Dr. Ahmad Belfon

The applicant sought entitlement to statutory accident benefits for physical rehabilitation, an orthopaedic assessment, and a social work assessment following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide sufficient medical evidence to prove the treatment plans were reasonable and necessary.

The Tribunal relied on the respondent's insurer examination reports, which concluded the applicant had sustained minor injuries, had benefited from prior treatment, and had successfully returned to his pre-accident employment and daily activities.

The applicant sought statutory accident benefits for various treatment and assessment plans following a motor vehicle accident, including chiropractic treatment, a chronic pain assessment, a neurological assessment, and a concussion assessment.

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

The Tribunal preferred the evidence of the respondent's insurer's examinations and the applicant's own family doctors' clinical notes, which did not corroborate the need for the proposed assessments or treatments.

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

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

The applicant argued for removal from the MIG, claiming he sustained a concussion.

The Tribunal found that the applicant's evidence, primarily from chiropractors, did not establish a concussion diagnosis.

Relying on the clinical notes of the applicant's family physician and an insurer's examination report, the Tribunal concluded the applicant sustained only minor injuries.

As the applicant was subject to the MIG limit, the disputed treatment plans and assessments were not payable.

The application was dismissed.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident, claiming catastrophic impairment under Criteria 7 (55% whole person impairment) and Criteria 8 (marked impairment in three of four domains).

The Licence Appeal Tribunal found the applicant's whole person impairment was 47%, falling short of the 55% threshold, and that he did not suffer marked impairment in social functioning.

The Tribunal denied most of the disputed treatment and assessment plans, finding them not reasonable and necessary, but approved a $2,665.50 chronic pain assessment.

Claims for attendant care benefits, an award for unreasonable delay, and costs were dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a non-earner benefit and various treatment plans for chiropractic and psychological services.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the applicant suffered a complete inability to carry on a normal life due to chronic pain and psychological impairments, entitling her to the non-earner benefit for the maximum 104-week period.

The Tribunal also partially approved several treatment plans for physical rehabilitation, acupuncture, and a psychological assessment, finding them reasonable and necessary.

Claims for an award under s. 10 of Reg. 664 were dismissed, but interest on overdue benefits was granted.

The applicant sought entitlement to statutory accident benefits for various treatment plans, including chiropractic services, a biopsychosocial assessment, a driving evaluation, and a chronic pain assessment, following a motor vehicle accident.

The respondent denied the benefits on the basis that the applicant had reached maximum medical recovery and that her ongoing complaints were related to subsequent, non-accident incidents.

The Licence Appeal Tribunal found that the applicant failed to provide objective medical evidence to demonstrate that the proposed treatment plans were reasonable and necessary as a result of the accident.

The application was dismissed, and no interest was awarded.

The applicant was injured in a motor vehicle accident and sought $1,779.60 for a physiotherapy treatment plan under the Statutory Accident Benefits Schedule.

The respondent denied the claim based on an insurer's examination report.

The Tribunal admitted late medical records from the applicant but ultimately found the treatment plan was not reasonable and necessary.

The applicant failed to provide corroborating medical evidence, there was a two-year gap in treatment records, and no evidence was provided to counter the insurer's examination report.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries fell outside the Minor Injury Guideline (MIG) due to psychological impairments and chronic pain.

The Licence Appeal Tribunal found the applicant failed to prove a psychological impairment, preferring the respondent's psychological assessment which aligned with the family physician's records.

The Tribunal also found the applicant did not establish chronic pain with functional limitations, noting he met at most one of the six criteria under the AMA Guides.

As the injuries were predominantly minor, the applicant was not entitled to the disputed treatment plans, an award, interest, or costs.

The application was dismissed.

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

The applicant argued for removal from the MIG based on pre-existing conditions, chronic pain, and psychological impairments.

The Tribunal found that the applicant failed to establish that his pre-existing conditions would prevent maximal recovery within the MIG.

Furthermore, the Tribunal concluded that the applicant's left knee injury was not accident-related, he did not meet the criteria for chronic pain, and his psychological symptoms were related to interpersonal challenges rather than the accident.

As the applicant's injuries were predominantly minor, he was not entitled to the disputed treatment plans or interest, and the application was dismissed.

The applicant sought statutory 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).

The Tribunal found that the applicant failed to prove her injuries, including alleged psychological impairments, chronic pain, and radiculopathy, warranted removal from the MIG.

However, the Tribunal ordered the respondent to pay for certain incurred treatment expenses because the respondent failed to provide compliant denial notices under sections 38(8) and 38(9) of the Schedule.

The applicant's claim for an award for unreasonable delay was dismissed.

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

The respondent denied certain treatment plans on the basis that the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG).

The applicant argued she suffered from chronic pain syndrome, relying on a chiropractor's diagnosis.

