were reasonable and necessary.

The application was dismissed.

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's physical injuries were predominantly minor soft tissue injuries and that she failed to provide compelling evidence of a psychological impairment that would warrant removal from the MIG.

Consequently, the applicant was not entitled to the disputed treatment plans, interest, or an award for unreasonable delay.

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 a pre-existing left knee condition warranted removal from the MIG.

The Tribunal found insufficient evidence of a documented pre-existing condition that would prevent maximal recovery within the MIG.

Consequently, the applicant's injuries were deemed predominantly minor, and the disputed treatment plans and interest were denied.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically disputing a treatment plan for psychological services.

The respondent argued the application was barred by res judicata, as a previous Tribunal decision had already determined the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal agreed, finding the four preconditions for res judicata were met and that the applicant's new medical reports did not constitute fresh evidence that would conclusively impeach the original result.

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

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to a chronic pain assessment, psychological treatment, and a driving rehabilitation plan.

The Licence Appeal Tribunal excluded late-filed clinical notes and records due to non-compliance with production deadlines.

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

The applicant did not meet the criteria for chronic pain under the AMA Guides, and failed to provide compelling evidence for the disputed portions of the psychological and driving rehabilitation plans.

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

The Licence Appeal Tribunal found that the applicant failed to provide compelling evidence of a psychological impairment caused by the accident or a documented pre-existing condition that would prevent maximal recovery within the MIG.

The Tribunal preferred the respondent's psychological and musculoskeletal assessments, which concluded the applicant suffered only minor soft tissue injuries and no diagnosable psychological condition.

As the MIG limit was already exhausted, the disputed treatment plans for chiropractic services and the claim for interest were dismissed.

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 Tribunal found that the applicant suffered from psychological impairments, including adjustment disorder and automobile anxiety, which warranted removal from the MIG.

The Tribunal ordered the respondent to pay $2,200.00 for a psychological assessment and interest on overdue payments, but denied the applicant's request for a special award, finding no bad faith by the respondent.

The applicant sought statutory accident 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 that pre-existing neck and back pain from previous accidents warranted removal from the MIG.

The Tribunal found that the medical evidence did not establish a documented pre-existing condition that would prevent maximal recovery within the MIG.

The application for treatment plans and interest was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a chronic pain assessment and removal from the Minor Injury Guideline (MIG).

The respondent denied the benefits, arguing the applicant's injuries were predominantly minor and the MIG limit had been exhausted.

The Tribunal found that the applicant failed to establish that her accident-related soft tissue injuries caused functional impairment or met the criteria for chronic pain syndrome under the AMA Guides.

The Tribunal concluded the injuries were predominantly minor, dismissed the claim for the chronic pain assessment, and denied claims for an award and interest.

The applicant sought accident benefits following a motor vehicle accident, which the respondent denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant sought removal from the MIG due to physical and psychological impairments, as well as entitlement to non-earner benefits (NEBs) and specific treatment plans.

The Tribunal found that the applicant's physical and psychological injuries were minor and did not warrant removal from the MIG.

Relying on medical assessments and surveillance evidence showing the applicant working and driving, the Tribunal concluded the applicant did not suffer a complete inability to carry on a normal life.

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

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

The respondent denied several treatment plans, leading the applicant to apply to the Licence Appeal Tribunal.

The Tribunal dismissed the claims for the outstanding balances of two psychological treatment plans, finding the applicant failed to justify an enhanced hourly rate for a social worker.

The Tribunal also dismissed the claim for physiotherapy services, as the medical evidence did not support physical impairments requiring such treatment.

However, the Tribunal granted the claim for a chronic pain assessment, relying on medical evidence from an orthopaedic surgeon and a psychiatrist diagnosing the applicant with chronic pain syndrome.

The applicant was also awarded interest on overdue payments.

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

The Licence Appeal Tribunal dismissed the application, finding that the applicant was not entitled to the unpaid balances of two partially approved treatment plans because the services were provided by a psychotherapist rather than a psychologist, and the insurer's approved hourly rate of $91.43 was reasonable.

The Tribunal also denied a third treatment plan for psychological services, preferring the respondent's section 44 assessment which concluded no further counselling was recommended, supported by the applicant's admission that therapy provided no benefit.

Claims for an award and interest were consequently dismissed.

The applicant requested a reconsideration of a decision finding his injuries fell within the Minor Injury Guideline and denying his treatment plans.

The applicant argued the Tribunal failed to consider arguments regarding sections 38, 44, and 64 of the Schedule.

The Tribunal dismissed the request, finding that while it may have erred in not fully outlining its analysis of section 38, the error would not have changed the outcome because the insurer provided proper notice of denial.

The Tribunal also found no errors regarding sections 44 and 64.

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

The Tribunal found that the applicant's injuries were predominantly minor soft tissue injuries and that she failed to provide compelling medical evidence of a psychological impairment, pre-existing condition, or chronic pain with functional impairment that would justify removal from the MIG.

The Tribunal also dismissed the applicant's claim for a non-earner benefit, finding she had not demonstrated a complete inability to carry on a normal life.

All disputed treatment plans and claims for interest were denied.

The applicant sought removal from the Minor Injury Guideline (MIG) and payment for a psychological assessment and a functional abilities evaluation following a motor vehicle accident.

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

The Tribunal found that the applicant failed to provide sufficient evidence of a psychological impairment or chronic pain syndrome, preferring the respondent's section 44 insurer examination reports which concluded the applicant suffered only minor sprains and strains.

The application was dismissed, and the applicant was held to the $3,500 MIG limit.

The applicant sought accident benefits following a rear-end motor vehicle collision.

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

The applicant argued she should be removed from the MIG due to a T7 vertebral fracture.

The Tribunal preferred the evidence of the respondent's orthopaedic surgeon, finding the fracture was not accident-related.

As the applicant's injuries were predominantly minor, she was subject to the $3,500 MIG limit, and the disputed treatment plans exceeding that limit were not payable.

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) and that she was barred from claiming a non-earner benefit (NEB) due to misrepresenting her primary residence.

The Tribunal found the applicant failed to prove her physical, psychological, or chronic pain injuries warranted removal from the MIG.

Furthermore, the Tribunal found the applicant misrepresented her primary residence to obtain a lower premium, disentitling her to an NEB.

The application was dismissed.

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

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

The applicant argued for removal from the MIG based on psychological impairments and chronic pain.

The Tribunal found the applicant failed to provide compelling evidence of a psychological impairment or chronic pain syndrome that would warrant removal from the MIG, preferring the evidence of the respondent's experts and the applicant's family doctor.

As the applicant remained subject to the MIG limit, the disputed treatment plans were not payable.

The claims for interest and an award were also dismissed.