Dr. A. Oshidari

The Applicant sought statutory accident benefits following a 2013 motor vehicle accident.

The Tribunal first extended the two-year limitation period under section 7 of the LAT Act, allowing the application to proceed.

On the substantive issues, the Tribunal found the Applicant did not sustain a catastrophic impairment under criterion (f) for mental and behavioural impairments, concluding his limitations were primarily physical due to a herniated disc rather than psychological.

However, the Tribunal found the disputed physiotherapy, chiropractic, and psychological treatment plans to be reasonable and necessary.

The Tribunal also excluded late-filed evidence from the Applicant and rebuttal reports obtained without notice by the Respondent.

The Applicant was awarded interest on overdue payments and a section 10 award of $1,077.43 for the Respondent's unreasonable delay in adjusting the 2017 plans.

No costs were awarded.

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 sought removal from the MIG based on chronic pain and psychological impairments.

The Tribunal found the applicant failed to meet the burden of proving chronic pain with functional impairment or a psychological condition warranting removal.

The Tribunal also found the respondent's denial letters were compliant with s. 38(8) of the Schedule, as the applicant failed to comply with s. 33 requests for information.

The application was dismissed.

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

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

The applicant claimed he developed psychological injuries and chronic pain syndrome warranting treatment outside the MIG.

The Tribunal found insufficient evidence of a psychological injury or chronic pain condition, preferring the respondent's insurer examination reports over the applicant's chronic pain assessment.

The Tribunal concluded the applicant sustained a minor injury, the disputed plans were not reasonable and necessary as they fell outside the MIG, and no award or interest was payable.

The application was dismissed.

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

The respondent insurer denied the benefits, arguing the applicant's impairments were pre-existing and not caused or exacerbated by the accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to meet the "but for" test for causation.

The Tribunal relied on extensive pre-accident medical records and independent medical examinations demonstrating the applicant had a significant history of chronic pain, substance abuse, and psychological impairments that were unaffected by the accident.

Claims for an award for unreasonable delay and interest were also dismissed.

The applicant sought statutory accident benefits following a 2019 motor vehicle accident, claiming catastrophic impairment due to mental and behavioural impairments.

At the outset of the hearing, the adjudicator denied the applicant's request for an adjournment, noting the significant delay, previous adjournments, and the new counsel's lack of preparation.

The hearing proceeded with the applicant self-represented after her counsel failed to appear.

The adjudicator found the applicant did not sustain a catastrophic impairment, as she failed to prove a marked impairment in three of the four spheres of functioning under Criterion 8.

The adjudicator also dismissed the claims for post-104-week income replacement benefits and attendant care benefits, finding insufficient medical evidence of a complete inability to work and no evidence of incurred attendant care expenses.

As the applicant's non-catastrophic limits were exhausted, the claims for medical benefits and expenses were also dismissed.

The applicant, who was twelve years old when struck by a car while crossing the street, sought statutory accident benefits for chiropractic and psychological services.

The respondent denied the chiropractic services based on an independent medical examination concluding the physical injuries were predominantly minor and required no further passive treatment.

The respondent partially approved the psychological services based on an assessment recommending shorter sessions, but agreed to pay the balance during the hearing.

The Tribunal dismissed the claim for chiropractic services as the applicant failed to provide medical evidence proving they were reasonable and necessary.

The Tribunal awarded interest on the psychological services but denied a special award under s. 10 of Regulation 664, finding the respondent did not act unreasonably in relying on its medical assessments.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits (IRBs), a physiotherapy treatment plan, and an in-home assessment.

The Licence Appeal Tribunal found that the applicant failed to prove a substantial inability to perform the essential tasks of her pre-accident employment as a waitress, preferring the respondent's insurer's examination reports over the applicant's medical evidence.

Consequently, the claim for IRBs was denied.

The Tribunal also denied the in-home assessment, noting the applicant reported independence with activities of daily living.

However, the Tribunal approved the physiotherapy treatment plan as reasonable and necessary to address ongoing neck and back pain, and awarded interest on that plan.

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 Tribunal found that the applicant failed to prove her physical or psychological impairments warranted removal from the MIG.

The Tribunal also dismissed the claims for non-earner benefits, attendant care benefits, and various treatment plans, finding the applicant did not meet her evidentiary burden and preferring the objective expert evidence provided by the respondent.

The application was dismissed in its entirety.

The applicant was injured in a motor vehicle accident and sought medical benefits for two chiropractic treatment plans and one psychological treatment plan under the Statutory Accident Benefits Schedule.

The respondent denied the plans based on insurer's examinations.

The Licence Appeal Tribunal found the first chiropractic treatment plan reasonable and necessary, noting the applicant's ongoing pain and the physical impairments documented even in the respondent's own medical examination.

However, the Tribunal dismissed the claims for the second chiropractic plan and the psychological plan, finding insufficient evidence of ongoing physical impairment and concluding the applicant had already reached her psychological treatment goals.

The applicant was awarded the cost of the first chiropractic plan plus interest.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found her injuries fell within the Minor Injury Guideline.

The applicant argued the Tribunal erred in its weighing of the medical evidence, specifically regarding the reports of Dr. Nathanson, Dr. Oshidari, and Dr. Wilderman.

The adjudicator dismissed the request, finding that the Tribunal properly exercised its discretion in weighing the evidence, including giving limited weight to diagnoses of chronic pain and severe PTSD that lacked sufficient foundation or were outside the assessors' scope of expertise.

