Raymond Selbie

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

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

The applicant argued that he suffered from chronic pain, radiculopathy, and fibromyalgia, which warranted removal from the MIG.

The Tribunal found that the medical evidence, including contradictory reports from the applicant's own physicians, did not establish on a balance of probabilities that the applicant's injuries required treatment outside the MIG.

As the applicant remained subject to the MIG, the disputed treatment plans were denied, and no interest was payable.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

The respondent insurer denied a treatment plan for 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 impairments, including chronic pain and anxiety, exceeded the MIG definition.

The Tribunal ordered the respondent to pay $2,200.00 for the psychological assessment and interest on overdue payments.

The applicant's claim for a special award under s. 10 of Regulation 664 was dismissed, as there was insufficient evidence of unreasonable conduct by the insurer.

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

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

After the applicant was removed from the MIG following an insurer examination, the Tribunal assessed the disputed treatment plans.

The Tribunal found that the psychological assessment, psychological services, and two medical services plans were reasonable and necessary, relying on evidence of chronic pain and adjustment disorder.

However, the Tribunal denied a transportation expense claim because the applicant failed to prove the distance exceeded 50 kilometres, and denied a chiropractic services plan because the applicant failed to submit a signed OCF-18.

Interest was awarded on the overdue payments.

The applicant sought payment for three physiotherapy treatment plans following a motor vehicle accident.

The respondent denied the plans because the health care provider and facility were not registered with the Health Claims for Auto Insurance (HCAI) system and the plans were not submitted through the Central Processing Agency (CPA) as required by the HCAI Guideline and the Statutory Accident Benefits Schedule.

The Tribunal found that the HCAI Guideline applied and the respondent had not waived the submission requirements.

The application for benefits, an award, and interest was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

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

The Tribunal found that the applicant sustained a psychological impairment and chronic pain that exceeded the MIG definition, relying on evidence from the applicant's treating practitioners and admissions from the respondent's own assessors.

The Tribunal ordered the respondent to pay for the disputed physiotherapy, psychological assessments, psychological services, and chronic pain assessment, along with interest.

However, the Tribunal declined to order a special award under s. 10 of Regulation 664, finding insufficient evidence that the insurer unreasonably withheld or delayed payments.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

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

The applicant sought payment for two outstanding physiotherapy treatment plans and one chiropractic treatment plan.

The Tribunal dismissed the claims for the physiotherapy plans because the applicant provided no evidence to support them.

However, the Tribunal granted the claim for the chiropractic treatment plan, finding it reasonable and necessary as part of a multi-disciplinary approach to treat the applicant's physical and psychological injuries.

Interest on the overdue payment was also awarded.

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

The respondent denied several 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 Tribunal found that the applicant failed to establish a fundamental psychological or chronic pain impairment that would remove him from the MIG.

Relying on insurer examinations, the Tribunal concluded the applicant's distress was related to a loss of independence rather than accident-related psychological issues.

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

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

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

The Tribunal found that the insurer's medical examinations were conducted without reviewing the applicant's treating medical records.

Relying on the applicant's medical evidence, the Tribunal concluded the applicant sustained chronic pain and psychological impairments that removed her from the MIG.

The disputed treatment plans were deemed reasonable and necessary, and interest was awarded.

The applicant's claim for a special award under s. 10 of O. Reg. 664 was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including occupational therapy, home maintenance expenses, and equipment for a web design course.

The Tribunal found the applicant was entitled to the occupational therapy plan, including a treadmill and exercise app, as reasonable and necessary for her mental health recovery.

The Tribunal also approved the computer, printer, and textbook required to complete a previously approved web design course.

However, the Tribunal denied the claim for home maintenance and renovation expenses, finding they were regular property maintenance and not incurred as a result of the accident.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

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 sustained chronic pain and psychological impairments (including PTSD and driving phobia) that removed her from the MIG.

The Tribunal preferred the evidence of the applicant's treating practitioners and in-person assessors over the insurer's paper reviews and examinations.

The applicant was awarded all disputed medical and rehabilitation benefits, totaling over $10,000, plus interest on overdue payments.