Dr. Desai

The applicant sought income replacement benefits (IRBs) and a treatment plan following a motor vehicle accident that exacerbated her pre-existing migraines.

The Tribunal found the applicant was entitled to a pre-104 IRB, as her migraines prevented her from performing the essential tasks of her employment as a restaurant manager.

The Tribunal also awarded a post-104 IRB for a limited period, terminating when medical evidence showed her headaches had significantly improved with prophylaxis, enabling her to engage in part-time employment.

The treatment plan and a claim for a special award were denied, but interest on overdue benefits was granted.

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

The respondent denied non-earner benefits and various medical and rehabilitation benefits, arguing the applicant's injuries fell within the Minor Injury Guideline.

The applicant argued that the respondent's denial notices were defective and that the insurer's examination reports should be struck.

The Tribunal found that the applicant did not suffer a complete inability to carry on a normal life and dismissed the claim for non-earner benefits.

However, the Tribunal granted a cannabis treatment plan, preferring the treating physician's recommendation over the insurer's assessor.

The Tribunal also granted a psychological treatment plan because the respondent failed to provide a proper medical reason for its denial, applying the Suarez principle.

The remaining claims for medical benefits and a special award were dismissed.

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 claimed his injuries, including a concussion, psychological impairments, and chronic pain, warranted removal from the MIG.

The Tribunal found insufficient objective medical evidence to support a concussion or psychological impairment diagnosis.

Applying the AMA Guides, the Tribunal also found the applicant's chronic pain did not result in a functional impairment.

The Tribunal concluded the injuries were predominantly minor and subject to the MIG limits, which had been exhausted.

The application was dismissed.

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

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

The Tribunal found that the applicant's injuries fell outside the MIG due to significant accident-related psychological impairments, relying on the evidence of her treating psychiatrist.

The Tribunal approved one treatment plan for physiotherapy services but denied the remaining plans for physical treatment, devices, and various assessments, finding them not reasonable and necessary.

The applicant's claim for a non-earner benefit was dismissed as she failed to prove a complete inability to carry on a normal life.

The claim for a special award was also dismissed.

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

The Licence Appeal Tribunal found that the applicant was entitled to funding for physiotherapy, Botox injections, a mental health driving assessment, a virtual social work assessment, a sleep study, an oculo-visual assessment, and prescription medication, as these were reasonable and necessary to treat his accident-related impairments, including a mild traumatic brain injury.

However, claims for a functional cognitive assessment, an attendant care assessment, and occupational therapy were denied because the applicant demonstrated an ability to engage in pre-accident activities and perform necessary tasks independently.

The Tribunal also denied the applicant's request for a special award, finding that the insurer reasonably relied on its assessors' opinions.

The applicant was struck by a vehicle while riding her bicycle and sought statutory accident benefits.

The insurer terminated her income replacement benefits (IRBs) and denied a physiotherapy treatment plan.

The Tribunal found the applicant was entitled to post-104-week IRBs, as her cognitive impairments, fatigue, and required pacing strategies rendered her completely unable to engage in any employment for which she was reasonably suited.

However, the Tribunal denied the physiotherapy treatment plan, finding no ongoing physical impairments that necessitated it.

The claim for an award for unreasonable delay was also dismissed, as the insurer reasonably relied on its assessors' medical opinions.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs) and treatment plans, which were denied by the respondent.

The applicant had pre-existing injuries from a workplace slip and fall but was improving and expected to return to work prior to the accident.

The adjudicator found that the motor vehicle accident exacerbated her pre-existing conditions, causing a substantial inability to perform the essential tasks of her employment.

The adjudicator ordered the respondent to pay IRBs, the disputed chiropractic treatment plan, and the chronic pain assessment, along with interest, but denied the applicant's request for a special award.

The applicant sought a non-earner benefit (NEB) following a motor vehicle accident in which she sustained a concussion and a fractured sacrum.

The Tribunal applied the Heath test to compare her pre- and post-accident activities.

Finding the applicant credible and her limitations corroborated by her family doctor, the Tribunal concluded she suffered a complete inability to carry on a normal life for the first ten months post-accident.

The insurer's medical examinations, conducted at the 23-month mark, were deemed unhelpful for assessing the earlier period.

