Dr. Abram

The applicant sought entitlement to two psychological treatment plans, a special award, and interest following a 2018 motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the proposed treatment plans were redundant and duplicative of previously funded assessments.

The Tribunal noted a lack of contemporaneous evidence in the family doctor's clinical notes to support the need for further mental health assessments three to four years post-accident.

As no benefits were payable, the claims for interest and a special award were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to several treatment plans for physiotherapy, psychological, chronic pain, and vocational assessments.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to meet the burden of proving his injuries warranted removal from the MIG, noting a lack of persuasive medical evidence for chronic pain or psychological impairment.

As the MIG limits were exhausted, the disputed treatment plans were deemed not reasonable and necessary, and the application was dismissed.

The applicant sought various statutory accident benefits following a 2015 motor vehicle accident, including attendant care benefits, occupational therapy assessments, and a concussion assessment.

The Licence Appeal Tribunal denied the claims for attendant care and occupational therapy, finding the applicant had returned to full-time work and was independent in his activities of daily living.

However, the Tribunal granted the request for a concussion assessment, noting the applicant's ongoing headache and balance issues warranted further investigation, and preferred the evidence of concussion experts over the insurer's physiatrist.

The claim for a special award under O. Reg. 664 was dismissed as the insurer reasonably relied on its assessors' reports.

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 and psychological impairments.

The Tribunal found the applicant's physical injuries were predominantly minor and not supported by diagnostic imaging.

The Tribunal preferred the respondent's psychological and medical assessments, concluding the applicant did not suffer from chronic pain or a psychological condition warranting removal from the MIG.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his pre-existing chronic back pain was exacerbated.

He disputed the respondent's denial of treatment plans for acupuncture, physiotherapy, hydrotherapy, and personal training.

The Tribunal found that while the accident was a necessary cause of his current pain complaints, the applicant failed to prove the treatment plans were reasonable and necessary.

The evidence, including the applicant's own statements to medical professionals, indicated that he found the proposed treatments painful, unhelpful, or was not interested in participating in them.

The application was dismissed in its entirety.

The applicant sought Non-Earner Benefits (NEBs) and Attendant Care Benefits (ACBs) following a motor vehicle accident.

The Tribunal dismissed the claim for NEBs, finding the applicant failed to prove a complete inability to carry on a normal life, noting surveillance evidence showing she could still drive, perform personal care, and shop.

The Tribunal also dismissed the claim for ACBs, finding the requested 90 hours per month was not reasonable or necessary given her demonstrated functionality, and the expenses were not incurred.

Claims for an award and interest were also dismissed.

The applicant sought post-104-week income replacement benefits following a motor vehicle accident.

The insurer denied the benefits based on insurer's examinations concluding the applicant did not suffer a complete inability to engage in suitable employment.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to provide sufficient recent medical evidence to rebut the insurer's expert reports and prove a complete inability to work.

Claims for interest and a special award were also dismissed.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, as well as post-104 week income replacement benefits (IRB), which the respondent insurer denied.

The Licence Appeal Tribunal found that the applicant likely suffered a concussion and continued to experience dizziness, cognitive impairments, and psychological difficulties.

The Tribunal determined that the proposed treatment plans for occupational therapy, physiotherapy, and speech language therapy were reasonable and necessary, with the exception of a weighted vest.

Furthermore, the Tribunal concluded that the applicant met the test for post-104 week IRB, as her ongoing impairments rendered her completely unable to engage in any employment for which she was reasonably suited.

The respondent was ordered to pay the disputed benefits and interest.