Dr. Debra Mandel

The applicant sought statutory accident benefits following a motor vehicle accident, claiming removal from the Minor Injury Guideline (MIG) due to chronic pain, psychological impairments, and a hernia.

The Tribunal found the applicant failed to prove chronic pain with functional impairment, noting he did not meet the AMA Guides criteria.

The Tribunal preferred the respondent's psychological assessment over the applicant's social worker letter, finding no psychological condition warranting removal from the MIG.

The applicant was held to remain within the MIG and was denied the disputed treatment plans and interest.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, which the respondent insurer denied on the basis that her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG due to psychological impairments and chronic pain with functional impairment.

The Tribunal found that the applicant failed to provide sufficient medical evidence linking her psychological complaints or ongoing pain to a functional impairment caused by the accident.

As the $3,500 MIG limit was exhausted, the disputed treatment plans were denied.

The Tribunal also found the insurer complied with the notice requirements under s. 38(8) of the Schedule and dismissed the claims for an award and interest.

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

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

The applicant argued for removal from the MIG on the basis of chronic pain and functional impairment.

The Tribunal applied the AMA Guides criteria for chronic pain and found the applicant only met one of the required three criteria.

Relying on the respondent's section 44 assessments, the Tribunal concluded the applicant failed to prove his injuries warranted removal from the MIG.

The application for physiotherapy benefits and interest was dismissed.

The applicant sought entitlement to three physiotherapy treatment plans following a motor vehicle accident.

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

The sole issue raised by the applicant was whether the respondent failed to provide adequate medical reasons for the denials under s. 38(8) of the Schedule.

The Tribunal found that the respondent complied with s. 38(8), as the denial letters clearly stated the injuries were considered minor and relied on Insurer Examination reports from a physiatrist and a psychologist.

The application was dismissed.

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

The insurer denied an income replacement benefit (IRB) and two treatment plans.

On a rehearing, the Tribunal found the applicant was entitled to the IRB, as medical evidence supported a substantial inability to perform the essential tasks of his pre-accident employment due to chronic pain and a right shoulder impairment.

The Tribunal denied the April 11, 2022 treatment plan as it was submitted while the applicant was in the Minor Injury Guideline (MIG) and duplicated an approved OCF-23.

The September 21, 2022 treatment plan was approved as reasonable and necessary.

The Tribunal denied the applicant's request for a special award, finding the insurer's reliance on its assessors' reports was not unreasonable.

The applicant requested reconsideration of a Licence Appeal Tribunal decision that denied his claims for an income replacement benefit and treatment plans following a motor vehicle accident.

The Vice-Chair found that the original adjudicator made significant factual errors by overlooking a key letter from the applicant's treating physician that connected his injuries to the accident, and by failing to explicitly consider the applicant's psychological expert evidence.

These errors were found to likely have impacted the outcome of the decision.

The request for reconsideration was granted, the original decision was cancelled, and the matter was ordered to be reheard by a new adjudicator based on the existing written record.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including income replacement benefits, treatment plans for physiotherapy and psychological services, assessments, and assistive devices.

The Licence Appeal Tribunal found that the applicant failed to prove entitlement to income replacement benefits, psychological services, and most assessments.

However, the Tribunal approved several physiotherapy plans and a portion of the requested assistive devices, finding them reasonable and necessary to manage the applicant's chronic pain.

The applicant's claim for a special award under s. 10 of O. Reg. 664 was dismissed, as the insurer's reliance on its assessors' reports was not unreasonable.

The applicant sought statutory accident benefits, including income replacement benefits (IRBs) and funding for seven physiotherapy treatment plans, following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application in its entirety.

The adjudicator found the applicant's self-reporting to medical assessors unreliable due to symptom magnification and surveillance evidence showing the applicant working long hours at a restaurant.

Consequently, the applicant failed to prove a substantial inability to perform the essential tasks of his employment for pre-104 week IRBs, or a complete inability to engage in any employment for post-104 week IRBs.

The physiotherapy plans were deemed not reasonable and necessary, as the applicant contemporaneously reported to his family doctor that the treatments were ineffective.

The applicant sought a non-earner benefit, interest, and an award following a motor vehicle accident.

The Tribunal found that the applicant failed to prove on a balance of probabilities that she suffered a complete inability to carry on a normal life.

