Robert Watt

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

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

The Tribunal found that the applicant's physical injuries were minor and that she failed to establish chronic pain or an accident-related psychological impairment warranting removal from the MIG.

As the MIG limits were exhausted, the disputed treatment plans were not payable.

Claims for an award and interest were also dismissed.

The applicant sought entitlement to various statutory accident benefits, including treatment plans for an occupational therapy assessment, a functional abilities evaluation, a concussion assessment, and physical therapy, following a motor vehicle accident.

The adjudicator found that the applicant failed to provide objective medical evidence to support the treatment plans.

Relying on the respondent's insurer's examination report, which found the applicant had full range of motion and required no further facility-based treatment, the adjudicator concluded the disputed benefits were not reasonable and necessary.

The application was dismissed in its entirety.

The applicant sought reconsideration of a decision denying entitlement to a $2,165 medical and rehabilitation benefit for physiotherapy.

The applicant argued the Tribunal violated procedural fairness by failing to provide reasons regarding Dr. Wilderman's evidence.

The adjudicator dismissed the request, noting that while all evidence must be reviewed, an adjudicator is not required to refer to every piece of evidence in the decision, and the original reasons for denying the claim were clear.

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

The respondent denied several treatment plans for physiotherapy, psychological services, and physiatry assessments on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered soft tissue injuries and did not establish that pre-existing conditions, chronic pain with functional impairment, or psychological impairments warranted removal from the MIG.

As the $3,500 MIG limit was exhausted, the disputed treatment plans were not payable.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought an income replacement benefit (IRB).

The respondent conceded entitlement but delayed payment, arguing it needed more financial information to calculate the quantum for the self-employed applicant.

The Tribunal found the respondent had sufficient information and its requests for additional documents were excessive.

The Tribunal awarded the applicant $32,488.04 in IRBs up to October 6, 2020, plus $5,023.71 in interest.

The Tribunal declined to order a special award under s. 10 of O. Reg. 664, finding the respondent's reliance on its accounting expert did not meet the threshold for unreasonable behaviour.

The Tribunal also ruled on procedural motions, admitting a late preliminary expert report from the respondent but excluding a late supplementary report.

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 that her pre-existing migraines and back pain were exacerbated by the accident, and that she suffered from chronic pain and a possible concussion, warranting removal from the MIG.

The Tribunal found insufficient medical evidence to support removal from the MIG, noting the applicant's functional abilities remained intact and there was no formal diagnosis of a concussion or chronic pain syndrome.

As the MIG limits were exhausted, the disputed treatment plan was deemed not reasonable and necessary.

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

The insurer denied the benefits on the basis that the applicant failed to submit her application within the 30-day time limit prescribed by section 32 of the Statutory Accident Benefits Schedule.

The applicant submitted her application nearly a year after receiving the forms, explaining that she 'takes her time doing things.' The adjudicator found that the applicant did not provide a reasonable explanation for the delay under section 34 of the Schedule.

Consequently, the application was dismissed as statute-barred under section 55.

The applicant sought a medical and rehabilitation benefit of $2,165.00 for physiotherapy treatment following a 2014 motor vehicle accident.

The respondent denied the benefit.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that her ongoing shoulder and back pain were caused by the accident, noting potential work-related causes and a pre-existing cyst.

The Tribunal also found the treatment was not reasonable and necessary as maximum medical recovery had likely been reached.

The application was dismissed, with no interest or award payable.

The applicant was injured in a motor vehicle accident and sought a medical benefit for psychological treatment.

The respondent partially approved the treatment plan but denied the remainder, disputing the hourly rate charged for a social worker providing the services.

The Tribunal found that the insurer was not required to pay above the Guideline rates and that the approved rate was reasonable, as there was insufficient evidence of the social worker's specialized training or private practice rates to justify the higher psychologist rate.

The application was dismissed.

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

The respondent denied several treatment plans and assessments, and the applicant applied to the Licence Appeal Tribunal for dispute resolution.

The Tribunal found that the applicant's claims for the treatment plans and assessments were statute-barred, as the application was filed more than two years after the respondent's clear and straightforward denials, and there were no reasonable grounds to extend the limitation period.

Furthermore, relying on the uncontradicted reports of the respondent's medical assessors, the Tribunal concluded that the applicant's injuries fell within the Minor Injury Guideline (MIG).

Because the applicant had already exhausted the $3,500 MIG limit, the claim for additional medication expenses was dismissed.

