Tanjoyt Deol

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit (NEB) and medical/rehabilitation benefits outside the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove a complete inability to carry on a normal life for the NEB.

The Tribunal also held that the applicant's injuries were predominantly minor and that he did not establish removal from the MIG on the basis of pre-existing schizophrenia, chronic pain, or psychological impairments.

Consequently, the disputed treatment plans and interest were denied.

The applicant requested a reconsideration of a previous Licence Appeal Tribunal decision that denied her entitlement to a treatment plan for vestibular physiotherapy.

The applicant argued the Tribunal erred in law by applying the incorrect legal test for res judicata.

The Adjudicator agreed, finding that the previous decision relied on an incorrect four-part test rather than the binding three-part test from the Supreme Court of Canada, and failed to properly analyze whether the same issue had been previously decided.

Upon reconsidering the merits, the Adjudicator found the applicant was partially entitled to the treatment plan in the amount of $2,697.28, as the treatment was reasonable and necessary for her accident-related post-concussion symptoms, though costs incurred prior to the plan's submission were excluded under s. 38(2) of the Schedule.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to a TMJ assessment and a treatment plan for chiropractic, physiotherapy, and acupuncture services.

The respondent denied the benefits.

The Tribunal found that the applicant failed to prove the TMJ assessment was reasonable and necessary, noting inconsistencies in his self-reporting and preferring the respondent's dental assessor over the applicant's chronic pain specialist.

The Tribunal also found insufficient evidence to support the need for the proposed chiropractic, physiotherapy, and acupuncture services.

The application was dismissed, and no interest was payable.

The applicant requested reconsideration of a preliminary issue decision that barred him from proceeding with his claim for failing to attend insurer's examinations.

The Tribunal found that the preliminary decision finally disposed of the appeal, making it eligible for reconsideration.

The Tribunal granted the reconsideration, finding it had erred in law by reversing the statutory onus under s. 44(9)2(i) of the Schedule, incorrectly requiring the applicant to prove the examination location was inconvenient rather than requiring the insurer to prove it made reasonable efforts to schedule a convenient location.

The preliminary issue was ordered to be reheard by a different adjudicator.

The applicant sought accident benefits following a motor vehicle accident, which the respondent denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal for various treatment plans, the cost of a Disability Certificate, income replacement benefits (IRBs), interest, and an award.

The Tribunal found that the applicant's injuries were predominantly minor, noting that his accident-related complaints had resolved prior to a subsequent bicycle accident.

The Tribunal dismissed the claims for treatment plans as the applicant remained within the MIG limit.

The claim for IRBs was also dismissed because the applicant failed to meet his evidentiary burden and the evidence showed he had returned to work.

Consequently, the claims for interest and an award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and two treatment plans for chiropractic services.

The Tribunal found that the applicant failed to meet her burden of proof to establish entitlement to a higher quantum of pre-104 IRBs or entitlement to post-104 IRBs, as she provided no substantive submissions on these points.

The Tribunal also rejected the applicant's arguments that the respondent's notices were non-compliant with the Schedule, finding that the respondent provided adequate medical and other reasons for its denials under s. 38(8) and properly requested an insurer's examination under s. 37(1).

As the applicant failed to establish that the proposed treatments were reasonable and necessary, the application was dismissed.

The applicant sought statutory accident benefits from the Motor Vehicle Accident Claims Fund following a motor vehicle accident.

The Fund denied benefits on the basis that the applicant was not ordinarily resident in Ontario at the time of the accident, pursuant to s. 25(1) of the Motor Vehicle Accident Claims Act.

The Tribunal found that the applicant, a citizen of China and a refugee protection claimant subject to a conditional removal order, had temporary ties to Ontario and failed to produce material evidence regarding his immigration status.

The Tribunal concluded the applicant was not ordinarily resident in Ontario and dismissed the application.

The applicant, who sustained catastrophic impairments in a motor vehicle accident, sought $334,363.41 in disputed rehabilitation benefits for extensive home modifications, including new flooring, rewiring, and a home addition.

The Licence Appeal Tribunal found that the majority of the proposed modifications were not reasonable and necessary, as the applicant failed to establish a sufficient connection between the requested renovations and her accident-related impairments.

The Tribunal approved only the costs associated with relocating the kitchen fridge to allow access to the fuse panel, along with applicable interest, dismissing the remainder of the claim.

The applicant sought non-earner benefits (NEB) and medical benefits for chiropractic services following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to provide evidence comparing his pre- and post-accident activities to establish entitlement to NEB.

The Tribunal also held that the applicant's injuries fell within the Minor Injury Guideline (MIG), as he provided insufficient medical evidence to support his claims of chronic pain and psychological impairment.

As the MIG limit was exhausted, the treatment plan was denied, and claims for interest and a special award were dismissed.

The applicant sought entitlement to statutory accident benefits for chiropractic and massage services, cognitive devices, and physiatry and orthopaedic assessments following a 2019 motor vehicle accident.

The adjudicator found that the applicant failed to prove the treatment plans for chiropractic and massage services were reasonable and necessary, noting a lack of recommendation from her treating physicians and conclusions from assessors that she had reached maximum medical improvement.

