Alexander Hartwig

The applicant, who was deemed catastrophically impaired following a 2015 motor vehicle accident, sought payment for several treatment plans denied by the respondent insurer.

The Licence Appeal Tribunal found that the proposed physiotherapy services were not reasonable and necessary, as the applicant had reached maximum medical recovery and previous treatment yielded no functional gains.

The Tribunal partially approved the psychological services plan for the OCF-18 completion fee but denied administrative and planning costs.

The Tribunal approved the occupational therapy and case management plans, finding the requested hours for documentation and planning to be reasonable.

The applicant's claim for a special award was dismissed, as the insurer's conduct was not found to be unreasonable.

The plaintiff sought to amend her claim to proceed under Rule 76 of the Rules of Civil Procedure, capping damages at $200,000, after the action had been set down for a jury trial.

The court dismissed the motion, finding the prejudice to the defendant too great and the timing of the amendment to be an abuse of process.

The decision discusses the availability of accommodations for disabled litigants, the prejudice inherent in late procedural changes, and the tactical nature of the plaintiff’s request.

The applicant sought non-earner benefits following a motor vehicle accident.

The Tribunal found that the applicant failed to meet the burden of proof to establish a complete inability to carry on a normal life, as his oral testimony was uncorroborated and contradicted by documentary evidence, including medical assessments and his own activity questionnaire.

The application for non-earner benefits and interest was dismissed.

In this personal injury action, the defendants sought production of the complete and unredacted file of the Family and Children’s Services of Frontenac, Lennox and Addington (FCS) concerning the plaintiffs from 2014 to present.

The plaintiffs opposed, arguing it was a fishing expedition and that the utility of the records would be tangential.

The court dismissed the defendants' motion, finding that the burden for production of such highly intrusive records is high, and the prejudicial effect of disclosure greatly outweighed any potential benefit to the defendants, especially given that the information sought was likely of tangential relevance.

The applicant sought payment for five OCF-6 claims for prescription medication, medical cannabis, and parking expenses following a motor vehicle accident.

The respondent denied the claims and requested the applicant attend an insurer's examination (IE), which she refused.

The Tribunal found that the applicant was barred from proceeding with her application under s. 55(1) of the Schedule due to her failure to attend the IE.

Furthermore, the Tribunal held that the applicant failed to prove the expenses were reasonable and necessary, noting pre-existing pain issues that raised causation concerns.

The application was dismissed.

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

The Licence Appeal Tribunal found the applicant was entitled to $7,000 for a septorhinoplasty to correct a re-displaced septum caused by the accident.

However, claims for assistive devices and hyperbaric oxygen therapy were denied as not reasonable and necessary.

The claim for attendant care benefits was also denied because the applicant had not incurred any expenses for such care.

Interest was awarded on the approved septorhinoplasty treatment plan.

The applicant, who was catastrophically impaired following a 2014 motor vehicle accident, sought payment for massage therapy, chiropractic services, physiotherapy, and occupational therapy.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to meet the burden of proving the treatments were reasonable and necessary.

The Tribunal accepted the respondent's section 44 physiatry report, which concluded that further facility-based treatment was not warranted six years post-accident without evidence of improvement.

Claims for an award, interest, and costs were also dismissed.

The applicant sought statutory accident benefits following a 2015 motor vehicle accident.

The Tribunal found the applicant was not entitled to an income replacement benefit because she failed to comply with section 57(2) of the Schedule by not engaging in recommended psychological treatment for her psychological impairments.

The Tribunal granted the claims for medical cannabis and occupational therapy services because the respondent failed to provide proper denial notices under section 38(8) of the Schedule.

The request for an electric mattress and elongated toilet was dismissed as the devices were found to be reasonable but not necessary.

A claim for chiropractic services was found payable directly to the treatment provider.

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

The insurer denied the NEB on the basis that the applicant did not suffer a complete inability to carry on a normal life, and denied the medical benefit as not reasonable and necessary.

The adjudicator found that the applicant was not entitled to the NEB, as she had successfully returned to school and secured full-time employment post-accident, demonstrating an ability to engage in substantially all of her pre-accident activities.

However, the adjudicator found the proposed chiropractic treatment plan to be reasonable and necessary for pain relief, noting that the applicant's symptoms had improved with similar past treatment.

The medical benefit was granted with interest.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits (ACBs), an orthopedic mattress and pillow, and medicinal cannabis.

The Tribunal found the applicant did not meet her onus for the mattress, pillow, or cannabis, noting a lack of medical evidence and the fact that the mattress was purchased the morning after the accident.

The Tribunal partially granted the ACBs, awarding $537.00 per month based on the applicant's functional limitations with reaching and bending.

However, the Tribunal declined to deem the ACBs incurred under s. 3(8) of the Schedule, finding the insurer's reliance on s. 44 assessments to deny the benefits was not unreasonable.

