Dino Ranchan Pius

The applicant sought entitlement to various medical assessments and interest on income replacement benefits (IRBs) following a motor vehicle accident.

The Licence Appeal Tribunal found the proposed psychological and chronic pain assessments were reasonable and necessary, and not reasonably available through OHIP, ordering them payable with interest.

However, the orthopaedic assessment was denied as available through OHIP, and the physiatry assessment was denied as duplicative.

The Tribunal also denied the claim for interest on IRBs, finding the insurer's delay in payment was justified by the applicant's failure to provide reasonably requested documentation under section 33 of the Schedule.

A claim for a bad faith award under section 10 was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including funding for chiropractic services, psychological services, and various expenses such as a bike and mattress.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to prove the treatments and expenses were reasonable and necessary.

The Tribunal preferred the respondent's medical evidence, which concluded the applicant had reached maximum medical recovery and that his ongoing pain was not directly attributable to the accident.

The application was dismissed in its entirety, and claims for interest and a special award were denied.

The respondent insurer requested a reconsideration of a Tribunal decision finding it failed to respond to a $3,733.86 treatment plan within the 10-day period required by s. 38(8) of the Schedule.

The insurer argued the Tribunal erred in fact regarding the submission date of the treatment plan.

The Tribunal dismissed the reconsideration request, finding that the insurer was advancing a new argument not raised at the initial hearing.

Furthermore, the Tribunal noted that even if an error of fact had been made, it would not have changed the outcome, as the original decision found no amounts were payable under the treatment plan because it was not incurred during the period of non-compliance.

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

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

The Tribunal found the applicant's injuries were predominantly minor, relying on the respondent's s. 44 assessors and noting a lack of compelling medical evidence of chronic pain or psychological impairment.

Although the respondent breached the 10-day response requirement under s. 38(8) for the physiotherapy treatment plan, no amounts were payable as the treatment was not incurred during the delay.

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

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

The Licence Appeal Tribunal found that the proposed cognitive training was reasonable and necessary based on a functional cognitive assessment.

However, the Tribunal dismissed the claims for a driver reintegration assessment, psychological services, and chiropractic treatment, preferring the respondent's medical evidence that the applicant's psychological and soft tissue injuries had resolved.

The Tribunal awarded interest on the overdue cognitive training benefit but declined to make a special award, finding no egregious conduct by the insurer.

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 applied to the Licence Appeal Tribunal, arguing she should be removed from the MIG due to pre-existing conditions, psychological impairments, and chronic pain.

The Tribunal found the applicant failed to provide sufficient medical evidence that her pre-existing conditions prevented maximal recovery under the MIG, or that she suffered from accident-related psychological impairments or chronic pain warranting removal.

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

The Tribunal also dismissed the applicant's claim for an award and interest, and declined to award costs to the respondent.