The reconsideration was dismissed.

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

The respondent insurer deemed the injuries to fall within the Minor Injury Guideline (MIG), capping benefits at $3,500.

The applicant argued she suffered from chronic pain and psychological injuries that removed her from the MIG.

The Tribunal found the applicant's medical evidence unpersuasive, noting methodological flaws in her expert's chronic pain diagnosis and a lack of psychological testing.

Preferring the respondent's multidisciplinary assessments, the Tribunal concluded the applicant's injuries were predominantly minor and subject to the MIG limit.

The appeal was denied.

The applicant, who was deemed catastrophically impaired following a motor vehicle accident, sought payment for four physiotherapy treatment plans.

The insurer denied the claims on the basis that the applicant had reached maximal medical recovery for his musculoskeletal injuries.

The adjudicator preferred the evidence of the insurer's medical examiners, finding that the applicant's pain complaints had a strong non-organic component and that further physiotherapy would not be beneficial.

The adjudicator also found that the insurer's notices of denial were sufficient.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a physiatry assessment, assistive devices, and physiotherapy.

The respondent insurer denied the benefits, relying on insurer's examinations which concluded the applicant had reached maximum medical recovery from minor soft tissue injuries.

The adjudicator found that the applicant failed to prove the claimed benefits were reasonable and necessary, preferring the detailed analysis of the insurer's experts over the applicant's medical evidence.

The appeal was dismissed and no benefits or interest were awarded.

The applicant sought income replacement benefits (IRB) and medical benefits following a motor vehicle accident.

The Licence Appeal Tribunal found the applicant was not entitled to IRB as she failed to provide medical evidence demonstrating a substantial inability to perform the essential tasks of her employment.

The Tribunal also determined the applicant's injuries fell within the Minor Injury Guideline (MIG), as she provided no medical diagnosis of chronic pain or psychological impairment to remove her from the MIG cap.

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

Finally, the Tribunal awarded $250 in costs to the respondent because the applicant and her counsel failed to attend the teleconference hearing without providing reasonable notice, which constituted bad faith.

The applicant was injured in a T-bone collision and received income replacement benefits (IRBs) for two years.

The insurer terminated IRBs at the 104-week mark, arguing the applicant could return to suitable employment.

The Tribunal found that the applicant's accident-related soft tissue injuries aggravated pre-existing arthritis in his hand, resulting in chronic pain and functional limitations.

Given his physical restrictions, limited education, and lack of transferable skills, the Tribunal concluded he suffered a complete inability to engage in suitable employment and was entitled to ongoing IRBs.

Claims for further chiropractic and massage treatments were dismissed as not reasonable or necessary.

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

The respondent insurer denied treatment plans for chiropractic care and a physiatry assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained predominantly soft tissue injuries and failed to establish any underlying neurological disorder that would warrant removal from the MIG.

As the injuries were minor, the applicant was limited to the $3,500 funding cap, and the Tribunal did not need to assess the reasonableness or necessity of the disputed treatment plans.

The appellant appealed an arbitrator's decision finding that her 1999 motor vehicle accident did not cause her 2001 discectomy and chronic pain, and that she did not sustain a catastrophic impairment.

The Director's Delegate upheld the arbitrator's factual findings on causation, noting they were supported by evidence and not based on a misapprehension of law.

However, the Delegate found that the arbitrator erred by failing to follow the required methodology under the AMA Guides to calculate the appellant's Whole Person Impairment (WPI) for her other impairments.

The matter was remitted to the arbitrator to determine the specific impairment ratings and whether they combine to 55% or more WPI.

The Appellant appealed an Arbitrator's decision finding she had not sustained a catastrophic impairment following a motor vehicle accident.

The Director's Delegate allowed the appeal, finding the Arbitrator erred in law by refusing to rate the Appellant's left upper extremity and right knee impairments because they had not stabilized, and by failing to properly address and rate her claimed sleep disorder and chronic pain.

The preliminary issue of catastrophic impairment was returned to arbitration for a new hearing.

The applicant was injured in a pedestrian motor vehicle accident and sought a determination that she suffered a catastrophic impairment under the Statutory Accident Benefits Schedule.

The arbitrator found that while the applicant's combined physical and psychological impairments resulted in a 39% whole person impairment, falling short of the 55% threshold under clause (f), she did meet the criteria under clause (g).

Specifically, the arbitrator accepted the CAT DAC assessment that the applicant's pain disorder and physical limitations resulted in a Class 4 marked impairment in her activities of daily living.

The arbitrator held that a single marked impairment is sufficient to meet the definition of catastrophic impairment.

The applicant was seriously injured in a motor vehicle accident, resulting in a through-the-knee amputation of his right leg.

He applied for a catastrophic impairment designation under paragraph 2(1)(f) of the Statutory Accident Benefits Schedule, claiming a whole person impairment (WPI) of 55% or more.

The arbitrator evaluated the applicant's physical, skin, and mental/behavioural impairments using the AMA Guides.

The arbitrator found that the applicant sustained a 37% WPI for his lower extremity, a 20% WPI for skin impairment, a 15% WPI for mental and behavioural disorders, and additional minor ratings for his low back, left knee, and left wrist/elbow.

Combining these ratings, the arbitrator concluded the applicant sustained a 62% WPI, meeting the threshold for catastrophic impairment.