Robert Rock

The applicant sought accident benefits following a 2019 motor vehicle accident, claiming catastrophic impairment due to psychological issues.

The adjudicator first held that the applicant was barred from disputing attendant care benefits because he failed to attend scheduled insurer's examinations without a valid reason.

On the catastrophic impairment issue, the adjudicator preferred the respondent's psychiatric assessment, finding that the applicant's marked psychological impairments were attributable to extensive pre-existing conditions, including bereavement following his mother's death, rather than the subject accident.

As the applicant did not meet the catastrophic impairment threshold and his non-catastrophic limits were exhausted, the claims for disputed treatment plans were dismissed.

The applicant requested a reconsideration of a previous Licence Appeal Tribunal decision that denied various treatment plans, interest, and an award.

The applicant argued the Tribunal acted outside its jurisdiction by removing undisputed issues and made errors of law or fact in its analysis of the evidence.

The Tribunal dismissed the request, finding that the applicant failed to meet the high threshold for reconsideration and was attempting to re-litigate the original decision.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing that his injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain with functional impairment.

The Licence Appeal Tribunal found that the applicant's medical evidence, including a chronic pain assessment, relied heavily on subjective reporting and was contradicted by contemporaneous clinical notes showing a return to work and physical activities.

Relying on the insurer's examinations, the Tribunal concluded the applicant suffered from uncomplicated soft tissue injuries and failed to meet the burden for removal from the MIG.

Consequently, the disputed treatment plans, interest, and an award for unreasonable delay were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to treatment plans for chiropractic services and a psychological assessment outside the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on a psychological condition and a potential concussion.

The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from a psychological condition or a concussion, relying on the family doctor's clinical notes and an insurer's examination that suggested malingering.

As the applicant remained within the MIG, the disputed treatment plans were not payable, and claims for an award and interest were dismissed.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident.

The Licence Appeal Tribunal found the applicant was barred from claiming a non-earner benefit because he failed to dispute the insurer's denial within the two-year limitation period.

The Tribunal also held that the applicant's injuries fell within the Minor Injury Guideline (MIG), as he failed to establish a pre-existing condition, chronic pain with functional impairment, or a psychological condition that would warrant removal.

Consequently, the disputed treatment plans were denied, and no award or interest was payable.

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

Prior to the written hearing, the respondent approved four of the disputed treatment plans and partially approved two catastrophic impairment assessment plans.

The applicant withdrew the dispute regarding the remaining amounts for the partially approved plans.

The Tribunal found the applicant was entitled to interest on the four approved plans but dismissed the claim for a special award under s. 10 of O. Reg. 664, as the applicant provided no evidence that the respondent unreasonably withheld or delayed benefits.

The application was dismissed.

The applicant sought income replacement benefits (IRB) and medical benefits for chiropractic treatment following a motor vehicle accident.

The respondent denied the benefits based on multiple insurer's examinations (IEs) which concluded the applicant did not suffer a substantial inability to perform the essential tasks of his employment.

The Tribunal found that the applicant failed to meet his burden of proof, as his family doctor's clinical notes did not directly attribute his ongoing pain to the accident and did not address his inability to work.

The Tribunal accepted the consistent findings of the respondent's IE assessors and dismissed the claims for IRB, medical benefits, interest, and an award.

The applicant requested a reconsideration of a previous Tribunal decision that denied two treatment plans for psychological and catastrophic impairment assessments.

The applicant argued the adjudicator made errors of law and fact regarding a provider's hourly rate, session notes, additional time for form completion, and the respondent's compliance with s. 38(8) of the Schedule.

The Tribunal found that the applicant failed to establish any errors of law or fact that would have likely changed the result.

The request for reconsideration was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits, physiotherapy, psychological services, and a psychological assessment.

The respondent denied the benefits.

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

The Tribunal also found the applicant did not suffer a complete inability to carry on a normal life, relying on independent medical examinations indicating the applicant continued to work and attend school without significant functional limitations.

