Dr. A. Shaul

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 for removal from the MIG due to chronic pain syndrome and psychological impairment.

The Tribunal found insufficient medical evidence to support a diagnosis of chronic pain syndrome.

The Tribunal also preferred the respondent's psychological assessment over the applicant's, concluding there was no clinically significant psychological impairment.

As the applicant's injuries were predominantly minor and the $3,500 MIG limit was exhausted, the application for further benefits and a section 10 award was dismissed.

The applicant, a personal support worker struck by a motor vehicle as a pedestrian, sought statutory accident benefits including an income replacement benefit (IRB), a chronic pain assessment, and psychological treatment.

The Licence Appeal Tribunal dismissed the application.

The Tribunal found the applicant was barred from receiving an IRB for the initial period because she failed to submit a disability certificate until September 2019.

For the subsequent periods, she failed to prove a substantial or complete inability to work, as her family physician's notes indicated she was able to work after November 2018 and she provided no functional abilities evaluation.

The Tribunal also denied the chronic pain assessment and the disputed portion of the psychological treatment plan, finding them not reasonable or necessary based on the medical evidence.

The Applicant sought medical benefits and the Respondent sought repayment of overpaid income replacement benefits (IRBs) following a motor vehicle accident.

The Tribunal found that the Applicant's injuries fell within the Minor Injury Guideline (MIG), as he failed to prove that his pre-existing conditions, alleged psychological injuries, or chronic pain warranted removal from the MIG.

Consequently, the claims for medical benefits beyond the $3,500 limit were denied.

The Tribunal also dismissed the Respondent's claim for a $6,400 IRB repayment, finding that the Respondent's notice of overpayment was equivocal and failed to comply with the strict 12-month notice requirement under section 52 of the Schedule.

The applicant, a pedestrian struck by a vehicle in 2014, sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule after being denied by the respondent insurer.

The Licence Appeal Tribunal found that further physical treatments, including occupational therapy, physiotherapy, and chiropractic services, were not reasonable and necessary, as the applicant had largely recovered from her physical injuries and could manage residual pain with self-directed exercises.

Claims for orthopaedic, neurocognitive, and certain psychological assessments were dismissed as statute-barred under s. 38(2) because they were incurred before the treatment plans were submitted.

However, the Tribunal granted entitlement to a psychological assessment and psychological services, preferring the applicant's expert evidence that she continued to suffer from somatic symptom disorder and adjustment disorder.

Claims for an award and costs were denied due to a lack of submissions.

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

The respondent denied various treatment and assessment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The adjudicator found that the applicant's physical and psychological injuries were predominantly minor and that she failed to establish that pre-existing conditions or chronic pain warranted removal from the MIG.

As the $3,500 MIG limit had been exhausted, the disputed treatment plans were deemed not reasonable and necessary, and the application was dismissed.

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

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

The Tribunal found that the applicant sustained a psychological impairment, removing him from the MIG.

The Tribunal ordered the respondent to pay for a psychological assessment, a chronic pain assessment, and portions of the proposed psychological treatment and chronic pain program, along with interest.

The applicant's claim for a special award under s. 10 of Regulation 664 was dismissed.

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

The respondent insurer denied several treatment and assessment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been exhausted.

The applicant applied to the Licence Appeal Tribunal, arguing that pre-existing knee pain, chronic pain, and psychological injuries warranted removal from the MIG.

The Tribunal found no compelling evidence that the pre-existing condition precluded recovery, and preferred the respondent's medical assessors over the applicant's assessors regarding chronic pain and psychological injuries.

The Tribunal concluded the applicant sustained predominantly minor injuries, was subject to the MIG, and was not entitled to the disputed treatment plans as the funding limit was exhausted.

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

The respondent denied medical benefits beyond the $3,500 Minor Injury Guideline cap.

The Tribunal found that the applicant's physical and psychological injuries were predominantly minor and treatable within the Guideline.

As the funding limit was exhausted, the claims for additional medical benefits and assessments were dismissed.

Furthermore, the Tribunal ordered the applicant to repay $372.21 for an overpayment of income replacement benefits.

The applicant sought reconsideration of a decision finding he sustained a minor injury and was not entitled to non-earner benefits.