Claims for a special award were dismissed, but interest was awarded on the payable ACBs.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and a medical benefit for physiotherapy.

The Licence Appeal Tribunal found that the applicant suffered a substantial inability to perform the essential tasks of his pre-accident employment as a janitorial cleaner due to physical and psychological impairments, entitling him to pre-104-week IRBs.

However, the applicant failed to establish a complete inability to engage in any suitable employment, and was therefore denied post-104-week IRBs.

The Tribunal also denied the proposed physiotherapy treatment plan, noting the applicant had an unexhausted, previously approved treatment plan and had provided inconsistent evidence regarding the benefits of physiotherapy.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule for post-concussion syndrome and physical injuries.

The respondent insurer denied several treatment plans.

The Licence Appeal Tribunal found that the applicant was entitled to an in-home assessment, occupational therapy, a portion of a neuropsychological assessment, and assistive devices, as these were reasonable and necessary to address her cognitive and emotional symptoms.

However, claims for massage therapy, physiotherapy, and a rehabilitation support worker were dismissed because the applicant had reached maximum medical improvement from an orthopedic perspective and passive treatments provided only temporary relief.

The applicant was injured in a motor vehicle accident in November 2016 and sought statutory accident benefits from the respondent insurer.

The insurer denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant suffered from chronic pain syndrome and a specific driving-related phobia caused by the 2016 accident, removing her from the MIG.

The Tribunal granted the applicant's claims for a physiotherapy treatment plan and a psychological assessment, finding them reasonable and necessary, but denied a claim for occupational therapy services.

The applicant was also awarded interest on overdue benefits.

The applicant was struck by a motor vehicle as a pedestrian and sought statutory accident benefits, including income replacement benefits (IRBs), a functional abilities evaluation, and physiotherapy.

The insurer denied the claims.

The Licence Appeal Tribunal dismissed the appeal, finding the applicant was barred from claiming IRBs due to her failure to provide reasonably requested financial information under section 33 of the Schedule.

The Tribunal also found the applicant failed to prove the requested medical benefits and assessments were reasonable and necessary, preferring the insurer's medical evidence that the applicant had suffered uncomplicated soft tissue injuries that did not require further treatment.

The applicant sought a non-earner benefit following a motor vehicle accident.

The respondent denied the claim, arguing the applicant's activity levels were already limited by pre-existing conditions and that she retained the physical capacity to perform light tasks.

The Tribunal found that while the applicant had pre-existing physical issues, the accident caused a psychological impairment (Adjustment Disorder with Mixed Anxiety and Depressed Mood) that continuously prevented her from engaging in substantially all of her pre-accident activities, particularly her role as a homemaker.

The Tribunal awarded the non-earner benefit from the date her psychological symptoms were first documented, along with interest.

The respondent's request for costs was denied.

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

The respondent denied funding for various treatment plans and assessments on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's physical injuries, including ongoing pain, did not warrant removal from the MIG, as range of motion was normal and the applicant had returned to pre-accident activities.

The Tribunal also preferred the respondent's psychological assessment, finding no psychological injury.

As the applicant had exhausted the $3,500 MIG limit, the claims for further medical benefits and examinations were dismissed, along with claims for an award and interest.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming attendant care benefits and the cost of an in-home assessment.

The Licence Appeal Tribunal dismissed the application, finding that the in-home assessment cost was incurred prior to submitting a treatment plan and while the applicant was under the Minor Injury Guideline.

The Tribunal also found that the applicant was not entitled to attendant care benefits because no expenses were actually incurred, and the insurer did not unreasonably delay or withhold payment.

Claims for an award under Regulation 664 and interest were also dismissed.

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

The respondent denied a non-earner benefit and certain medical benefits, asserting the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's accident-related injuries were minor and subject to the $3,500 funding limit, noting that pre-existing degenerative issues did not preclude recovery within the MIG.

The Tribunal also dismissed the claim for a non-earner benefit, finding insufficient evidence of a complete inability to carry on a normal life.

The application was dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought $2,000 for an orthopaedic assessment under the Statutory Accident Benefits Schedule.

The respondent insurer denied the treatment plan.

The Licence Appeal Tribunal found that the applicant had significant pre-existing conditions and that the medical evidence did not establish an orthopaedic injury resulting from the accident.

Preferring the respondent's medical examination report, which found no physical impairments, the Tribunal concluded the assessment was not reasonable and necessary.

The application was dismissed.

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

The insurer denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the treatment plans were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant's physical injuries were predominantly minor and that she failed to prove on a balance of probabilities that she suffered from chronic pain or a psychological impairment that would warrant removal from the MIG.

As the applicant had exhausted the $3,500 MIG limit, the application for further benefits and interest was dismissed.