Catherine Zingg

The applicant sought an income replacement benefit (IRB) and funding for four psychological treatment plans following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove a substantial inability to perform the essential tasks of his pre-accident employment, noting he had been laid off due to a shortage of work and received regular employment insurance benefits.

The Tribunal also denied the treatment plans, concluding the applicant did not provide sufficient explanation or evidence to justify the outstanding amounts for brokerage, planning, and documentation support services beyond what the insurer had already approved.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that a pre-existing knee condition and accident-related chronic pain warranted removal from the MIG.

The Licence Appeal Tribunal found the applicant failed to provide compelling medical evidence that her pre-existing condition prevented recovery within the MIG, and preferred the respondent's physiatrist's evidence that the injuries were soft-tissue in nature.

The Tribunal also dismissed the claim for an income replacement benefit, finding no evidence that the applicant suffered a substantial inability to perform the essential tasks of her pre-accident employment.

The application was dismissed in its entirety.

The applicant sought payment for a psychological treatment plan following a motor vehicle accident.

The respondent partially approved the plan but denied the balance of $4,918.00.

The Tribunal found that the applicant established the reasonableness and necessity of a sound machine and relaxation CD/DVD, awarding $188.00 plus interest.

However, the applicant failed to prove that the remaining balance, which included additional therapy session time, a CES medical device, and virtual reality sessions, was reasonable and necessary.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, psychological services, an occupational therapy assessment, and out-of-pocket expenses.

The Tribunal found that the applicant was not entitled to the non-earner benefit because she failed to provide sufficient evidence comparing her pre- and post-accident activities to establish a complete inability to carry on a normal life.

The Tribunal also denied the psychological treatment plans because the applicant failed to justify the service providers charging rates higher than those prescribed for psychotherapists in the Professional Services Guideline, and failed to justify transportation costs.

The requests for an occupational therapy assessment, a massage chair, and a flight cancellation fee were also dismissed as not reasonable and necessary or not payable under the Schedule.

Claims for an award and interest were dismissed.

The applicant sought payment for the unapproved balances of three treatment plans for psychological assessment and treatment following a motor vehicle accident.

The respondent had partially approved the plans based on the recommendations of its psychological assessor and the rates set out in the Professional Services Guideline.

The Tribunal found that the applicant failed to provide any evidence to contradict the respondent's assessor or to establish that the unapproved balances were reasonable and necessary.

The application was dismissed.

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

The respondent denied benefits and the applicant applied to the Licence Appeal Tribunal.

The Tribunal found the applicant was barred from proceeding with her claim for post-104 week income replacement benefits due to her failure to attend a reasonably necessary physiatry insurer's examination without a reasonable explanation.

The applicant also failed to prove that any pre-104 week income replacement benefits remained outstanding.

However, the Tribunal found that four of the five disputed treatment plans, including those for physical therapy, therapeutic devices, a home/attendant care assessment, and a driver reintegration assessment, were reasonable and necessary to address the applicant's chronic pain and functional impairments.

A treatment plan for a psychological assessment was denied as duplicative.

The applicant requested a reconsideration of a Tribunal decision that barred her from proceeding with her application due to alleged non-attendance at insurer's examinations.

The applicant argued that the Tribunal failed to consider her preliminary issue reply submissions due to an administrative error.

The Tribunal agreed that the failure to consider the submissions caused an unjust outcome and granted the reconsideration, ordering a new hearing on both the preliminary and substantive issues.

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

The insurer denied funding for various assessments and psychological treatment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 limit.

The Tribunal found that the applicant suffered from chronic pain causing functional impairment, removing her from the MIG.

The Tribunal ordered the insurer to fund the proposed chronic pain assessment, psychological assessment, and psychological services, finding them reasonable and necessary.

However, the request for MRIs was denied as they were reasonably available under OHIP.

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

The respondent insurer raised a preliminary issue that the applicant was barred from proceeding with her application because she failed to attend multiple scheduled insurer examinations to assess her entitlement to an income replacement benefit.

The Tribunal found that the respondent made numerous reasonable attempts to schedule and accommodate the applicant, who failed to attend without providing a reasonable excuse.

Given the extensive delay of over three years, the Tribunal held that the prejudice to the respondent could not be remedied by rescheduling.

The application was dismissed pursuant to section 55(1)2 of the Schedule.

The applicant sought accident benefits following a motor vehicle accident.

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

The Tribunal found that the applicant failed to prove on a balance of probabilities that his physical injuries, alleged psychological impairments, pre-existing conditions, or chronic pain warranted removal from the MIG.

As the MIG limit was exhausted, the disputed treatment plans were not payable, and claims for interest and a Regulation 664 award were dismissed.

The applicant sought payment for a psychological treatment plan following a motor vehicle accident.

