Rasha El Sissi

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

The Tribunal found the applicant was removed from the Minor Injury Guideline (MIG) due to an accident-related psychological impairment, preferring the evidence of the applicant's psychologist over the insurer's section 44 assessors.

The applicant's claim for a non-earner benefit was dismissed as she failed to demonstrate a complete inability to carry on a normal life under the Heath test.

Several treatment plans were found payable either because they were reasonable and necessary or because the insurer failed to provide adequate medical reasons for denial as required by section 38(8) of the Schedule.

The claim for an award for unreasonable delay was dismissed.

The applicant insurer sought repayment of $39,942.85 in income replacement benefits (IRB) paid to the respondent, alleging the respondent wilfully misrepresented his pre-accident income on his 2018 tax return.

The Tribunal found that while the respondent's reported income was not in accordance with the facts due to his cash-based business practices, the misrepresentation was not wilful.

The insurer failed to prove the respondent fabricated his income with a conscious wrong or evil purpose to falsely qualify for IRB.

The application for repayment 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 argued she should be removed from the MIG due to psychological impairments, specifically an adjustment disorder with mixed anxiety and depressed mood, and driving anxiety.

The Tribunal found the applicant's evidence insufficient to establish a psychological condition warranting removal from the MIG, noting that her psychometric test results showed low anxiety and minimal depression, and her treating physician considered her driving anxiety a natural reaction that did not require treatment.

As the applicant remained within the MIG limit, her claims for psychological services and assessments were dismissed, along with her claim for interest.

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

The applicant was removed from the Minor Injury Guideline due to a psychological impairment.

The Tribunal found that the applicant was not entitled to two treatment plans for chiropractic services, as the medical evidence indicated full physical recovery.

The Tribunal also denied the outstanding balances for two psychological treatment plans, finding the applicant failed to justify sessions longer than one hour or an hourly rate of $149.61 for a psychotherapist.

However, the Tribunal approved a 2024 psychological treatment plan, subject to a reduced hourly rate of $91.43 for the psychotherapist, awarding $1,474.30 plus interest.

The applicant's request for an award under section 10 of Reg. 664 was dismissed.

The applicant sought entitlement to statutory accident benefits for psychological and physiotherapy treatment plans, a general practitioner's assessment, and a special award following a 2019 motor vehicle accident.

The Licence Appeal Tribunal found the applicant was partially entitled to one psychological treatment plan, preferring the treating psychiatrist's clinical notes over the respondent's section 44 assessor.

The remaining psychological and physiotherapy plans were denied as the applicant failed to prove they were reasonable and necessary, with the Tribunal finding the applicant had reached maximum medical improvement physically.

The claim for the general practitioner's assessment was barred by issue estoppel from a previous Tribunal decision.

No special award was granted as the insurer's conduct was not unreasonable.

The applicant sought statutory accident 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).

The Tribunal found that the applicant failed to provide sufficient medical evidence of ongoing psychological or physical impairments to warrant removal from the MIG.

Consequently, the disputed treatment plans for physiotherapy and psychological treatment were denied, along with claims for interest and a section 10 award.

The applicant sought statutory accident benefits following a 2019 motor vehicle accident.

The Tribunal found the applicant was barred from disputing the denials of an assistive devices plan and a chiropractic plan because she failed to commence the application within the two-year limitation period under section 56 of the Schedule, and declined to extend the time under section 7 of the LAT Act.

On the substantive issues, the Tribunal denied the psychological services plan for lack of medical evidence but approved the orthopedic assessment plan, finding the applicant's complex and persistent musculoskeletal complaints warranted further investigation.

Claims for a special award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically a $1,696.00 treatment plan for physiotherapy.

The respondent denied the plan, arguing the applicant sustained minor soft tissue injuries that had healed.

The Tribunal found the treatment plan reasonable and necessary, preferring the applicant's physiatrist's evidence that the treatment provided pain relief for ongoing musculoskeletal injuries.

The Tribunal ordered the respondent to pay for the treatment plan plus interest, but declined to order an award under s. 10 of Reg. 664 as the applicant provided no submissions to justify it.

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 physical injuries, including a partial tendon tear and degenerative issues, as well as psychological impairments.

The Tribunal found that the physical injuries were predominantly sprains and strains or non-accident-related degenerative conditions.

The Tribunal also rejected the psychological assessment report, preferring the contemporaneous clinical notes of the treating physician, which did not support an accident-related psychological impairment.

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

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for psychological services and an attendant care assessment.

The respondent partially denied the psychological services and fully denied the attendant care assessment.

The Licence Appeal Tribunal found the applicant was entitled to 90-minute psychological sessions but not the higher hourly rate requested for a psychotherapist.

