Dr. Czok

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.

The Licence Appeal Tribunal found that the applicant failed to meet the burden of proving his injuries fell outside the MIG, noting that the medical evidence, including insurer examinations, supported a diagnosis of soft tissue injuries with no significant functional limitations.

As the $3,500 MIG limit had been exhausted, the applicant's claims for additional chiropractic and psychological treatment plans were denied.

Claims for interest and an award for unreasonable delay were also dismissed.

The applicant sought payment for various treatment plans for psychological therapy, physiotherapy, occupational therapy, and assessments following a motor vehicle accident.

The Licence Appeal Tribunal found that the psychological treatment plans were funded at the appropriate rate for a psychotherapist, rather than a psychologist.

The Tribunal also found that the remaining physical therapy and assessment plans were not reasonable and necessary, as the applicant had reached maximum medical recovery and further assessments would be duplicative.

The claims for a special award and interest were dismissed.

The applicant sought entitlement to multiple treatment plans for chiropractic services, various assessments (psychological, neurological, cognitive, chronic pain, FAE, attendant care), and assistive devices following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to meet her burden of proving the proposed treatments and assessments were reasonable and necessary.

The Tribunal noted a lack of objective medical evidence, reliance on self-reports, and failure to provide clinic treatment records or progress reports to justify the ongoing identical treatment plans.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The insurer denied claims for a non-earner benefit, physiotherapy, and a psychological assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant failed to provide objective medical evidence warranting removal from the MIG, noting inconsistencies in the applicant's psychological evidence and a lack of documented functional impairment.

The Tribunal also dismissed the claim for a non-earner benefit, as the applicant failed to demonstrate a complete inability to carry on a normal life.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits for physiotherapy and psychological services following a motor vehicle accident.

The respondent denied the physiotherapy treatment plans on the basis that the applicant had reached maximum medical recovery, and disputed the hourly rate claimed for psychological services rendered by a social worker.

The adjudicator found that the applicant had recovered from uncomplicated soft-tissue injuries and had no residual impairments, making further physiotherapy not reasonable and necessary.

The adjudicator also held that the social worker was not entitled to the enhanced hourly rate reserved for psychologists under the Professional Services Guideline.

Claims for an award and interest were dismissed as no benefits were unreasonably withheld or overdue.

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

The respondent denied a physiotherapy treatment plan on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to demonstrate that her physical or psychological impairments warranted removal from the MIG, noting a lack of objective evidence and preferring the respondent's medical assessments.

Consequently, the disputed treatment plan was deemed not reasonable and necessary, and the application was dismissed.

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

The respondent insurer denied a physiotherapy treatment plan on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's physical injuries were predominantly sprains and strains, and he failed to provide sufficient medical evidence of chronic pain, a psychological condition, or a pre-existing condition that would preclude recovery within the MIG.

Consequently, the treatment plan was deemed not reasonable and necessary, and the application was dismissed.

The applicant sought various medical and rehabilitation benefits following a 2012 motor vehicle accident.

The Licence Appeal Tribunal denied claims for PRP injections, a neuropsychological assessment, an in-home assessment balance, and assistive devices, finding them either not reasonable and necessary or statute-barred for failure to attend an insurer's examination.

The Tribunal partially approved a treatment plan for psychological counselling, awarding $3,118.77 plus interest, after finding the proposed costs for transportation, brokerage, and documentation to be gratuitous and inflated.

The applicant sought accident benefits following a motor vehicle accident.

The respondent determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and terminated his income replacement benefits (IRB).

The Tribunal found that the applicant's physical injuries were predominantly minor, consisting of sprains and strains, and that he failed to prove he suffered from chronic pain.

The Tribunal also found the applicant was not entitled to an IRB, as there was insufficient medical evidence to establish a substantial inability to perform the essential tasks of his pre-accident employment.

The application was dismissed.

The applicant sought a non-earner benefit and a medical rehabilitation benefit following a motor vehicle accident.

The insurer denied the benefits, arguing the applicant did not suffer a complete inability to carry on a normal life and that the treatment was not reasonable and necessary.