The Tribunal found that diagnosing chronic pain is outside a chiropractor's scope of practice and gave it no weight.

The Tribunal concluded the applicant sustained predominantly minor injuries, as she had not demonstrated functional impairment and had returned to work and daily activities.

The application for treatment plans, interest, and an award was dismissed.

The applicant was involved in a rear-end motor vehicle accident and sought statutory accident benefits, including income replacement benefits and funding for physiotherapy and psychological assessments.

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 objective medical evidence that his physical or psychological injuries fell outside the MIG, or that he met the AMA Guides criteria for chronic pain.

The Tribunal also found the applicant did not prove a substantial inability to perform the essential tasks of his pre-accident employment, relying on the clinical notes of his treating physician which lacked mention of accident-related symptoms or inability to work during the disputed period.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care, medical and rehabilitation benefits, and a functional abilities evaluation.

The respondent insurer denied the benefits, arguing the applicant's impairments were not caused by the accident and that she was independent in her activities of daily living.

The Tribunal found that the accident was a necessary cause of the applicant's impairments, satisfying the 'but for' test, and that her injuries were not minor.

Relying on the in-person observations of the respondent's occupational therapist over the virtual assessment of the applicant's expert, the Tribunal concluded that some attendant care was reasonable and necessary.

The applicant was awarded partial attendant care benefits of $2,820.16 with interest, but her claims for medical and rehabilitation benefits and the functional abilities evaluation were dismissed for lack of evidence.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to four treatment plans and attendant care benefits.

The Tribunal found the applicant was entitled to one treatment plan for physiotherapy services, as it was supported by contemporaneous medical records and recommended by the family physician.

The remaining treatment plans were denied because the applicant failed to prove they were reasonable and necessary, and the proposed assessments were duplicative.

The claim for attendant care benefits was denied because the applicant failed to provide evidence that the expenses were incurred.

The applicant sought $1,733.72 for chiropractic services following a motor vehicle accident.

The respondent denied the benefit, arguing the applicant had reached maximum medical recovery.

The Tribunal found that the applicant had a pre-existing back condition with similar physical limitations prior to the accident.

Relying on the insurer's examination, the Tribunal concluded the proposed treatment was not reasonable and necessary, as it would only provide temporary relief without substantial functional restoration.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her injuries fell outside the Minor Injury Guideline (MIG) due to pre-existing physical and psychological conditions.

She also sought a non-earner benefit and funding for various treatment plans.

The Tribunal found that the applicant failed to provide compelling medical evidence that her pre-existing conditions were exacerbated by the accident or prevented her from achieving maximum medical recovery within the MIG.

The Tribunal preferred the evidence of the respondent's assessors, finding the applicant's injuries were predominantly minor.

The claim for a non-earner benefit was dismissed as the applicant did not demonstrate a complete inability to carry on a normal life compared to her pre-accident activities.

Consequently, the proposed treatment plans outside the MIG were deemed not reasonable and necessary, and claims for an award and interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to treatment plans for chiropractic services, a psychological assessment, and a chronic pain assessment.

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

The Tribunal found that the applicant failed to prove her chronic pain and psychological impairments were accident-related or severe enough to warrant removal from the MIG.

As the MIG limits were exhausted, the claims for treatment plans, a section 10 award, and interest were dismissed.

The applicant sought statutory 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).

The applicant argued he should be removed from the MIG due to pre-existing conditions, chronic pain, and psychological impairments.

The Tribunal found the applicant's evidence, including expert reports, unreliable and inconsistent with his family doctor's clinical notes.

The Tribunal preferred the respondent's insurer examination reports, concluding the applicant failed to prove his injuries warranted treatment beyond the MIG.

As the MIG limits were nearly exhausted, the disputed treatment plans were denied and the application was dismissed.

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

The respondent denied certain medical benefits, asserting the injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to prove his injuries, including partial shoulder tears, pre-existing conditions, psychological impairments, and chronic pain, warranted removal from the MIG.

The Tribunal preferred the respondent's psychological assessment over the applicant's, noting inconsistencies in the applicant's evidence.

The disputed treatment plans were deemed reasonable and necessary up to the remaining MIG limits.

The applicant's request for an award for bad faith conduct was dismissed.

The applicant sought statutory accident benefits for three treatment plans following a motor vehicle accident.

The respondent denied the plans and requested the exclusion of the applicant's late-filed submissions and evidence.

The adjudicator admitted the late evidence and the disputed treatment plans, finding no prejudice to the respondent and noting the tribunal's obligation to consider necessary documents.

On the merits, the adjudicator dismissed the application, finding the applicant failed to prove the treatment plans were reasonable and necessary.

The adjudicator preferred the respondent's insurer's examination reports, which consistently found the facility-based treatments unnecessary, over the applicant's clinic records.

The respondent's request for costs was also denied.