Nidhi Punyarthi

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

The respondent denied benefits beyond the $3,500 limit, arguing the injuries were predominantly minor.

The Tribunal allowed late medical evidence but ultimately found that the applicant's injuries were predominantly minor, noting minor vehicle damage, delayed medical attention, and insufficient evidence of chronic pain or a pre-existing condition preventing maximal recovery.

The application was dismissed.

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

The respondent denied the claim and raised a preliminary issue that the applicant was barred from proceeding under s. 55(1)2 of the Schedule for failing to attend an independent medical examination (IE).

The applicant also brought a motion to file a sur-reply.

The Tribunal dismissed the motion for a sur-reply, finding no exceptional circumstances.

On the preliminary issue, the Tribunal found that the respondent complied with the notice requirements for the IE and that the IE was reasonably necessary.

Because the applicant failed to attend, he was barred from proceeding with his application.

The Tribunal declined to grant relief under s. 55(2) due to prejudice to the respondent, and denied costs to both parties.

The applicant sought reconsideration of a Licence Appeal Tribunal decision that found the respondent insurer did not unreasonably withhold or delay payment of a psychological assessment.

Upon reviewing the hearing transcript, the adjudicator found a material error of fact: the respondent's adjuster had admitted on cross-examination that an in-person insurer examination was not required to approve the benefit.

The adjudicator concluded that the respondent maintained a stubborn and inflexible position by insisting on an unnecessary examination, thereby unreasonably delaying payment.

The reconsideration was granted, the original decision was varied, and the respondent was ordered to pay a special award of 45% of the assessment amount under s. 10 of Regulation 664.

The applicant sought statutory accident benefits following a 2012 motor vehicle accident, including attendant care benefits and various medical and rehabilitation expenses.

The Tribunal found that the applicant's need for attendant care was caused by the accident, given her diagnoses of chronic pain, possible traumatic brain injury, and aggravated psychological conditions.

However, based on surveillance evidence and the applicant's pre-accident baseline, the Tribunal reduced the claimed attendant care for meal preparation from seven days a week to three days a week, and denied claims for bathroom and medication management assistance.

The Tribunal denied claims for optometric, hearing aid, and psychotherapy services because the applicant failed to submit treatment plans prior to incurring the expenses, as strictly required by s. 38(2) of the Schedule.

The claim for Whole Therapy expenses was allowed, as a treatment plan had been submitted and the insurer had previously approved mileage for the same treatment.

The claim for pelvic floor physiotherapy was denied for failing to establish causation.

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

The applicant claimed exceptions to the MIG based on a pre-existing condition, psychological conditions, and chronic pain, and sought $2,230.64 for a chiropractic treatment plan.

The adjudicator found that the applicant's injuries were minor and that his ongoing pain was likely aggravated by his work as a driver rather than caused by the accident.

The applicant failed to provide objective medical evidence to support any of the claimed exceptions.

The application was dismissed, including claims for the treatment plan, interest, and a special award under Regulation 664.

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

The respondent insurer denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the claimed benefits exceeded the $3,500 limit.

The applicant argued he should be removed from the MIG due to a pre-existing condition, psychological injuries, and chronic pain.

The Tribunal found the applicant's evidence, including expert reports, to be contradictory and unsupported by the objective medical records.

The Tribunal concluded the injuries were minor and dismissed the application, including claims for an award under Regulation 664.

The applicant sought to withdraw certain issues from a scheduled hearing without prejudice.

The respondent argued that the issues not identified for withdrawal remained in dispute, including attendant care benefits, and both parties sought costs.

The Licence Appeal Tribunal held that the applicant could withdraw issues without prejudice, as imposing a 'with prejudice' withdrawal would create access to justice barriers.

The Tribunal also found that attendant care benefits were not in dispute, having been decided in a previous preliminary issue decision.

Finally, the Tribunal declined to award costs to either party, finding no evidence of unreasonable, frivolous, vexatious, or bad faith conduct.

The applicant was involved in a motor vehicle accident and applied for a determination of catastrophic impairment and entitlement to non-earner benefits.

The Licence Appeal Tribunal found that the applicant sustained a 55% whole person impairment due to a combination of physical and psychological impairments, meeting the threshold for catastrophic impairment under Criterion 7 of the Schedule.

The Tribunal also found that the applicant suffered a complete inability to carry on a normal life, entitling him to non-earner benefits.

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

The respondent insurer denied the claim and raised a preliminary issue regarding the applicant's eligibility under s. 5(1) of the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant was not employed at the time of the accident, was not receiving employment insurance benefits, and had not worked for at least 26 weeks in the 52 weeks preceding the accident.

Consequently, the Tribunal held that the applicant was ineligible to claim income replacement benefits.

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

The respondent insurer denied the treatment plans for physiotherapy, assistive devices, psychological treatment, and chiropractic treatment based on its insurer's examinations.

The Licence Appeal Tribunal found the respondent's expert opinions unpersuasive and insufficiently explained, preferring the evidence of the applicant and her treating practitioners.