The Tribunal dismissed the application, finding the applicant failed to meet the stringent test for a non-earner benefit, largely due to a lack of detailed comparison between her pre- and post-accident functioning and the impact of her pre-existing conditions.

The Tribunal also found the proposed treatment plan was not reasonable and necessary, preferring the insurer's medical evidence that the applicant had reached maximum medical improvement.

The applicant sought entitlement to an income replacement benefit and several treatment and assessment plans following a motor vehicle accident.

The respondent denied the income replacement benefit, arguing that the applicant's inability to work was due to congestive heart failure, a stroke, and cardiac arrhythmia that were not caused by the accident.

The adjudicator applied the 'but for' test and found that the applicant failed to establish a causal link between the accident and his subsequent cardiac and neurological conditions.

Consequently, the claim for an income replacement benefit was dismissed.

However, the adjudicator found that the applicant was entitled to medical benefits for chiropractic and psychological services, as well as the cost of an attendant care assessment, because these were reasonable and necessary to treat accident-related impairments.

A treatment plan for other goods and services was denied.

The applicant sought statutory accident benefits for a physiotherapy treatment plan and the balance of a psychological assessment following a motor vehicle accident.

The Tribunal found that the physiotherapy treatment plan was not reasonable and necessary, preferring the respondent's expert who conducted an in-person examination and concluded the applicant had reached maximum medical recovery.

The Tribunal also denied the balance of the psychological assessment, preferring the respondent's expert who provided a more detailed and specific description of the time and cost necessary for the assessment.

The application was dismissed, and claims for interest and an award were denied.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits, attendant care benefits, and medical benefits.

The Licence Appeal Tribunal found the applicant was not entitled to ongoing income replacement benefits or attendant care benefits, as the medical evidence did not support a substantial inability to perform essential tasks or a need for ongoing care.

The Tribunal also denied requests for psychological and chronic pain assessments.

However, the Tribunal found that orthotic devices were reasonable and necessary, ordering the respondent to pay for them.

Claims for an award and costs were dismissed.

The applicant sought entitlement to a $2,486 chronic pain assessment following a motor vehicle accident.

The insurer denied the treatment plan, arguing the applicant's chronic pain was a pre-existing condition and that he only suffered a minor strain in the accident.

The Tribunal agreed with the insurer, finding that video surveillance contradicted the applicant's claims of impairment and the conclusions of his assessing physician.

The Tribunal concluded the accident did not cause the chronic pain and the treatment plan was not reasonable and necessary.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for an in-home assessment, prescription medication, a chronic pain assessment, and chiropractic treatment.

The respondent insurer denied the claims.

The Licence Appeal Tribunal found that the applicant was not entitled to the in-home assessment or the prescription expenses, as the evidence did not establish they were reasonable and necessary for accident-related impairments.

However, the Tribunal granted the claims for the chronic pain assessment and chiropractic treatment, finding that the applicant's pre-existing chronic pain was exacerbated by the accident and that the proposed treatments were reasonable and necessary to manage her symptoms.

Interest was awarded on the overdue payments for the approved benefits.

The applicant sought statutory accident benefits for physiotherapy, chiropractic treatment, and the cost of completing an OCF-18 following a motor vehicle accident.

The Tribunal found the $2,495.48 treatment plan reasonable and necessary to assist in the applicant's recovery.

However, the $3,260.64 treatment plan was dismissed as the applicant was statute-barred under s. 55 for failing to attend an insurer's examination.

The claim for the cost of completing the OCF-18 was also dismissed as it did not meet the criteria under s. 25(1)3.

The Tribunal declined to order an award under s. 10 of O. Reg. 664, finding no evidence that the insurer acted in bad faith.

The applicant sought medical and rehabilitation benefits, as well as a non-earner benefit, following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that she did not meet the test for a non-earner benefit.

The Tribunal found that the applicant failed to prove her chronic pain was not a sequelae of her soft tissue injuries, and failed to provide compelling evidence of a pre-existing condition that would prevent maximal recovery within the MIG.

The Tribunal also found the applicant did not suffer a complete inability to carry on a normal life, as she continued to engage in many of her pre-accident activities.

The application was dismissed.