Dr. Dessouki

The applicant sought a determination that she sustained a catastrophic impairment as a result of a motor vehicle accident, along with entitlement to various accident benefits, an award, and interest.

The Tribunal evaluated the medical evidence under Criterion 7 and Criterion 8 of the Statutory Accident Benefits Schedule.

The Tribunal preferred the respondent's expert evidence, finding the applicant did not have Complex Regional Pain Syndrome and that her physical and psychological impairments did not meet the catastrophic impairment thresholds.

As the applicant's non-catastrophic medical rehabilitation limits were exhausted, the claims for attendant care and treatment plans were dismissed.

The claims for an award and interest were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and several treatment plans.

The Licence Appeal Tribunal dismissed the claim for the non-earner benefit, finding the applicant failed to prove a complete inability to carry on a normal life, largely due to unreliable self-reporting and significant pre-existing conditions.

The Tribunal also dismissed claims for a neurological assessment and psychological services as not reasonable and necessary.

However, the Tribunal ordered the respondent to pay for a chronic pain assessment because the respondent's denial notices were confusing and failed to comply with section 38(8) of the Schedule.

The applicant sought statutory accident benefits following a 2014 motor vehicle accident, including funding for physiatry, chronic pain, and neurological assessments, as well as assistive devices.

The respondent denied the treatment plans on the basis of a lack of contemporaneous medical evidence and the application of the Minor Injury Guideline.

The Tribunal found that the applicant failed to establish on a balance of probabilities that the disputed treatment plans were reasonable and necessary, noting the absence of contemporaneous medical records corroborating the applicant's self-reported chronic pain.

The Tribunal also found that the respondent complied with the notice requirements under s. 38(8) of the Schedule.

The application was dismissed in its entirety.

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

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

The Tribunal found the applicant was removed from the MIG due to accident-related chronic pain that impaired her function, relying on treating practitioner records and the insurer's own physiatry assessments.

The Tribunal awarded partial entitlement to attendant care benefits, but found them not payable as they had not been incurred.

Various treatment plans for occupational therapy, assistive devices, a psychological assessment, and physiotherapy were partially or fully approved as reasonable and necessary.

The applicant's claim for a special award was dismissed due to procedural non-compliance in her submissions.

The applicant requested reconsideration of a Licence Appeal Tribunal decision that found he was not catastrophically impaired and dismissed his claims for an income replacement benefit (IRB) and other benefits following a motor vehicle accident.

The applicant argued the Tribunal erred in its causation analysis and failed to address his argument for IRB entitlement under s. 36(6) of the Statutory Accident Benefits Schedule.

The Vice-Chair dismissed the causation arguments, finding no error in the Tribunal's application of the 'but for' test.

However, the Vice-Chair granted the reconsideration request in part, finding the Tribunal erred by failing to explicitly consider the applicant's s. 36(6) argument regarding the insurer's alleged failure to provide a compliant denial.

A written re-hearing was ordered solely to determine the applicant's entitlement to an IRB under s. 36(6), along with related claims for an award and interest.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident, claiming catastrophic impairment under Criteria 6, 7, and 8 of the Schedule.

The Tribunal gave no weight to the applicant's key expert witness, who failed to attend the hearing for cross-examination, citing procedural fairness.

Relying on surveillance evidence that contradicted the applicant's claims of severe impairment and social isolation, the Tribunal found the applicant did not meet the threshold for catastrophic impairment.

Consequently, claims for medication expenses beyond the non-catastrophic limit, a special award, and interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits, occupational therapy, a home modification assessment, and psychological services.

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal found the applicant's credibility was significantly impacted by his failure to disclose a pre-existing right knee impairment to assessors.

Surveillance evidence and inconsistent self-reports further undermined his claims for attendant care and occupational therapy.

The Tribunal also found the applicant had not utilized previously approved psychological treatment, failing to prove the necessity of additional sessions.

Claims for interest and a special award were consequently dismissed.

The applicant sought a determination of catastrophic impairment and entitlement to income replacement benefits and medical benefits following a 2016 motor vehicle accident.

The Tribunal found that the accident was not a necessary cause of the applicant's right hip osteoarthritis aggravation or his psychological impairments, which were instead attributed to a post-accident stroke and subsequent loss of his driver's licence.

Consequently, the applicant did not meet the 55% whole person impairment threshold for catastrophic impairment.

The claims for income replacement benefits and medical assessments were also dismissed as the applicant failed to prove they were reasonable, necessary, or caused by the accident.

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

The respondent denied two treatment plans for a chronic pain assessment and physiotherapy services, arguing the applicant's physical injuries were minor and she had pre-existing conditions.

The Tribunal found the applicant failed to meet her burden of proving the plans were reasonable and necessary, noting the expert opinions of two s. 44 assessors who concluded the physical injuries were minor sprains/strains.

