Dr. Aviv Ouanounou

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

The Licence Appeal Tribunal considered claims for psychological services, dental services, and a chronic pain management program.

The Tribunal awarded the psychological services, finding the hourly rate for psychotherapy reasonable.

The Tribunal also awarded the chronic pain management program, accepting the applicant's expert evidence that treatment was necessary despite the respondent's argument that the applicant did not meet the criteria for chronic pain syndrome.

The claim for dental services was dismissed due to insufficient evidence linking the injuries to the accident.

Interest was awarded on the overdue payments.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to a TMJ assessment and a treatment plan for chiropractic, physiotherapy, and acupuncture services.

The respondent denied the benefits.

The Tribunal found that the applicant failed to prove the TMJ assessment was reasonable and necessary, noting inconsistencies in his self-reporting and preferring the respondent's dental assessor over the applicant's chronic pain specialist.

The Tribunal also found insufficient evidence to support the need for the proposed chiropractic, physiotherapy, and acupuncture services.

The application was dismissed, and no interest was payable.

The applicant sought $25,000 for a dental treatment plan following a motor vehicle accident.

The respondent insurer denied the claim, arguing the dental issues were caused by pre-existing periodontal disease rather than the accident.

The Tribunal applied the 'but for' test and found the accident was a necessary cause of the rapid deterioration of the applicant's dental health, relying on the opinion of the applicant's dental surgeon.

The Tribunal concluded the proposed treatment was reasonable and necessary, ordering the respondent to pay for the treatment plan plus interest.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, which were denied by the respondent insurer on the basis that the injuries fell within the Minor Injury Guideline (MIG).

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

The Tribunal found that the applicant failed to establish on a balance of probabilities that the accident was a necessary cause of his dental impairments or his left ankle impairment.

While the accident was a necessary cause of his right ankle, foot, and other soft tissue injuries, the applicant did not provide sufficient medical evidence of chronic pain or psychological impairment to warrant removal from the MIG.

The application for the disputed treatment plans and interest was dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought a medical benefit of $2,195.00 for a temporomandibular joint (TMJ) assessment.

The respondent insurer denied the treatment plan, arguing the applicant's injuries fell within the Minor Injury Guideline and relying on an insurer's examination that found no TMJ disorder.

The Tribunal preferred the applicant's medical evidence, noting that the applicant had sustained broken teeth in the accident and that the treating dentist's assessment was more thorough than the insurer's examination.

The Tribunal found the TMJ assessment to be reasonable and necessary, and ordered the respondent to pay the benefit with interest.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits, medical and rehabilitation benefits, and the cost of assessments.

The Licence Appeal Tribunal found that the applicant failed to prove a complete inability to carry on a normal life, dismissing the claim for non-earner benefits.

The Tribunal partially approved treatment plans for physiotherapy and psychological services, finding them reasonable and necessary.

Claims for chiropractic treatment, dental services, replacement eyewear, and various assessments were dismissed due to insufficient evidence or failure to prove they were reasonable and necessary as a result of the accident.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to dental services and psychological services.

The Licence Appeal Tribunal dismissed the application.

The Tribunal found the applicant failed to prove on a balance of probabilities that his dental issues were caused by the accident, preferring the respondent's dental assessment over the applicant's dental surgeon's letter.

The Tribunal also denied the unapproved portion of a treatment plan for psychological services, finding the respondent's approved hourly rate of $100 for a psychotherapist was reasonable and the applicant failed to justify a higher rate or the necessity of additional administrative fees.

Claims for an award and interest were consequently dismissed.

The applicant sought statutory accident benefits for dental services following a motor vehicle accident.

The insurer denied the claim, arguing the dental issues were not caused by the accident.

The Tribunal found that the applicant failed to prove causation, noting the absence of reported dental injuries in the immediate post-accident medical records and a documented history of pre-existing dental problems.

Relying on the insurer's dental examination report, the Tribunal concluded the recommended treatments likely addressed pre-existing deficiencies.

The application for benefits, interest, and a special award was dismissed.

The insurer appealed an arbitrator's preliminary decision that the insured's medical and rehabilitation claim was not subject to the $3,500 limit under the Minor Injury Guideline (MIG).

The Director's Delegate allowed the appeal, finding that the arbitrator erred by failing to apply the correct test of whether the impairment was predominantly a minor injury, improperly shifting the burden of proof to the insurer, and incorrectly concluding that the MIG was non-binding.

Furthermore, the arbitrator breached procedural fairness by conducting independent research and relying on legal arguments without giving the parties an opportunity to respond.

The decision was rescinded and the matter remitted for a full hearing before a different arbitrator.

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

The insurer took the position that the applicant's injuries were restricted by the Minor Injury Guideline (MIG), limiting his benefits to $3,500.

The applicant argued that he suffered from pre-existing conditions and subsequent psychological disabilities, including chronic pain, PTSD, and TMJ syndrome, which took him outside the MIG.

The arbitrator found that the insurer bears the burden of proving that an insured falls within an exception to coverage, such as the MIG.

The arbitrator concluded that the applicant's TMJ, chronic pain, and psychological impairments were separate and distinct from his soft tissue injuries and were supported by credible evidence.

Therefore, the applicant was not precluded from claiming benefits beyond the $3,500 limit.