Anil Hampole

The applicant insurer sought repayment of $30,112.00 in income replacement benefits (IRBs) paid to the respondent insured, alleging she wilfully misrepresented her post-accident employment status.

The Tribunal found that the respondent was employed and received Employment Insurance benefits during the period she collected IRBs, and that she deliberately failed to disclose this income to the insurer.

Concluding that the respondent wilfully misrepresented her employment status, the Tribunal ordered her to repay $30,016.00 in IRBs to the applicant.

The applicant sought entitlement to a $4,008.42 physiotherapy treatment plan following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to provide contemporaneous medical evidence from a qualified physical rehabilitation specialist to support the plan.

The Tribunal preferred the evidence of the respondent's physiatrist, who concluded the applicant had full range of motion and the treatment was not reasonable and necessary.

Claims for interest and a section 10 award were also dismissed.

The applicant sought payment for two treatment plans for psychological services following a motor vehicle accident.

The Tribunal found the applicant failed to establish that the outstanding balance of the first plan was payable, as he did not justify a higher hourly rate for a psychotherapist or the need for additional brokerage, planning, and documentation services.

The Tribunal also denied the second plan, relying on an insurer's examination report indicating the applicant had reached maximum medical improvement and had no interest in further psychotherapy.

The application was dismissed in its entirety.

The applicant sought entitlement to a treatment plan for psychiatric services following a 2017 motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the claim was barred by the 260-week limitation period under section 20(1) of the Schedule, as the treatment plan was submitted more than five years after the accident.

The Tribunal further held that even if the limitation period did not apply, the applicant failed to demonstrate that the proposed psychiatric treatment was reasonable and necessary.

Claims for an award and interest were also dismissed.

The applicant sought $14,750.81 for a catastrophic impairment assessment following a 2019 motor vehicle accident.

The respondent denied the treatment plan and argued that the issue of the applicant's chronic pain was res judicata based on a prior Tribunal decision.

The Tribunal found that res judicata did not apply as the issues were different and the prior decision did not address the cost of a catastrophic assessment.

The Tribunal partially approved the treatment plan, finding the physiatry, psychological, and occupational therapy assessments reasonable and necessary, but denied the costs for clinic file reviews, transportation, and interpretation.

The applicant was awarded $8,400.00 plus interest, but the claim for a special award under s. 10 of Regulation 664 was dismissed.

The applicant was injured in a motor vehicle accident and sought non-earner benefits, medical benefits for physiotherapy, an attendant care assessment, an award, and interest.

The respondent denied the benefits.

The Tribunal found that the applicant did not meet the test for a non-earner benefit, as medical evidence showed he had resumed most pre-accident activities shortly after the accident.

The Tribunal also denied the physiotherapy treatment plan, preferring the respondent's orthopaedic assessment which found no objective evidence of significant impairment.

The attendant care assessment was denied because it was incurred before the treatment plan was submitted, contrary to s. 38(2) of the Schedule.

Claims for an award and interest were consequently 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 that the applicant failed to provide sufficient medical evidence of physical or psychological impairments that would warrant removal from the MIG.

Consequently, the disputed treatment plans for psychological services and assessments were denied, along with claims for an award and interest.

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

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

The applicant applied to the Licence Appeal Tribunal, claiming removal from the MIG due to chronic pain and psychological impairment.

The Tribunal found that the applicant failed to provide compelling medical evidence to support removal from the MIG.

As the MIG limits were exhausted, the applicant was not entitled to the disputed psychological assessment or medication expenses.

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

The applicant sought statutory accident benefits following a motor vehicle accident, including chiropractic services, psychological services, and medication expenses.

The Licence Appeal Tribunal dismissed the application, finding that the proposed chiropractic and psychological treatments were not reasonable and necessary based on the respondent's expert medical assessments, which showed no objective physical impairments and a deterioration in mood despite prior psychological treatment.

The medication expense had already been reimbursed.

Claims for interest and a special award were also dismissed.

