7 total
Applicant removed from Minor Injury Guideline due to psychological impairment; physiotherapy denied but psychological assessment approved.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found the applicant suffered a psychological impairment, specifically unspecified depressive disorder and PTSD, warranting removal from the MIG.
The Tribunal preferred the applicant's psychological assessment over the respondent's insurer examination.
However, the Tribunal denied the applicant's claims for physiotherapy, finding a lack of compelling contemporaneous medical evidence of physical impairment beyond soft tissue injuries.
A psychological assessment was approved at a reduced hourly rate for the psychotherapist, along with interest.
Applicant's claim for accident benefits outside the Minor Injury Guideline dismissed due to insufficient objective evidence.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming psychological impairments and a concussion warranted removal from the Minor Injury Guideline (MIG).
The respondent denied the claims, arguing the injuries were minor.
The Tribunal found the applicant's self-reported limitations inconsistent with his post-accident ability to attend school and work.
The Tribunal gave no weight to the applicant's treating practitioners, who were not qualified as experts and relied on assumptions or invalid test profiles.
Accepting the respondent's expert evidence, the Tribunal concluded the applicant failed to meet his burden to prove his injuries fell outside the MIG.
All claims for attendant care, treatment plans, and an award were dismissed.
Application for non-earner benefits and treatment plans dismissed as applicant failed to prove reasonable necessity.
The applicant sought entitlement to a non-earner benefit, various treatment plans for physiotherapy and psychological services, an attendant care assessment, and an award under the Statutory Accident Benefits Schedule following a motor vehicle accident.
The Tribunal found the applicant failed to establish a complete inability to carry on a normal life, as there was insufficient evidence comparing his pre- and post-accident activities.
The Tribunal also dismissed the claims for the treatment plans, preferring the respondent's insurer examination reports which indicated the applicant had returned to his activities of daily living and sustained only minor injuries.
The application was dismissed in its entirety.
Application for accident benefits granted in part; partial chronic pain program approved, IRB denied.
The applicant sought various statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB), medical benefits, and an award under s. 10 of O. Reg 664.
The Tribunal found the applicant did not suffer a substantial inability to perform the essential tasks of his employment as a personal support worker and Lyft driver, relying on the respondent's medical assessments and the applicant's family doctor's clinical notes.
The Tribunal denied the claims for IRB, psychological services, a chronic pain assessment, and a driving reintegration assessment.
However, the Tribunal partially approved a treatment plan for a chronic pain program, awarding $2,346.70 for physical therapy and an SI belt based on a neutral OHIP-funded assessment.
The claim for a s. 10 award was dismissed.
Applicant removed from Minor Injury Guideline due to psychological condition; psychological treatment plans approved.
The respondent insurer denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant suffered an accident-related psychological condition, removing her from the MIG.
The Tribunal preferred the evidence of the applicant's psychological assessor over the respondent's, noting it was corroborated by medical records of post-traumatic headaches and sleep disturbances.
The Tribunal awarded the costs of a psychological assessment and psychological treatment, but denied a treatment plan for physiotherapy, finding the physical injuries were minor and unrelated degenerative issues.
Application for accident benefits dismissed; applicant failed to prove injuries warranted removal from the Minor Injury Guideline.
The applicant sought statutory accident benefits following a rear-end motor vehicle collision.
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 he should be removed from the MIG due to accident-related psychological impairments and a pre-existing psychological condition.
The Tribunal found that the applicant's pre-accident medical records showed severe anxiety and depression, contradicting his expert's report that symptoms began after the accident.
The Tribunal concluded the applicant failed to prove that his pre-existing condition would prevent maximal recovery from his minor injuries if kept within the MIG.
The application was dismissed, with the applicant remaining subject to the $3,500 MIG limit.
Applicant's claim for removal from the Minor Injury Guideline dismissed due to lack of objective evidence.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming his psychological impairments and soft tissue injuries warranted removal from the Minor Injury Guideline (MIG).
The respondent denied the benefits, arguing the injuries were predominantly minor.
The Tribunal found that the applicant failed to prove a psychological impairment, preferring the respondent's psychological assessment which indicated the applicant was 'faking bad' on validity testing.
The Tribunal also accepted the respondent's musculoskeletal assessment that the applicant sustained uncomplicated soft tissue injuries.
Consequently, the applicant remained within the MIG and was not entitled to the disputed treatment plans, interest, or an award for unreasonable delay.
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