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

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that his impairments were caused by the accident, as his medical complaints were identical to his extensive pre-accident medical history.

Furthermore, the Tribunal found that the disputed treatment plans for a chronic pain program, chiropractic treatment, and massage therapy were not reasonable and necessary, as the applicant had returned to work and was engaging in significant physical activities.

The application was dismissed in its entirety.

The applicant sought entitlement to a non-earner benefit, various medical and rehabilitation benefits, and the cost of assessments following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, as he continued to engage in many pre-accident activities and was employed at the time of the accident.

The Tribunal also dismissed the claims for physiotherapy, a functional ultrasound, a chronic pain assessment, and a cognitive assessment, finding them not reasonable and necessary given the soft-tissue nature of the injuries.

The respondent was ordered to pay $460.00 for the outstanding cost of a psychological assessment, but claims for an award and interest were dismissed.

The applicant sought reconsideration of a Licence Appeal Tribunal decision denying entitlement to medical benefits and interest.

The applicant argued the Tribunal violated procedural fairness by ruling on settled issues, limiting written submissions, and failing to award interest on overdue payments.

The applicant also alleged errors of law and fact regarding the causation of a shoulder injury and the necessity of various treatment plans.

The adjudicator dismissed the majority of the request, finding no procedural unfairness or errors of law, and noting that a reconsideration is not an opportunity to re-argue facts.

However, the adjudicator granted the request in part, ordering the respondent to pay interest on two treatment plans it had previously agreed to fund.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied entitlement to medical benefits.

The applicant argued the Tribunal breached procedural fairness and made errors of law and fact by failing to properly consider evidence and arguments regarding the denial of treatment plans under section 38(8) of the Statutory Accident Benefits Schedule.

The adjudicator dismissed the request, finding that the Tribunal is not required to address every argument in its reasons, had provided sufficient reasons for finding the treatment plans were not reasonable and necessary, and that the respondent's section 44 reports met the requirements for denying the plans.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found his claims fell within the Minor Injury Guidelines (MIG) and denied further medical benefits.

The applicant argued the Tribunal made significant errors of law and fact, specifically regarding the mandatory payment provisions under s. 38(11) of the Statutory Accident Benefits Schedule and the consideration of a psychological assessment.

The adjudicator found no significant errors of law or fact that would have changed the outcome, noting that the proposed treatment plans were not reasonable and necessary.

The request for reconsideration was dismissed.

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

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

The Licence Appeal Tribunal found that the applicant sustained predominantly minor injuries, noting the absence of any documented pre-existing condition that would prevent maximal recovery.

The Tribunal accepted the insurer's expert evidence over the applicant's psychological assessment, concluding that the disputed treatment plans and assessments were not reasonable and necessary.

The application was dismissed.

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

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

The Tribunal found that the applicant failed to provide medical evidence to show her injuries fell outside the MIG, including failing to meet the criteria for chronic pain.

The Tribunal also found the requested treatment plans were not reasonable and necessary, as the applicant provided no evidence of treatment goals or incurred expenses.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits for a psychological assessment and chiropractic treatments, arguing his injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain.

The Licence Appeal Tribunal found that the applicant failed to prove his injuries were outside the MIG, as there was no evidence of a pre-existing condition or that he met the criteria for chronic pain syndrome.

Relying on insurer's examinations, the Tribunal concluded the requested treatments were not reasonable and necessary.

The application was dismissed, and claims for interest and an award were denied.

The applicant was injured in a rear-end motor vehicle accident and sought various medical and rehabilitation benefits, including psychological, chiropractic, physiotherapy services, and a neurological assessment.

The insurer denied the benefits.

The Licence Appeal Tribunal dismissed the application in its entirety, finding that the applicant had reached maximum medical recovery for his soft tissue injuries and that the proposed psychological services could be provided at a lower hourly rate by a subordinate practitioner.

The Tribunal also found the neurological assessment was not reasonable and necessary as the applicant's headaches were not directly caused by the accident.

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

The insurer denied treatment plans for physiotherapy, psychological services, a neuropsychological assessment, and an attendant care assessment.

The Tribunal found that the applicant's left shoulder injury was a pre-existing condition that was not caused or exacerbated by the accident, failing the "but for" causation test.

The Tribunal preferred the insurer's psychological assessment over the applicant's experts, finding insufficient objective evidence to support a psychological diagnosis.

The application was dismissed, and no benefits or interest were awarded.