Dr. Arpita Biswas

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, funding for a psychological assessment, and physiotherapy services.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that she suffered a complete inability to carry on a normal life, noting inconsistencies in her self-reporting and a failure to provide evidence of her pre-accident activities.

The Tribunal assigned little weight to the applicant's expert reports due to methodological flaws and reliance on incomplete medical records.

The claims for the remaining balances of the psychological assessment and physiotherapy services were dismissed as they exceeded the maximum amounts permitted under the Schedule and Guidelines.

The application was dismissed in its entirety.

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 that chronic pain and psychological impairments warranted removal from the MIG.

The Tribunal found that the applicant failed to demonstrate a psychological impairment or chronic pain with functional impairment, placing significant weight on the respondent's psychological assessment which found only subclinical symptoms.

As the applicant remained within the MIG, the disputed treatment plans were not payable.

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

The applicant sought statutory accident benefits following a 2018 motor vehicle accident.

In a previous 2020 decision, the Tribunal found the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant brought a second application seeking removal from the MIG based on alleged new medical evidence and claiming entitlement to additional treatment plans.

The Tribunal held that the doctrine of res judicata barred the applicant from relitigating the MIG issue, as the new medical reports did not constitute fresh evidence that would conclusively impeach the original result.

The Tribunal also found the respondent provided proper notice of denial for the disputed treatment plans.

The application was dismissed.

The applicant sought payment for two treatment plans for psychological services following a motor vehicle accident.

The Tribunal found the applicant failed to establish that the outstanding balance of the first plan was payable, as he did not justify a higher hourly rate for a psychotherapist or the need for additional brokerage, planning, and documentation services.

The Tribunal also denied the second plan, relying on an insurer's examination report indicating the applicant had reached maximum medical improvement and had no interest in further psychotherapy.

The application was dismissed in its entirety.

The applicant sought entitlement to several treatment plans for injuries allegedly sustained in a motor vehicle accident, as well as an award and interest.

The respondent denied the plans based on Insurer's Examinations (IEs) which concluded the injuries were either minor, resolved, or attributable to a prior accident.

The Tribunal found that the applicant failed to meet her burden of proving the treatment plans were reasonable and necessary, often relying on brief clinical notes that did not address causation or adequately contradict the detailed IE reports.

The application was dismissed in its entirety.

The applicant sought payment for the unapproved balances of three treatment plans for psychological assessment and treatment following a motor vehicle accident.

The respondent had partially approved the plans based on the recommendations of its psychological assessor and the rates set out in the Professional Services Guideline.

The Tribunal found that the applicant failed to provide any evidence to contradict the respondent's assessor or to establish that the unapproved balances were reasonable and necessary.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including several chiropractic treatment plans, a cognitive assessment, and a chronic pain assessment.

The Tribunal found that the applicant was removed from the Minor Injury Guideline during a prior case conference.

However, the applicant failed to provide sufficient medical evidence to prove that the disputed treatment plans were reasonable and necessary.

The application was dismissed.

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

The respondent insurer denied several treatment plans, arguing they were not reasonable and necessary, largely due to the applicant's pre-existing conditions.

The Tribunal found that the applicant was not entitled to benefits for a new mattress or an in-home occupational therapy assessment, preferring the respondent's medical evidence on those issues.

However, the Tribunal granted the treatment plans for aqua-therapy, chiropractic services, and psychological assessments, finding them reasonable and necessary to address the applicant's accident-related pain and impairments.

The Tribunal also awarded a 50% special award on a nominal $87.19 chiropractic form completion fee, finding the respondent's denial of this standard fee to be unreasonable.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs), medical benefits, and cost of examinations.

The respondent denied the benefits, arguing the applicant had returned to work and suffered only minor injuries.

The Tribunal found the applicant was entitled to IRBs up to June 2018, but made no order for payment as the applicant failed to provide post-accident income information.

The Tribunal also found the applicant was entitled to various medical benefits, including physiotherapy, psychological services, shockwave therapy, and a chronic pain program, as the evidence demonstrated she suffered from chronic pain caused by the accident.

The claims for cost of examinations and a Regulation 664 award were dismissed.

The applicant, an Uber driver, was injured in a motor vehicle accident and claimed entitlement to post-104 week income replacement benefits (IRBs).

The insurer terminated IRBs on the basis that the applicant could return to suitable employment.

The Tribunal found that the applicant suffered a complete inability to engage in any employment for which he was reasonably suited by education, training, or experience, due to the synergistic impact of his physical injuries and psychological impairments, including chronic pain and depression.

The Tribunal ordered ongoing IRBs at $200 per week plus interest, but dismissed the applicant's claims for a special award and costs, finding the insurer's conduct was not unreasonable or in bad faith.

The applicant was injured in a motor vehicle accident and sought an income replacement benefit and a chronic pain assessment under the Statutory Accident Benefits Schedule.

The respondent denied the benefits, arguing the applicant did not suffer a substantial inability to perform his pre-accident employment and questioning his credibility and reported income.

The Tribunal found that the applicant's accident-related left knee pain caused a substantial inability to perform the essential physical tasks of his restaurant manager position.

The Tribunal also accepted the applicant's updated Canada Revenue Agency filings to calculate the quantum of the benefit and found the chronic pain assessment to be reasonable and necessary.

The application was allowed.

The applicant was injured in a motor vehicle accident and sought various medical benefits under the Statutory Accident Benefits Schedule, which were denied by the respondent insurer.

The applicant applied to the Licence Appeal Tribunal to dispute the denials of treatment plans for acupuncture, physiotherapy, chiropractic treatment, chronic pain programs, a functional abilities evaluation, and disability certificates.

The Tribunal found that the applicant proved the reasonableness and necessity of the acupuncture, physiotherapy, chiropractic treatment, functional abilities evaluation, and the psychological components of the chronic pain programs.

The physical components of the chronic pain programs and the disability certificates were denied.

Furthermore, the Tribunal awarded the applicant a 25 percent special award under O. Reg. 664 for the insurer's unreasonable delay and withholding of specific benefits, noting the insurer failed to properly consider all available medical information, including its own assessors' reports.

The applicant sought payment for a neurological assessment and the disputed balance of a driving evaluation assessment following a motor vehicle accident.

The Tribunal found the neurological assessment was not reasonable and necessary, as the insurer's examination concluded injuries were soft tissue in nature and the applicant provided no corroborating expert evidence.

For the driving evaluation assessment, the Tribunal allowed the cost of preparation services but denied the costs for mental health counselling (which duplicated an earlier psychological assessment) and the treatment provider's mileage (which is not payable under the Schedule).