He argued the adjudicator erred in law by allowing the respondent to file insurer's examination reports and violated procedural fairness by failing to impartially assess his evidence.

The adjudicator dismissed the request, finding no error in law or breach of procedural fairness, as the applicant failed to properly identify the evidence he sought to exclude and failed to meet his burden of proof regarding his entitlement to benefits.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for a psychological assessment and chiropractic treatment.

The respondent insurer denied the treatment plans following insurer's examinations.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment and assessment plans were reasonable and necessary, noting a lack of compelling contemporaneous medical evidence and preferring the respondent's expert reports which indicated minimal psychological and physical impairment.

The application was dismissed and no interest was payable.

The applicant was a pedestrian struck by a vehicle and sought statutory accident benefits.

The respondent insurer limited the applicant's medical and rehabilitation benefits to the $3,500 cap under the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing that chronic pain and psychological impairment warranted removal from the MIG.

The adjudicator found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain or a psychological impairment, preferring the objective findings of the insurer's examination assessors over the subjective reports of the applicant's experts.

As the injuries fell within the MIG and the maximum benefits had already been approved, the disputed treatment plans were denied.

The claims for an award and costs were also dismissed, as the insurer did not act unreasonably.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including non-earner benefits and treatment beyond the Minor Injury Guideline (MIG) limit.

The respondent denied the claims, arguing the injuries were minor.

The Tribunal found that the applicant's physical and psychological injuries fell within the MIG, preferring the respondent's psychological assessment over the applicant's.

The Tribunal also dismissed the claim for non-earner benefits, finding insufficient evidence that the applicant suffered a complete inability to carry on a normal life, noting inconsistencies in the applicant's self-reporting and a lack of supporting medical evidence.

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

The respondent insurer determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and refused to fund treatment plans exceeding the $3,500 limit.

The applicant applied to the Licence Appeal Tribunal, arguing that pre-existing conditions, psychological injuries, and chronic pain warranted removal from the MIG.

The Tribunal found that the applicant failed to provide sufficient medical evidence to support removal from the MIG, noting that the psychological report's conclusions were unsupported by its own psychometric testing and uncorroborated by other medical records.

The application was dismissed, and the disputed treatment plans were denied as the MIG funding limit had been exhausted.

The applicant, a pedestrian struck by a vehicle, sought statutory accident benefits for medical and rehabilitation treatments.

The respondent denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit was exhausted.

The Tribunal found that the applicant's physical injuries were minor and that she failed to prove a pre-existing condition or a psychological impairment that would warrant removal from the MIG.

The Tribunal preferred the respondent's comprehensive psychological assessment over the applicant's pre-screen.

As the injuries fell within the MIG and the limit was exhausted, the claims for further treatment and interest were dismissed.

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

The respondent denied funding for various treatment plans and assessments on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's physical injuries, including ongoing pain, did not warrant removal from the MIG, as range of motion was normal and the applicant had returned to pre-accident activities.

The Tribunal also preferred the respondent's psychological assessment, finding no psychological injury.

As the applicant had exhausted the $3,500 MIG limit, the claims for further medical benefits and examinations were dismissed, along with claims for an award and interest.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision.

The respondent insurer 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's diagnosed psychological injury (Adjustment Disorder) removed them from the MIG, despite the applicant's reported disinterest in psychological treatment.

While the Tribunal approved the psychological assessment and treatment plans, it denied the physiotherapy, assistive devices, and chronic pain plans, finding them not reasonable and necessary based on the medical evidence.

The Tribunal also ordered the respondent to pay an award of $1,110.95 under O. Reg. 664 for unreasonably withholding the psychological benefits by misinterpreting the Schedule.

The applicant sought payment for various medical and assessment benefits following a motor vehicle accident.

The respondent insurer denied the benefits on the basis that the applicant's injuries were predominantly minor and subject to the $3,500 limit under the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's injuries were soft tissue in nature and fell within the MIG.

The Tribunal preferred the evidence of the insurer's examiners over the applicant's assessors, noting the former reviewed comprehensive medical records.

Furthermore, the applicant failed to provide compelling evidence of a pre-existing medical condition that would warrant an exception to the MIG cap.

The application was dismissed.