Dr. A. Kachooie

The applicant sought various statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB), medical benefits, and an award under s. 10 of O. Reg 664.

The Tribunal found the applicant did not suffer a substantial inability to perform the essential tasks of his employment as a personal support worker and Lyft driver, relying on the respondent's medical assessments and the applicant's family doctor's clinical notes.

The Tribunal denied the claims for IRB, psychological services, a chronic pain assessment, and a driving reintegration assessment.

However, the Tribunal partially approved a treatment plan for a chronic pain program, awarding $2,346.70 for physical therapy and an SI belt based on a neutral OHIP-funded assessment.

The claim for a s. 10 award was dismissed.

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

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

The Tribunal found that the applicant suffered from a chronic pain condition with functional impairment, warranting removal from the MIG.

The Tribunal approved five physiotherapy treatment plans proposed by Active Therapy Works as reasonable and necessary, supported by the treating physician's records.

However, a treatment plan from The Rehab Centre was denied due to insufficient medical evidence.

The applicant was awarded interest on the approved overdue benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The insurer denied a treatment plan for a psychological assessment and weekly non-earner benefits, taking the position that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing her injuries fell outside the MIG due to psychological impairments and chronic pain.

The Tribunal found that the applicant failed to prove on a balance of probabilities that she suffered from a psychological impairment or chronic pain arising from the accident.

The Tribunal also found the applicant was not entitled to the psychological assessment or non-earner benefits, as she failed to prove a complete inability to carry on a normal life.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a chronic pain management program and an orthopaedic assessment.

The respondent insurer denied the treatment plans, arguing they were not reasonable or necessary.

The Licence Appeal Tribunal found the applicant's medical evidence, which included diagnoses of chronic pain syndrome and recommendations for multidisciplinary treatment, to be more persuasive than the insurer's assessments.

The Tribunal ordered the respondent to pay for the chronic pain program and the orthopaedic assessment, along with interest on incurred expenses.

However, the Tribunal dismissed the applicant's claim for a special award under Regulation 664, finding no evidence that the insurer acted unreasonably or in bad faith.

The applicant, a tow truck driver, was injured in a rear-end motor vehicle accident and sought income replacement benefits (IRBs).

The insurer terminated the IRBs after eight months, arguing that the applicant's ongoing pain was due to pre-existing degenerative disc disease rather than the accident.

The Tribunal found the applicant credible and preferred the evidence of his treating specialists over the insurer's expert, concluding that the accident aggravated his underlying condition and caused chronic pain and radiculopathy.

The Tribunal held that the applicant was substantially unable to perform the heavy physical duties of his pre-accident employment and was therefore entitled to ongoing IRBs.

The applicant sought interim income replacement benefits following a motor vehicle accident.

The insurer denied the claim, alleging it was out of time.

The applicant brought a motion for interim benefits, claiming urgent financial need and a deterioration in her physical condition.

The arbitrator dismissed the motion, finding that the applicant failed to establish a prima facie case of entitlement, as the medical evidence largely indicated she was able to perform her essential tasks of employment.

Furthermore, the applicant failed to provide sufficient evidence to prove financial urgency.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement, medical, housekeeping, and assessment costs.

The insurer terminated benefits based on an assessment by a general practitioner and a Disability DAC report.

The arbitrator found that the applicant suffered a substantial inability to perform her pre-accident employment as a sewing machine operator for the first 104 weeks, relying on the chronic pain diagnosis of her treating physiatrist and psychologist.

However, the applicant failed to meet the stricter "complete inability" test for post-104 week benefits.

The arbitrator awarded the claimed medical, housekeeping, and assessment expenses.

Furthermore, the arbitrator ordered the insurer to pay a $10,000 special award under s. 282(10) of the Insurance Act, finding that the insurer unreasonably withheld benefits by relying on flawed assessments, ignoring substantial medical evidence, and improperly requesting a supplementary report from a neutral DAC assessor.

The appellant appealed an Arbitrator's decision that limited his income replacement benefits and attendant care benefits, awarded a nominal special award, and reduced his arbitration expenses due to his deceit and exaggeration of symptoms.

The respondent cross-appealed, arguing the Arbitrator failed to deduct income tax when calculating the appellant's pre-accident income.

The Director's Delegate dismissed the appellant's appeal, finding the Arbitrator's conclusions on disability, credibility, expenses, and the special award were well-supported by the evidence, including surveillance footage that contradicted the appellant's claims.

The Delegate allowed the respondent's variation application, correcting the benefit rate to account for income tax deductions.

The Delegate also upheld the Arbitrator's ruling that he lacked jurisdiction to order interest accruing after the date of his decision, but ordered the respondent to pay the appellant's post-decision implementation expenses due to its unjustified delay in complying with the original order.

The applicant was injured in a motor vehicle accident and received income replacement benefits for 104 weeks.

The insurer terminated benefits, and the applicant sought ongoing income replacement, attendant care, and housekeeping benefits.

The arbitrator found that the applicant did not suffer a complete inability to engage in suitable employment due to physical injuries, but did suffer such an inability due to psychological complications (severe depression and anxiety) until her condition stabilized.

The arbitrator awarded income replacement benefits for a closed period.

The claims for attendant care and housekeeping expenses were dismissed because the applicant failed to prove she incurred a cost or obligation to pay her husband for those services.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits and supplementary medical expenses.

