Dr. C. Bradbury

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

The respondent insurer denied the treatment plans, which included a chronic pain assessment, attendant care assessment, chiropractic treatment, massage therapy, and assistive devices.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to demonstrate on a balance of probabilities that the proposed goods and services were reasonable and necessary.

The adjudicator noted a lack of contemporaneous medical evidence supporting ongoing functional impairment and relied on insurer's examination reports which concluded the applicant did not suffer from structural injuries or significant psychological impairment.

As no benefits were payable, the claim for interest was also dismissed.

The applicant sought a determination of catastrophic impairment following a motor vehicle accident, claiming a class 5 extreme mental and behavioural impairment.

The applicant moved to exclude the respondent's insurer's examination report by a psychologist, which the Tribunal denied, finding that the restrictions in section 45(2) of the Schedule apply to insured persons, not insurers.

On the merits, the Tribunal found the applicant did not sustain a catastrophic impairment, giving no weight to her psychiatric expert's report due to methodological deficiencies, lack of an occupational therapy assessment, and over-reliance on the applicant's inconsistent self-reporting.

The application for benefits and an award was dismissed.

The applicant, a pedestrian struck by a vehicle, sought payment for three physiotherapy treatment plans under the Statutory Accident Benefits Schedule.

The respondent denied the benefits, relying on section 44 assessments indicating no further physical rehabilitation was necessary.

The Tribunal found the applicant's medical evidence unpersuasive, as the reports were either based on phone consultations, lacked physical examinations, or contradicted hospital records.

The Tribunal preferred the respondent's assessments and dismissed the application, finding the treatment plans were not reasonable or necessary.

The applicant sought non-earner benefits and attendant care benefits following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove she suffered a complete inability to carry on a normal life, as she was able to drive and travel internationally post-accident.

The Tribunal also denied attendant care benefits, preferring the respondent's detailed assessments over the applicant's unsupported occupational therapy assessment.

Claims for an award and interest were consequently dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRB) and a psychological treatment plan.

The respondent insurer delayed paying the IRB for over a year, demanding documentation that was not required to determine eligibility, despite having received the necessary OCF-2 and OCF-3 forms.

The Tribunal found the respondent's conduct in withholding the IRB to be imprudent, stubborn, and inflexible, and ordered an award of 50% of the delayed IRB amount under s. 10 of Regulation 664.

The Tribunal also found the disputed psychological treatment plan to be reasonable and necessary, noting it was not duplicative of the applicant's psychiatric consultations, and ordered it payable with interest.

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

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

The applicant contended that chronic pain and psychological impairments removed him from the MIG.

The Tribunal found that the applicant failed to provide sufficient objective medical evidence to establish chronic pain or a psychological impairment caused by the accident.

The Tribunal preferred the respondent's expert evidence, which found no significant physical or psychological impairments beyond minor sprains and strains.

As the applicant's injuries were predominantly minor and the $3,500 MIG limit was exhausted, the disputed treatment and assessment plans were not payable.

The Applicant was struck by a vehicle in a parking lot, sustaining a right knee sprain and psychological injuries.

She also had a pre-existing hip condition that required surgery.

The Tribunal found that the accident did not cause or accelerate the need for hip surgery, but did cause chronic knee pain that prevented her from working.

The Applicant was awarded income replacement benefits, physiotherapy, and psychological treatment.

Claims for attendant care benefits and occupational therapy related to her hip surgery were dismissed, as was her claim for a special award.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, which the respondent insurer denied.

The Licence Appeal Tribunal found that the applicant suffered from ongoing post-concussion symptoms that caused a substantial inability to perform the essential tasks of her pre-accident employment, entitling her to income replacement benefits.

The Tribunal also approved treatment plans for an attendant care assessment, a functional abilities assessment, and a portion of a psychological treatment plan, finding them reasonable and necessary.

The Tribunal dismissed a claim for physical therapy services.

Finally, the Tribunal ordered a 25% award against the respondent under Ontario Regulation 664, finding that the insurer unreasonably withheld the attendant care and functional abilities assessments by failing to properly investigate the applicant's concussion symptoms and relying on flawed independent medical examinations.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and a psychological assessment.

The respondent insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 funding limit.

The Licence Appeal Tribunal found that the applicant sustained predominantly minor soft tissue injuries and failed to provide compelling evidence of a psychological injury that would warrant removal from the MIG.

The Tribunal preferred the respondent's psychological assessments, which reviewed the full medical file, over the applicant's assessment, which lacked a review of the family physician's clinical notes.

The application for benefits and interest was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, the cost of a psychological assessment, and a plastic surgery consultation fee.

The Licence Appeal Tribunal dismissed the claims.

The Tribunal found the applicant did not suffer a complete inability to carry on a normal life, as evidence showed he maintained independence and returned to school and work.

While the psychological assessment was deemed reasonable and necessary, it was not payable because the cost had not been incurred.

The plastic surgery consultation fee was denied because it was incurred before a treatment plan was submitted.