The Tribunal also granted the attendant care assessment based on the applicant's ongoing vertigo symptoms.

The applicant's request for a section 10 award for unreasonable delay was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the denial of treatment plans for a chronic pain assessment, physical therapy, and psychological services.

As a preliminary issue, the Tribunal found the applicant was not barred from proceeding despite missing an insurer's examination, accepting her history of epileptic seizures as a reasonable explanation.

On the substantive issues, the Tribunal dismissed the claims for the chronic pain assessment and physical therapy plans, finding them duplicative or not properly tailored to her specific shoulder injury.

The claim for psychological services was also dismissed because the provider failed to respond to the insurer's reasonable requests for information under section 46.2 of the Schedule.

The application was dismissed in its entirety.

The applicant sought entitlement to various treatment plans and an award under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The matter proceeded to a written hearing, but the applicant failed to file any written submissions or point to evidence supporting her claims, despite filing a document brief.

The adjudicator found the applicant failed to meet her burden of proof and dismissed the claims.

The respondent's request for costs was also denied, as the applicant's failure to file submissions did not amount to serious misconduct.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain syndrome and psychological impairments.

The respondent denied the benefits, arguing the injuries were predominantly minor soft tissue sprains and strains.

The Tribunal found the applicant's medical evidence, primarily a section 25 assessment, relied heavily on subjective reports and lacked objective findings compared to the respondent's section 44 assessments.

Applying the AMA Guides as an interpretative tool, the Tribunal concluded the applicant failed to establish chronic pain with functional impairment.

The application was dismissed, and the injuries were deemed subject to the $3,500 MIG limit.

The applicant sought statutory accident benefits following a motor vehicle accident, including treatment plans for psychological services, a psychological assessment, a dental assessment, and a chronic pain assessment.

The Licence Appeal Tribunal found the psychological services plan reasonable and necessary based on the treating psychotherapist's records and a supporting psychiatric assessment.

The remaining treatment plans were denied due to insufficient evidence or failure to make submissions.

The claim for a special award under s. 10 of Regulation 664 was dismissed as the applicant failed to demonstrate unreasonable conduct by the insurer.

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 and a concussion.

The Tribunal found insufficient medical evidence connecting the applicant's psychological issues or alleged concussion to the accident.

The Tribunal concluded the injuries were predominantly minor, subject to the MIG limit, and dismissed the claims for treatment plans, an award, and interest.

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 Tribunal found that the applicant suffered from chronic pain with functional impairment, warranting removal from the MIG.

The Tribunal approved treatment plans for physiotherapy, chiropractic services, and a chronic pain assessment, finding them reasonable and necessary.

However, a proposed psychological assessment was denied due to insufficient evidence of an accident-related psychological condition.

The Tribunal also awarded interest on overdue benefits but declined to order a special award, finding the respondent's conduct was not unreasonable.

The applicant sought payment for various psychological and chiropractic treatment plans following a motor vehicle accident.

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

The applicant argued that the insurer's denial notices were defective under s. 38(8) of the Schedule, triggering mandatory payment under s. 38(11).

The Tribunal found that the applicant failed to provide evidence to warrant removal from the MIG.

However, the Tribunal held that several of the insurer's denial notices lacked sufficient medical and other reasons, rendering them defective.

Consequently, the insurer was ordered to pay for the treatment plans associated with the defective notices, while the remaining plans were denied.

The applicant sought $3,445.28 for physical therapy services following a motor vehicle accident.

The insurer denied the treatment plan, and the applicant argued the denial letter failed to provide adequate medical reasons under s. 38(8) of the Schedule.

The Tribunal found the insurer's reasons were adequate and specific to the applicant's condition.

Because the applicant provided no evidence or submissions to demonstrate the treatment was reasonable and necessary, the claim was dismissed.

Claims for interest and a special award were also dismissed.

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

The respondent denied treatment plans for physiotherapy and a psychological assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

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

However, because the respondent's initial denial letter for the physiotherapy treatment plan failed to provide proper medical reasons as required by s. 38(8) of the Schedule, the Tribunal ordered the respondent to pay for any physiotherapy services incurred during the period of non-compliance.

The claims for the psychological assessment and a special award were dismissed.

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

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

The Tribunal found that the applicant suffered an accident-related psychological condition, removing her from the MIG.

The Tribunal preferred the evidence of the applicant's psychological assessor over the respondent's, noting it was corroborated by medical records of post-traumatic headaches and sleep disturbances.

The Tribunal awarded the costs of a psychological assessment and psychological treatment, but denied a treatment plan for physiotherapy, finding the physical injuries were minor and unrelated degenerative issues.