The applicant sought accident benefits following a motor vehicle accident, claiming entitlement to a psychological assessment and removal from the Minor Injury Guideline (MIG).

The respondent denied the benefits, arguing the applicant's psychological symptoms were related to his father's death rather than the accident.

The Licence Appeal Tribunal found that the applicant failed to demonstrate an accident-related psychological impairment, noting inconsistencies in his evidence and a lack of supporting medical documentation.

The application was dismissed, and the applicant remained subject to the MIG.

The applicant sought $4,115.12 for a physiotherapy treatment plan following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment was reasonable and necessary, as there was no contemporaneous medical evidence to corroborate the need for the plan 17 months after the last medical assessment.

The Tribunal also noted the applicant had reached maximum medical recovery according to the insurer's examination.

The application for benefits, an award, and interest 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 sufficient medical evidence to prove a psychological impairment that would warrant removal from the MIG.

The Tribunal also dismissed the claim for non-earner benefits, as the applicant did not demonstrate a complete inability to carry on a normal life.

Claims for a psychological assessment, an award, and interest were also dismissed.

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

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

The applicant applied to the Licence Appeal Tribunal, claiming her injuries were more than minor and that she suffered a psychological impairment and a complete inability to carry on a normal life.

The Tribunal found that the applicant failed to prove her injuries warranted removal from the MIG, relying on medical assessments that showed only soft tissue injuries and no clinical criteria for psychological impairment.

The Tribunal also found the applicant was not entitled to non-earner benefits, as an occupational therapy assessment demonstrated she was independent in most activities of daily living.

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 that the applicant failed to provide sufficient objective medical evidence to prove that his physical or psychological impairments warranted removal from the MIG.

As the $3,500 MIG limit had been exhausted, the claims for a physiotherapy treatment plan and a psychological assessment were dismissed, along with claims for interest and an award.

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 sought removal from the MIG based on physical pain and psychological impairment.

The Tribunal found the applicant failed to provide compelling medical evidence, such as clinical notes or objective medical examinations, to support removal from the MIG.

The disputed treatment plans for chiropractic services and a psychological assessment were deemed not reasonable and necessary.

The application was dismissed.

The Applicant sought entitlement to a treatment plan for physiotherapy services in the amount of $4,115.12, along with an award and interest, following a motor vehicle accident.

The Respondent denied the benefits.

The Tribunal found that the Applicant failed to meet her burden of proving the treatment plan was reasonable and necessary, noting a lack of contemporaneous or compelling medical evidence supporting the need for physical therapy.

The Tribunal preferred the comprehensive assessment of the Respondent's section 44 assessor over the Applicant's medical reports.

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

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, including removal from the Minor Injury Guideline (MIG), income replacement benefits, and payment for treatment plans.

The Licence Appeal Tribunal found that the applicant failed to prove her injuries warranted removal from the MIG, noting deficiencies in the psychological evidence.

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

The Tribunal also denied the claim for income replacement benefits because the applicant failed to provide sufficient evidence of her pre-accident employment and income as a food deliverer.

The application was dismissed.

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

The respondent denied benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued that persistent physical symptoms and psychological injuries warranted removal from the MIG.

The Tribunal found that the medical evidence, which consisted of a telephone consultation with a general practitioner and a physiotherapist's treatment plan, only supported minor physical injuries such as sprains and strains.

The Tribunal also found insufficient evidence of a psychological impairment.

As the applicant failed to meet the onus for removal from the MIG, the claims for further treatment, medication, interest, and an award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including removal from the Minor Injury Guideline (MIG), non-earner benefits, and funding for physiotherapy and a psychological assessment.

The Licence Appeal Tribunal found that the applicant failed to provide sufficient medical evidence to establish chronic pain or a psychological impairment warranting removal from the MIG.

As the $3,500 MIG limit was exhausted, the treatment plans were denied.

The Tribunal also dismissed the claim for non-earner benefits, finding the applicant failed to demonstrate a complete inability to carry on a normal life, and denied the request for a section 10 award.