The applicant was awarded the NEB from March 14, 2018, to December 31, 2018, along with interest on overdue payments, but denied benefits for the remainder of the claimed period due to a lack of medical evidence supporting ongoing impairment.

The applicant sought reconsideration of a decision denying income replacement benefits and various treatment plans on the basis that his injuries fell within the Minor Injury Guideline (MIG).

The applicant argued the adjudicator made significant errors of law and fact in weighing the medical evidence regarding his physical limitations, psychological impairment, and chronic pain.

The adjudicator dismissed the reconsideration request, finding no errors of law or fact in the original decision.

The adjudicator reaffirmed that the applicant failed to meet the burden of proving his injuries fell outside the MIG or that he suffered a substantial inability to perform the essential tasks of his employment.

The applicant was injured in a motor vehicle accident and sought payment for two chiropractic treatment plans totaling approximately $7,100.

The respondent insurer denied the plans, arguing the applicant had reached maximum recovery and further facility-based treatment was not medically indicated.

The Tribunal found the treatment plans were reasonable and necessary, preferring the clinical records of the applicant's treating family physician over the respondent's independent medical assessors.

The Tribunal noted the applicant experienced ongoing pain that improved with physical therapy.

The applicant was awarded entitlement to both treatment plans with interest.

The applicant, a pedestrian struck by a vehicle in a parking lot, sought entitlement to attendant care benefits and various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal found the applicant entitled to a reduced attendant care benefit for a limited period, preferring the respondent's occupational therapy assessment which accounted for the applicant's right-hand dominance.

The Tribunal also approved treatment plans for chiropractic and physiotherapy services, finding them reasonable and necessary for pain relief.

However, claims for an orthopaedic mattress, extended psychological sessions, occupational therapy, and transportation expenses were dismissed due to non-attendance at an insurer's examination, lack of justification, and statutory limitations.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits.

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

The adjudicator found that the applicant's injuries, which included radiculopathy and possible myeloradiculopathy as noted by the respondent's own neurological assessor, exhibited neurological signs that removed him from the MIG.

The adjudicator approved two physiotherapy treatment plans, finding one reasonable and necessary for pain relief, and the other payable because the respondent failed to provide adequate medical reasons for its denial under s. 38(8) of the Schedule.

An attendant care needs assessment was also approved.

However, the applicant's claim for a special award under Regulation 664 was dismissed as there was insufficient evidence that the respondent acted unreasonably.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including non-earner benefits, medical/rehabilitation treatments, and various assessments.

The insurer denied many of the benefits based on reports from its assessors.

The Licence Appeal Tribunal found that the applicant met the test for a complete inability to carry on a normal life and awarded non-earner benefits for the 104-week post-accident period.

The Tribunal also approved the disputed treatment plans and assessments, subject to the $2,000 statutory cap per assessment.

Furthermore, the Tribunal ordered the insurer to pay interest on overdue benefits and a special award of 33% under O. Reg. 664, finding that the insurer unreasonably delayed approving treatments that its own experts had recommended.

The respondent insurer requested a reconsideration of a Tribunal decision which found that the applicant's injuries fell outside the Minor Injury Guideline (MIG) and that six disputed treatment plans were reasonable and necessary.

The respondent argued the Tribunal made significant errors of law by failing to consider whether the injuries were 'predominately' minor, by ruling in the applicant's favour without submissions on the reasonable and necessary test, and by failing to cite the respondent's case law.

The Vice Chair dismissed the request, finding that the Tribunal had properly weighed the medical evidence, correctly concluded the applicant sustained a mild traumatic brain injury that was not predominately minor, and was not required to explicitly cite every piece of case law considered.

The applicant requested a reconsideration of a Tribunal decision denying her claims for non-earner benefits, chiropractic services, Botox injections, and psychological services following a 2015 motor vehicle accident.

The applicant argued the Tribunal failed to apply the correct legal tests, ignored medical evidence, and violated procedural fairness when an adjudicator lost hearing notes.

The adjudicator dismissed the reconsideration request, finding that the original Tribunal correctly applied the test for non-earner benefits, reasonably preferred the insurer's expert evidence regarding the disputed treatment plans, and that the loss of notes did not result in procedural unfairness.