The application was dismissed, and no interest was awarded.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to non-earner benefits and medical benefits for psychological and chiropractic services.

The insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that she failed to comply with section 33 requests for information.

The Tribunal found that the applicant's non-compliance with section 33 relieved the insurer of liability for non-earner benefits.

Furthermore, the Tribunal concluded the applicant sustained predominantly minor injuries, as she failed to prove pre-existing conditions, psychological impairments, or chronic pain that would warrant removal from the MIG.

Consequently, the disputed treatment plans were not reasonable and necessary as they exceeded the $3,500 MIG limit.

The application was 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 sought statutory accident benefits following a motor vehicle accident, including psychological services, a driving evaluation, and physiotherapy.

The respondent denied the treatment plans.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary.

The psychological services were not supported as the applicant did not recall previous sessions being helpful.

The driving evaluation was unnecessary as the applicant did not drive.

The physiotherapy was related to a significant pre-existing condition rather than the accident.

The application was dismissed.

The applicant sought a determination that he sustained a catastrophic impairment following a motor vehicle accident, claiming a whole person impairment of 55% or more.

The Tribunal reviewed extensive medical evidence and expert testimony regarding the applicant's physical and psychological impairments, including gait derangement, spine impairment, traumatic brain injury, and mental/behavioural disorders.

The Tribunal concluded the applicant's combined whole person impairment was 41%, falling short of the 55% threshold.

Consequently, claims for attendant care beyond the 104-week limit were dismissed.

The Tribunal partially approved treatment plans for a chronic pain program, chiropractic spinal manipulation, and psychotherapy, subject to remaining policy limits.

Claims for a special award and costs were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including removal from the Minor Injury Guideline (MIG), a Non-Earner Benefit (NEB), and funding for a psychological assessment.

The Tribunal found that the applicant's chronic pain warranted removal from the MIG and approved the psychological assessment as reasonable and necessary to investigate the pain symptomology.

However, the claim for an NEB was dismissed because the medical evidence and the applicant's post-accident activities, including returning to part-time work, did not demonstrate a complete inability to carry on a normal life.

The applicant requested a reconsideration of a decision denying him non-earner benefits.

He argued the Tribunal erred in fact and law by rejecting certain medical evidence, including a letter from Dr. Galley, and by accepting the evidence of Dr. Dessouki despite alleged procedural flaws.

The Adjudicator dismissed the request, finding that the Tribunal properly weighed the evidence, including the applicant's own testimony and family evidence, and correctly applied the legal test for non-earner benefits.

No error of law or fact was established.

The applicant sought income replacement benefits (IRBs) and medical benefits for chiropractic treatment following a motor vehicle accident.

The adjudicator dismissed the application, finding the applicant lacked credibility due to contradictory evidence regarding his return to work and pre-existing chronic back pain.

The applicant failed to prove a substantial inability to perform the essential tasks of his pre-accident employment as a driver.

Furthermore, the adjudicator found the disputed treatment plans were not reasonable and necessary, as the applicant provided insufficient medical evidence linking his ongoing complaints to the accident.

The applicant sought ongoing Income Replacement Benefits (IRBs) and a psychological assessment following a motor vehicle accident.

The insurer terminated IRBs after 104 weeks, arguing the applicant no longer met the test for entitlement.

The Tribunal found that while the applicant suffered from accident-related physical and psychological impairments, he failed to prove a substantial or complete inability to work as a real estate agent.

The applicant's credibility was significantly undermined by a forensic accounting report revealing he misrepresented his pre- and post-accident income to all assessors, and that he actually earned more in the year following the accident.

Consequently, the claim for ongoing IRBs was dismissed.

However, the Tribunal granted the $2,000 psychological assessment, finding it reasonable and necessary to address the applicant's ongoing psychological impairment.

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

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

The applicant argued for removal from the MIG based on pre-existing jaw pain, psychological issues, and chronic pain.

The Tribunal found insufficient medical evidence to support removal from the MIG, noting a lack of chronic pain diagnosis and preferring the respondent's psychological assessment which found symptom magnification.

As the MIG limits were exhausted, the claims for treatment plans and interest were dismissed.

The applicant, who was injured in a motorcycle accident, sought payment for two physiotherapy treatment plans that were denied by the respondent insurer.

The insurer denied the plans based on section 44 insurer's examinations which concluded the treatments were not reasonable and necessary.

The Tribunal found that the applicant failed to meet his burden of proving the treatments were reasonable and necessary, noting that the applicant spent half the year in Florida without facility-based treatment and lacked objective medical evidence supporting the need for ongoing treatment.

The application was dismissed.

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 for chiropractic care, a psychological assessment, and a chronic pain assessment on the basis that they were not reasonable and necessary.

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

The adjudicator relied on the insurer's section 44 examination reports, which found no objective evidence of ongoing accident-related impairments requiring the disputed treatments, and noted that the applicant's psychological and knee issues were pre-existing and well-documented.