The Tribunal ordered the respondent to pay all disputed treatment plans and overdue interest.

Furthermore, the Tribunal granted a maximum special award of 50% under Regulation 664, finding that the respondent unreasonably delayed or withheld payments by providing reasons for denial inconsistent with its actual reasons and failing to consider medical records on file.

The applicant was catastrophically impaired in a motor vehicle accident and sought statutory accident benefits, including attendant care and home modifications.

The respondent insurer partially denied the claims based on its own assessments.

The Licence Appeal Tribunal found that the applicant's functional limitations, including cognitive and physical impairments, necessitated the maximum attendant care benefit of $6,000 per month and home modifications totaling $344,864, which included an in-home elevator and therapy room.

The Tribunal also awarded the cost of a housing analysis assessment but denied the cost of a second attendant care assessment submitted prematurely.

Finally, the Tribunal ordered a special award under s. 10 of Regulation 664, finding the respondent unreasonably withheld benefits by failing to properly investigate the applicant's functional needs despite having access to medical evidence supporting the claims.

The respondent insurer brought a preliminary issue motion seeking to restrict the applicant from disputing the denial of income replacement benefits, arguing the applicant failed to attend ten scheduled insurer examinations.

The Tribunal found that the insurer failed to comply with its obligation under s. 44(9)2.i. of the Statutory Accident Benefits Schedule to schedule the examinations at a convenient day, time, and location for the applicant, who was working modified duties.

As the insurer, not the applicant, failed to comply with the Schedule, the motion was dismissed and the applicant was permitted to proceed with the claim.

The applicant brought a motion requesting that the adjudicator recuse herself and set aside a previous decision denying a special award under the Insurance Act.

The applicant alleged a reasonable apprehension of bias, arguing the adjudicator fabricated evidence and imposed her own legal tests.

The adjudicator dismissed the motion, finding that the applicant's allegations amounted to alleged errors of fact and law, which do not in themselves establish a reasonable apprehension of bias.

No costs were awarded.

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

The Licence Appeal Tribunal considered whether the applicant was entitled to treatment plans for social work services, chiropractic/massage/physiotherapy, and a psychological assessment, as well as a special award.

The Tribunal found the treatment plans reasonable and necessary, awarding the claimed amounts (with a minor deduction for the social work plan).

The claim for a special award was dismissed as there was no evidence the insurer unreasonably withheld or delayed payment.

The applicant sought non-earner benefits, cost of examinations, interest, and a special award following a 2015 motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant's physical limitations and depression pre-dated the accident and were not caused by it.

Consequently, the applicant did not suffer a complete inability to carry on a normal life as a result of the accident.

The claims for the cost of multidisciplinary assessments, interest, and an award for unreasonable delay were also dismissed.

The applicant sought increased attendant care benefits and payment for past attendant care expenses following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant's right arm impairments did not require Level 3 complex care, making the insurer's approved monthly amount reasonable and necessary.

The Tribunal also dismissed the claim for past expenses, finding the applicant failed to prove the expenses were 'incurred' under the Schedule due to insufficient documentation of the services provided.

The applicant sought statutory accident benefits following a motor vehicle accident, including physiotherapy, assistive devices, and costs of examinations for driving anxiety, functional abilities, and chronic pain.

The respondent denied the benefits, relying on an orthopedic assessment that placed the applicant in the Minor Injury Guideline.

The Tribunal found that the preponderance of medical evidence, including the applicant's OHIP claims history and clinical notes, supported the reasonableness and necessity of the disputed treatment plans and assessments.

The Tribunal ordered the respondent to pay the claimed benefits and interest, but denied the applicant's claim for a special award, finding no evidence of unreasonable delay or withholding.

The applicant sought a special award under Section 10 of Regulation 664, alleging the respondent insurer unreasonably withheld or delayed payment for a psychological assessment.

The insurer had requested a Section 44 examination before approving the assessment, which the applicant refused to attend without an audio recording.

The Tribunal found the insurer's actions, including its requests for a Section 44 examination and its eventual approval of the assessment by a new adjuster, were reasonable.

The application for a special award was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found she was not involved in an 'accident' as defined in the Statutory Accident Benefits Schedule.

The applicant argued the Tribunal erred in its causation analysis and failed to find that an automobile was not present.

The adjudicator dismissed the request, finding that the original decision clearly concluded on a balance of probabilities that an automobile was not involved and that the applicant's injuries were caused by slipping on ice.

The adjudicator held that the Tribunal correctly applied the causation test based on its factual findings.

The applicant sought to dispute the denial of income replacement and attendant care benefits more than two years after the insurer's denial.

The applicant had been found mentally incapable and required a litigation guardian.

The Tribunal held that the Limitations Act does not apply to its proceedings, but granted an extension of time under s. 7 of the Licence Appeal Tribunal Act, 1999.

Applying the Blenheim factors, the Tribunal found the delay was reasonably explained by the applicant's incapacity and the time required for his litigation guardian to navigate multiple legal proceedings, with no prejudice to the respondent.