The adjudicator partially approved the treatment plan for cognitive devices, awarding $89.95 for a Lumosity subscription but denying the cost of a tablet, as the applicant did not establish why a cell phone could not be used.

The requests for physiatry and orthopaedic assessments were denied as they were not recommended by treating practitioners and were duplicative of an already approved chronic pain assessment.

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

The respondent denied several treatment plans, leading to a dispute before the Licence Appeal Tribunal.

As a preliminary issue, the Tribunal struck portions of the applicant's reply submissions for improperly introducing new evidence and arguments, violating the rule against splitting a case.

On the merits, the Tribunal found the applicant was not entitled to the remaining balance for psychological treatment, as the respondent's partial approval at the rate of $99.75 per hour for a psychotherapist was reasonable.

The Tribunal also denied a chronic pain assessment as a duplication of services.

However, the Tribunal granted the treatment plans for chiropractic, massage, physical therapy, and physiotherapy services, finding them reasonable and necessary based on the applicant's ongoing chronic pain and the recommendations of his treating physicians.

Claims for a special award and costs were dismissed.

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 argued for removal from the MIG based on alleged post-concussion syndrome, chronic pain, and psychological impairments.

The Tribunal found that the medical evidence did not support a concussion diagnosis, that the applicant failed to demonstrate functional impairment from chronic pain, and that he did not prove an accident-related psychological impairment.

As the applicant's injuries were predominantly minor and the $3,500 MIG limit had been exhausted, the application for disputed treatment plans and interest was dismissed.

The applicant sought accident benefits following a motor vehicle accident, which the respondent denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG due to extensive tearing in the left shoulder and psychological impairments.

The Tribunal found that the applicant failed to prove a complete tear in the shoulder or a psychological impairment beyond mere sequelae of soft tissue injuries.

As the injuries were predominantly minor, the applicant was subject to the $3,500 MIG limit and was not entitled to the disputed treatment plans or interest.

The application was dismissed.

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

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

The Tribunal found the applicant failed to meet her burden to be removed from the MIG.

However, the Tribunal ordered the insurer to pay the $804.00 treatment plan for chiropractic services because its denial notice failed to provide sufficient medical reasons as required by s. 38(8) of the Schedule.

The claim for the TMJ assessment was dismissed as the denial notice for that plan was compliant.

Claims for an award under Regulation 664 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 argued for removal from the MIG based on chronic pain, post-concussion syndrome, and psychological impairments.

The Tribunal found the applicant failed to establish on a balance of probabilities that she suffered from any of these conditions, noting a lack of supporting medical evidence and preferring the respondent's expert reports.

The application for psychological services and interest was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits and several treatment plans for occupational therapy, physiotherapy, and a chronic pain assessment.

The adjudicator dismissed the application in its entirety.

The adjudicator preferred the respondent's section 44 assessments over the applicant's evidence, finding the applicant's occupational therapy report to be of limited evidentiary value due to inconsistencies with clinical notes and records.

Furthermore, the applicant failed to meet her evidentiary burden for the treatment plans by not providing copies of the disputed OCF-18s or specific submissions addressing the goals and costs of the proposed treatments.

The applicant sought a non-earner benefit and payment for two chiropractic treatment plans following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide submissions or evidence to establish entitlement to the non-earner benefit.

Furthermore, the applicant did not demonstrate that the proposed chiropractic treatments were reasonable and necessary, as he failed to identify treatment goals, provide contemporaneous medical evidence, or explain why further treatment was required after the insurer had recently approved identical treatment.

The applicant insurer sought repayment of $31,452.52 in Income Replacement Benefits (IRB) paid to the respondent, alleging wilful misrepresentation of her employment status and income.

The respondent did not participate in the written hearing.

The Tribunal found that the respondent wilfully misrepresented her pre-accident employment and income, as she claimed to be employed and earning $1,260 bi-weekly, but her Ontario Disability Support Program (ODSP) file and tax returns showed she was receiving social assistance and had no employment income.

The Tribunal ordered the respondent to repay the $31,452.52 in IRBs, plus interest, pursuant to section 52 of the Statutory Accident Benefits Schedule.

The applicant requested a reconsideration of a preliminary issue decision which found his claim for Income Replacement Benefits (IRBs) was statute-barred.

The applicant argued the adjudicator erred in finding the insurer's denial letter was clear and unequivocal, and in refusing to extend the limitation period under section 7 of the Licence Appeal Tribunal Act.

The Tribunal dismissed the request, finding the applicant was attempting to relitigate the initial decision and failed to establish any errors of law or fact that would have changed the outcome.

The Tribunal also rejected the applicant's attempt to introduce an undated resignation letter as new evidence.

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

The Tribunal found that the applicant was not barred from proceeding with her claim for a psychological assessment because the insurer's notices of examination failed to comply with s. 44(5) of the Schedule.

On the substantive issues, the Tribunal determined that the applicant's injuries fell within the Minor Injury Guideline (MIG), as she failed to establish chronic pain or psychological impairments warranting removal.

However, because the insurer failed to provide compliant medical reasons for denying the treatment plans under s. 38(8), the Tribunal ordered the insurer to pay for the psychological and chronic pain assessments pursuant to s. 38(11).

Claims for an award and costs were dismissed.