Claims for interest and an award for unreasonable delay 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 claimed she suffered from a psychological impairment warranting removal from the MIG.

The Tribunal found the applicant did not prove a psychological impairment, preferring the respondent's psychological assessment over the applicant's.

The Tribunal also found the respondent's denial notices complied with s. 38(8) of the Schedule.

The applicant's claims for treatment plans, income replacement benefits, interest, and an award were dismissed.

The applicant sought entitlement to a $3,463.69 occupational therapy treatment plan following a motor vehicle accident.

The respondent denied the benefit and scheduled an insurer's examination, which the applicant failed to attend.

The Tribunal found that the respondent complied with the 10-business-day notice requirement under section 38(8) of the Schedule.

Because the applicant failed to attend a reasonably necessary insurer's examination without a valid explanation, she was barred from proceeding to a hearing under section 55(1) of the Schedule.

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

The Tribunal also dismissed the claims for an income replacement benefit and various treatment plans, finding the respondent's notices of examination and benefit denials were compliant with the Schedule.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, including chiropractic services, psychological services, and neurological and chronic pain assessments.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide submissions or medical evidence demonstrating that the proposed treatment plans and assessments were reasonable and necessary.

Claims for interest and an award for unreasonable delay were also dismissed.

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

The respondent denied benefits and scheduled multiple insurer's examinations (IEs) to determine if the applicant's injuries fell within the Minor Injury Guideline and to assess a treatment plan.

The applicant failed to attend two scheduled IEs and cancelled four others without providing a reasonable explanation.

The Tribunal found the IEs were reasonably necessary and held that the applicant's non-compliance breached s. 44(1) of the Schedule.

Consequently, pursuant to s. 55(1), the applicant is barred from proceeding to a hearing for all benefits claimed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming outstanding balances for a psychological services treatment plan and a catastrophic impairment assessment.

The Licence Appeal Tribunal dismissed the claims, finding the insurer correctly applied the Professional Services Guideline rates for the psychotherapist and the $2,000 cap per assessment for the catastrophic impairment evaluation.

The Tribunal also found the insurer complied with the notice requirements under section 38(8) of the Schedule.

Claims for an award and interest were consequently denied.

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 she should be removed from the MIG due to pre-existing migraines, chronic pain, and a psychological condition.

The Tribunal found the applicant did not provide compelling medical evidence that her pre-existing migraines precluded recovery within the MIG, nor did she establish chronic pain with functional impairment or a psychological condition.

Consequently, the applicant remained subject to the MIG, and her claims for a psychological assessment, chiropractic services, 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 applicant argued for removal from the MIG based on chronic pain and psychological impairment.

The Tribunal found the medical evidence did not support chronic pain with functional impairment or a psychological impairment caused by the accident.

The Tribunal concluded the applicant remains in the MIG, and therefore dismissed the claims for the disputed treatment plans and interest.

The applicant, a minor, sought various statutory accident benefits following a motor vehicle accident, including chiropractic services, physiotherapy, and several assessments.

The respondent insurer denied the treatment plans based on independent medical examinations.

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

The Tribunal accepted the respondent's medical assessments, which concluded the applicant sustained uncomplicated strains and had no functional impairments.

The Tribunal also found the respondent's denial notices complied with the requirements of section 38 of the Schedule.

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

The Licence Appeal Tribunal found the applicant did not meet the burden of proof for removal from the MIG.

The medical evidence, including clinical notes and records, did not support a diagnosis of chronic pain with functional impairment or a psychological condition caused by the accident.

Furthermore, surveillance evidence contradicted the applicant's claims of functional limitation.

As the applicant remained in the MIG and the limits were exhausted, the disputed treatment plans were not considered, 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).

The applicant claimed he suffered from chronic pain with a functional impairment, warranting removal from the MIG.

The Tribunal found the applicant failed to provide objective medical evidence to substantiate his claim, while the respondent provided a physiatry examination indicating the injuries were minor and the applicant had no functional impairment.

The Tribunal concluded the applicant remains in the MIG and dismissed the claims for additional treatment plans.