The applicant did not provide sufficient evidence of her pre-accident activities or their frequency to allow for a comparison with her post-accident abilities.

The Tribunal preferred the respondent's psychological assessment over the applicant's evidence, noting inconsistencies in the applicant's social worker report.

The application was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her entitlement to six physiotherapy treatment plans and an occupational therapy assessment.

The applicant argued the adjudicator made errors of fact and law in weighing the medical evidence and in finding that section 38(8) of the Schedule did not apply because an OCF-1 was not in evidence.

The Tribunal dismissed the request, finding that the applicant was attempting to re-litigate the case and introduce new evidence without explaining why it was not previously available.

The Tribunal concluded there were no errors of fact or law in the original decision's weighing of the medical reports or its findings on the treatment plans.

The applicant sought various statutory accident benefits following a motor vehicle accident, including six treatment plans for physiotherapy, an orthopaedic assessment, an occupational therapy assessment, and a psychological assessment.

The Tribunal found that the insurer's denials complied with the medical reasons requirement under s. 38(8) of the Schedule.

On the merits, the Tribunal dismissed the claims for physiotherapy, finding that the applicant's pain was attributable to a somatic symptom disorder rather than a physical impairment, and physiotherapy was not a reasonable treatment for a psychological condition.

The occupational therapy assessment was also denied for lack of evidence linking it to attendant care needs.

However, the Tribunal granted the orthopaedic assessment, as it was reasonable for the applicant to investigate her pain prior to her psychological diagnosis, and the psychological assessment, as it was necessary and not duplicative.

Claims for an award were dismissed, but interest was awarded on the approved plans.

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

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

The applicant argued for removal from the MIG based on pre-existing conditions (Crohn's disease and knee pain), chronic pain, and psychological impairment.

The Tribunal found the applicant failed to provide compelling medical evidence that his pre-existing conditions prevented maximal recovery within the MIG.

The Tribunal also rejected the applicant's claims of chronic pain and psychological impairment, preferring the respondent's expert evidence.

The applicant was found to remain within the MIG and was entitled to the disputed treatment plans only up to the remaining $2,570.75 of the $3,500 MIG limit.

The respondent's request for costs was denied for failing to provide particulars.

The applicant was injured in a motor vehicle accident and sought payment for various medical and rehabilitation benefits, including chiropractic, physiotherapy, occupational therapy, a brain SPECT scan, an EMG assessment, and cognitive devices.

The respondent insurer denied the treatment plans on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to meet his burden of proof.

The Tribunal afforded little weight to the applicant's medical experts due to factual inaccuracies in their reports and relied on the respondent's assessors, who concluded the applicant had reached maximum medical improvement and that the proposed treatments were not medically justified.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) for 104 weeks.

The insurer terminated the benefits at the 104-week mark, arguing the applicant did not suffer a complete inability to engage in any employment for which she was reasonably suited by education, training, or experience.

The Tribunal reviewed the medical evidence, including reports from orthopedic surgeons, a psychologist, and a vocational assessor, and found that the applicant's physical and psychological impairments did not meet the post-104-week IRB test.

The application was dismissed, and no interest was payable.

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

The respondent denied claims for a psychological assessment and physiotherapy services on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained predominantly minor injuries and failed to prove that pre-existing conditions, chronic pain, or psychological impairments removed her from the MIG.

As the applicant had already been approved for the $3,500 funding limit, she was not entitled to the disputed treatment plans, interest, or an award.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic and physical therapy.

The insurer denied the treatment plan, arguing the applicant's injuries fell within the $3,500 limit of the Minor Injury Guideline (MIG).

The arbitrator found that while the applicant's impairments were predominantly minor injuries, she had documented pre-existing conditions, including scoliosis and degenerative disc disease, that constituted compelling evidence she could not achieve maximal recovery within the MIG limits.

The arbitrator ordered the insurer to pay the $3,487.60 treatment plan plus interest.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and medical benefits for physiotherapy and assistive devices.

The Licence Appeal Tribunal found that the applicant was substantially unable to perform the essential tasks of his pre-accident employment as a marble shop worker, which involved medium physical demand level work, and granted the IRBs.

However, the Tribunal denied the medical benefits for physiotherapy due to a lack of specificity in the treatment plan, and denied the assistive devices because there was no evidence linking the applicant's foot pathology to the accident.

Interest was awarded on the overdue IRBs.