Dr. Bruce Ballon

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of several treatment plans for physiotherapy, psychological services, and an attendant care assessment, as well as a claim for a special award.

The Tribunal found the applicant was not entitled to the physiotherapy plan or the attendant care assessment due to a lack of objective medical evidence demonstrating functional limitations.

However, the Tribunal granted the outstanding balances for four psychological treatment plans, preferring the treating psychologist's recommendation for 1.5-hour sessions over the insurer's 1-hour approvals.

A subsequent psychological treatment plan was denied based on a psychiatric assessment attributing current symptoms to non-accident-related factors.

The claim for a special award was dismissed as the insurer's conduct was not unreasonable.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her physical and pre-existing psychological injuries warranted removal from the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's physical injuries were minor soft tissue injuries falling within the MIG.

Furthermore, the Tribunal held that the applicant failed to provide compelling medical evidence that her pre-existing psychological condition was exacerbated by the accident or would prevent maximal medical recovery within the MIG limits.

The application for disputed treatment plans and interest was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain, psychological impairments, and pre-existing conditions including diabetes.

The Tribunal found that the applicant's ongoing complaints were consistent with pre-existing issues from a prior accident and that he did not meet the criteria for chronic pain under the AMA Guides.

The Tribunal concluded the applicant suffered predominantly minor injuries, and having exhausted the MIG limits, he was not entitled to the disputed treatment plan or interest.

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 motor vehicle accident.

The Tribunal found the applicant was entitled to the balance of a treatment plan for driver rehabilitation therapy because the insurer failed to provide sufficient medical reasons for its partial denial, triggering the consequences of section 38(11) of the Schedule.

However, the Tribunal dismissed the claims for chiropractic services and a psychological assessment, finding them not reasonable and necessary based on the medical evidence, including section 44 insurer examinations.

The claim for physiotherapy was also dismissed as the expenses were incurred before a treatment plan was submitted, contrary to section 38(2).

The applicant was involved in a 2019 rear-end motor vehicle accident and sought statutory accident benefits, including a non-earner benefit and various treatment plans.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that her ongoing symptoms were attributable to a prior 2014 accident.

The Tribunal found that the applicant failed to provide compelling medical evidence that her pre-existing chronic pain prevented her from achieving maximal recovery within the MIG.

The Tribunal also found the applicant did not meet the rigorous test for a non-earner benefit, as she could not establish a complete inability to carry on a normal life caused by the 2019 accident rather than her pre-existing condition.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit, psychological services, and chiropractic services.

The applicant, who was self-employed, failed to submit a disability certificate in a timely manner and did not provide sufficient medical evidence to prove a substantial inability to perform the essential tasks of his employment.

The respondent's medical assessments concluded the applicant could still perform his work tasks.

The Tribunal found the applicant failed to meet his evidentiary burden for all claimed benefits and dismissed the application, including claims for an award and interest.

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

The insurer denied several treatment plans for physiotherapy, psychological services, and various assessments.

The Tribunal first determined that the applicant was not barred from disputing a treatment plan denied more than two years prior, applying the COVID-19 limitation period suspension under O. Reg. 73/20 and granting an extension under s. 7 of the LAT Act.

On the merits, the Tribunal denied the physiotherapy and chronic pain assessment plans, finding the applicant's physical injuries were predominantly soft-tissue and had resolved.

However, the Tribunal approved the psychological, cognitive, biopsychosocial, and driving therapy plans, preferring the evidence of the applicant's assessors and certain insurer examinations that confirmed the applicant suffered from accident-related depression and anxiety.

Claims for an award and costs were dismissed due to lack of supporting submissions.

The applicant sought various medical and rehabilitation benefits, as well as the cost of several assessments, following a motor vehicle accident.

The respondent insurer denied the treatment plans.

The Tribunal found that the applicant failed to prove the disputed treatment plans and assessments were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's medical assessors, who reviewed the applicant's complete medical records and found that further facility-based treatment would not lead to significant improvements and that the applicant's psychological issues were largely pre-existing or subclinical.

The application was dismissed in its entirety.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) after the insurer terminated them.

The Tribunal found that the applicant, a self-employed painter and contractor, suffered a substantial inability to perform the essential tasks of his pre-accident employment within 104 weeks of the accident, primarily due to a specific phobia of driving.

For the post-104-week period, the Tribunal found the applicant was completely unable to engage in any employment for which he was reasonably suited by education, training, or experience, due to a combination of physical and psychological impairments caused by the accident.

The applicant was awarded ongoing IRBs and interest, but his claim for a special award under Regulation 664 was dismissed.

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 sought a $2,260 benefit for a chronic pain assessment following a motor vehicle accident, as well as a special award under Regulation 664 for unreasonable delay.

The adjudicator found that the applicant failed to prove the assessment was reasonable and necessary, noting that independent medical examinations and treating physicians did not diagnose chronic pain or indicate a need for further assessment.

The adjudicator also dismissed the applicant's request to exclude the respondent's evidence for alleged non-disclosure, finding the request overly broad and lacking evidence of prejudice.

The application for benefits and the claim for a special award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, neurobiofeedback, and physiotherapy.

The Tribunal found the applicant did not meet the threshold for a non-earner benefit, as his psychological impairments did not continuously prevent him from engaging in substantially all of his pre-accident activities.

The Tribunal granted the claim for neurobiofeedback, finding it reasonable and necessary to address the applicant's psychological distress and vehicular anxiety.

The claims for physiotherapy were dismissed, as the applicant had reached maximal medical recovery from a physical standpoint.