The insurer terminated her income replacement benefits, arguing she had recovered and could return to her pre-accident employment as a meat packer.

The arbitrator found that the applicant suffered from chronic pain syndrome and a major depressive disorder caused by the accident, rendering her substantially unable to perform the essential tasks of her employment.

The arbitrator preferred the evidence of the applicant's treating practitioners and experts over the insurer's assessors.

The applicant was awarded ongoing income replacement benefits, supplementary medical expenses, and interest on overdue benefits.

The applicant was injured in a motor vehicle accident while disembarking from a TTC bus.

She sustained soft tissue injuries to her right hip and ankle.

While undergoing physiotherapy for these injuries, she was required to perform a functional capacity evaluation, during which she sustained further injuries to her neck, back, and upper extremities.

The insurer terminated her income replacement benefits, arguing that the new injuries were not directly caused by the accident.

The arbitrator held that the 'as a result of' test in the SABS-1996 should be interpreted consistently with common law principles of causation and remoteness.

The arbitrator found that the injuries sustained during the functional capacity evaluation were a reasonably foreseeable consequence of treatment for the accident-related injuries, and there was no intervening cause breaking the chain of causation.

The applicant was awarded ongoing income replacement benefits, as well as various medical, rehabilitation, and housekeeping benefits.

The applicant was injured in a rear-end motor vehicle accident and sought income replacement benefits, physiotherapy expenses, and the cost of a functional assessment after the insurer terminated her benefits.

The arbitrator found that while the applicant's physical injuries were mild, she suffered from depression and anxiety significantly contributed to by the accident, which caused a substantial inability to perform the essential tasks of her pre-accident employment as a home health aide.

Income replacement benefits were awarded up to July 20, 1997, when psychological evidence indicated she was capable of resuming her pre-accident lifestyle.

The claims for physiotherapy and a functional assessment were dismissed as not reasonable or necessary.

The applicant sought income replacement benefits (IRBs) and other expenses following a 1995 motor vehicle accident.

The insurer reduced and then terminated the IRBs, and sought repayment of all benefits paid, alleging fraud.

The arbitrator found that the applicant had fabricated his employment history, concealed a previous disabling car accident, and grossly exaggerated his injuries, with medical evidence suggesting malingering.

The applicant's claims were dismissed in their entirety.

The arbitrator ordered the applicant to repay $37,879 in IRBs and rehabilitation expenses obtained through fraudulent misrepresentation, and awarded the insurer its arbitration expenses and assessment fee, finding the application frivolous and an abuse of process.

The applicant was injured when she fell on a TTC bus.

She applied for statutory accident benefits, including income replacement benefits and various medical and rehabilitation expenses.

The insurer terminated income replacement benefits based on a multidisciplinary DAC assessment.

The arbitrator found the applicant to be a poor historian prone to exaggeration and deceit, and preferred the evidence of the IME and DAC assessors over her treating physiatrist.

The claim for ongoing income replacement benefits was dismissed as the applicant failed to prove she was substantially unable to perform her duties as a housekeeper and nanny.

Claims for psychological treatment, massage therapy, a lumbosacral support, and some taxi fares were allowed, while the remaining claims were dismissed.

The appellant was injured while travelling as a passenger on a bus and received statutory accident benefits until they were terminated by the insurer.

At arbitration, it was determined that the appellant did not suffer a substantial inability to perform his essential tasks after the termination date.

The appellant appealed, arguing the arbitrator failed to accord appropriate weight to medical reports and misapplied the law.

The Director of Arbitrations dismissed the appeal, finding that the arbitrator's factual conclusions were supported by the evidence and that she correctly applied the provisions of the Statutory Accident Benefits Schedule to those findings.

The appellant was injured in a motor vehicle accident and received statutory accident benefits until they were terminated by the respondent insurer.

At arbitration, the arbitrator found that the appellant's right ulnar neuropathy was not caused by the accident and confirmed the termination of benefits.

The appellant appealed, seeking to introduce new medical evidence and arguing that her condition was a direct result of the accident.

The Director of Arbitrations refused to admit the new evidence, finding it either could have been adduced at the hearing or would not have affected the result.

The Director dismissed the appeal, holding that the arbitrator's findings on causation were fully supported by the evidence and that the appellate function does not permit re-weighing the evidence.

The appellant was denied her appeal expenses.

The applicant was injured in a minor motor vehicle accident and received statutory accident benefits until December 1993.

She sought ongoing weekly income benefits, claiming she was substantially unable to perform her pre-accident job as a Client Service Officer due to fibromyalgia and depression.

The arbitrator dismissed the claim for ongoing benefits, finding no objective signs of disability, noting the minor nature of the accident, and relying on surveillance evidence and the applicant's undisputed ability to work part-time.

The arbitrator awarded the applicant her arbitration expenses, finding the claim was not frivolous or vexatious.

The Applicant was injured in a motor vehicle accident and received statutory accident benefits.

The Insurer terminated weekly income benefits, arguing she was no longer substantially unable to perform her essential tasks.

The Applicant sought ongoing benefits and a special award.

The arbitrator found the Applicant was entitled to weekly income benefits for a limited period following the termination, as her ongoing disabilities after that period were attributable to pre-existing medical conditions and subsequent slip and fall accidents, not the motor vehicle accident.

The claim for a special award was dismissed as the Insurer did not unreasonably withhold payments.