The insurer partially approved the plan, reducing the hourly rate to that of a social worker, reducing session lengths to one hour, and denying travel time and extra documentation fees.

The Tribunal found the appropriate hourly rate was $100 for a social worker in private practice, but restored the session length to 1.5 hours as the insurer provided no medical basis for the reduction.

The Tribunal denied travel time and extra documentation fees due to insufficient evidence.

The applicant was awarded the $600 balance with interest, but a claim for a special award was dismissed as the insurer's reliance on the Professional Fees Guideline was not unreasonable.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB) and a treatment plan for chiropractic services.

The Tribunal found the IRB claim was statute-barred under s. 56 of the Schedule, as the application was filed more than two years after the insurer's clear and unequivocal denial.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act, noting the lack of a bona fide intention to appeal, an unexplained five-month delay, and prejudice to the respondent.

The claim for chiropractic services was also dismissed, as the applicant failed to provide expert evidence to rebut the respondent's insurer's examination report, which concluded the treatment was not reasonable and necessary.

The applicant was involved in a motor vehicle accident and sought non-earner benefits and medical benefits for chiropractic treatment under the Statutory Accident Benefits Schedule.

The respondent denied the benefits.

The Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, as she was still able to engage in substantially all of her pre-accident activities, particularly caring for her children.

The Tribunal also found that the proposed treatment plans were not reasonable and necessary, as the applicant had reached maximal recovery from her accident-related injuries and the treatments appeared to be directed at a transient ischemic attack that was not caused by the accident.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought payment for three chiropractic treatment plans under the Statutory Accident Benefits Schedule.

The respondent insurer denied the claims, relying on an insurer's examination that concluded the injuries fell within the Minor Injury Guideline.

The Tribunal found that the applicant had been removed from the Minor Injury Guideline due to psychological injuries and that the physical therapy provided pain relief.

The Tribunal concluded the treatment plans were reasonable and necessary, ordering the respondent to pay the claimed amounts with interest.

The respondent's request for costs was denied.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic and physiotherapy treatment plans, which the respondent insurer denied.

The adjudicator found that the medical evidence, including clinical notes and psychological assessments, demonstrated the applicant continued to experience accident-related pain and physical impairments.

The respondent's reliance on a three-year-old physiatry assessment and speculation about life events causing the pain were rejected.

The Tribunal concluded the treatment plans were reasonable and necessary to provide pain relief and improve functionality, granting the application in its entirety with interest.

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

The insurer determined her injuries fell within the Minor Injury Guideline (MIG) and denied several treatment and assessment plans.

The Tribunal found that the applicant's ongoing knee and back pain were likely due to pre-existing degenerative changes, and her psychological symptoms did not rise to a level that would remove her from the MIG.

As the applicant had already exhausted the $3,500 funding limit for minor injuries, she was not entitled to the disputed plans or interest.

The respondent insurer sought reconsideration of a Tribunal decision awarding the applicant non-earner benefits, a treatment plan for concussion management, interest, and a special award under s. 10 of O. Reg. 664.

The Vice Chair granted the reconsideration in part.

The Tribunal's award of the concussion management treatment plan was set aside because the applicant had failed to submit an OCF-18 as required by s. 38(2) of the Schedule.

The s. 10 award was also set aside, as the Tribunal had misapplied the legal test for unreasonable delay and relied on a significant factual error regarding the amount of medical benefits previously paid by the insurer.

The Tribunal's decision on non-earner benefits was upheld, but the interest calculation was varied.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a psychological assessment, physical therapy, and psychological treatment.

The respondent insurer denied portions of the treatment plans.

The Tribunal found that the applicant failed to prove the disputed costs for the psychological assessment and treatment were reasonable and necessary, as the insurer's examiners had found the proposed costs excessive or partially unnecessary.

However, the Tribunal awarded the cost of the physical therapy based on the recommendation of the applicant's family doctor, which the insurer failed to rebut with medical evidence.

The applicant sought income replacement benefits (IRBs) beyond the 104-week post-accident mark, claiming a complete inability to engage in reasonably suited employment due to physical and psychological impairments from a motor vehicle accident.

The Licence Appeal Tribunal reviewed the medical evidence and the applicant's employment history, determining that reasonably suited employment included light-to-medium manual labour.

The Tribunal found that the applicant did not suffer a complete inability to engage in such employment, as objective medical assessments indicated he retained the physical, psychological, and cognitive capacity to perform light-to-medium work.

The application for IRBs and interest was dismissed.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, arguing his injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain, pre-existing injuries, and psychological issues.

The Licence Appeal Tribunal found that the applicant failed to meet the burden of proving his injuries fell outside the MIG.

The medical evidence did not support a finding of chronic pain under the AMA criteria, nor did it establish a significant psychological impairment or that a pre-existing condition prevented maximal recovery.

Consequently, the claims for a psychological assessment, interest, and a special award were dismissed.