Dr. Dharamshi

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for massage therapy, botox injections, and acupuncture.

The respondent insurer denied the treatment plans.

The Tribunal found that the applicant established the massage therapy was reasonable and necessary to treat ongoing chronic neck and back pain, supported by clinical records.

However, the applicant failed to provide sufficient medical evidence or submissions demonstrating that the botox injections and acupuncture were reasonable and necessary.

The Tribunal ordered the respondent to pay for the massage therapy with interest, but dismissed the claims for botox and acupuncture.

The applicant, who was catastrophically impaired following a 2013 motor vehicle accident, sought non-earner benefits and payment for private school tuition.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove she suffered a complete inability to carry on a normal life within 104 weeks of the accident or continuously thereafter.

The Tribunal also denied the claim for private school tuition, as the applicant failed to establish it was reasonable and necessary, and the treatment plan was unsigned.

Claims for interest and a special award were consequently dismissed.

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

The Tribunal first dismissed the insurer's preliminary motion to bar the application for non-attendance at an insurer's examination, finding the request was made years after the application was filed.

On the substantive issues, the Tribunal found the applicant entitled to income replacement benefits for the pre-104-week period due to psychological impairments, but not for the post-104-week period as she did not suffer a complete inability to work.

The Tribunal also approved several treatment plans for occupational therapy, chiropractic, physiotherapy, and massage services, finding them reasonable and necessary.

Claims for a social work treatment plan balance and a special award were dismissed.

The applicant sought various statutory accident benefits following a motor vehicle accident, including treatment plans for chiropractic services, psychotherapy, a neurological assessment, a chronic pain assessment, and physiotherapy.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that any of the disputed treatment plans or assessments were reasonable and necessary.

The medical evidence, including independent medical evaluations and the applicant's own expert reports, largely recommended home-based exercises and did not support the need for the proposed facility-based treatments or specialized assessments.

The application was dismissed in its entirety.

The applicant sought income replacement benefits and funding for a psychological treatment plan following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove she suffered a substantial inability to perform the essential tasks of her employment as a result of the accident.

The Tribunal preferred the respondent's independent medical examination reports, noting the applicant had stopped working prior to the accident due to stress and reduced hours.

The Tribunal also found the respondent's notices and denials substantially complied with the Statutory Accident Benefits Schedule, and denied the claims for interest and a special award.

The applicant was injured in a bus accident and sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The respondent denied several treatment plans, including a catastrophic impairment assessment, assistive devices, and various therapies.

The Tribunal found that the applicant proved the OT CAT assessment and related forms were reasonable and necessary, noting the respondent's own assessor had recommended them.

However, the Tribunal dismissed the claims for the other treatment plans due to a lack of contemporaneous medical evidence.

The Tribunal also ordered the respondent to pay a special award of $440 under s. 10 of O. Reg. 664, finding that the respondent unreasonably delayed the OT CAT assessment for over four years despite its own assessor's recommendation.

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

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

The Tribunal found that the applicant failed to prove a substantial inability to perform the essential tasks of his pre-accident employment, relying on section 44 assessments that found no physical or psychological impairments preventing him from working.

The Tribunal also concluded that the applicant's injuries were predominantly minor, as there was insufficient evidence of a pre-existing condition, psychological impairment, or chronic pain with functional impairment to warrant removal from the MIG.

Consequently, the disputed treatment plans, which proposed treatment outside the MIG, were denied, along with claims for interest and a special award.

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

The respondent denied benefits beyond the $3,500 Minor Injury Guideline (MIG) limit.

The applicant argued that her physical injuries, pre-existing alopecia, psychological impairments, and chronic pain warranted removal from the MIG.

The Tribunal found that the applicant's physical injuries were uncomplicated soft-tissue injuries.

The Tribunal preferred the respondent's medical evidence, noting that the applicant's psychological and chronic pain diagnoses were not supported by her family physician's clinical notes and records, and that her experts failed to review fulsome medical documentation.

The application was dismissed, and the disputed treatment plans were found not payable.

The applicant sought a reconsideration of a Licence Appeal Tribunal decision that denied her claims for an income replacement benefit (IRB), attendant care benefits, and various treatment plans following a motor vehicle accident.

The applicant argued the Tribunal made errors of fact and law regarding her concussion diagnosis, surveillance evidence, and the medical assessments of several experts.

The Vice-Chair dismissed the request for reconsideration, finding that while there were minor factual inaccuracies in the original decision, they were not significant enough to have likely changed the result.

The Tribunal's original weighing of the medical evidence and surveillance footage was upheld.

The applicant sought income replacement benefits (IRB), attendant care benefits (ACB), and approval for numerous treatment plans following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal found the applicant failed to prove a substantial inability to perform her pre-accident employment as a cashier or a complete inability to work post-104 weeks, relying on video surveillance showing no physical distress and independent medical examinations.

The ACB claim was dismissed because the care was provided by family members who did not suffer an economic loss, and the benefit was not deemed incurred as it was not unreasonably withheld.

The disputed treatment plans were found not reasonable and necessary, as the medical evidence did not support the claimed injuries, including a concussion, and the applicant had reached maximum medical improvement.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision, including a non-earner benefit and various medical and rehabilitation benefits for chiropractic, physiotherapy, assistive devices, and an in-home assessment.

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, noting her evidence was inconsistent and uncorroborated.

The Tribunal also dismissed the claims for medical and rehabilitation benefits, relying on insurer's examinations and finding that the proposed treatment plans were not reasonable and necessary given the lack of functional improvement from prior treatments.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a rear-end motor vehicle accident.

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

The applicant contended he suffered from chronic pain and psychological impairments that removed him from the MIG.

The Tribunal found the applicant's injuries were predominantly minor, preferring the respondent's medical assessments over the applicant's self-reported chronic pain diagnosis.

The Tribunal approved a physiotherapy treatment plan up to the MIG limit.

It also found the respondent's notice denying a chronic pain program was deficient under s. 38(8) of the Schedule, making the plan payable if incurred until proper notice is provided.

Claims for a chronic pain assessment, interest, and a special award were dismissed.

The applicant was involved in a motor vehicle accident and suffered a cardiac arrest twelve days later, resulting in severe anoxic brain damage.

He sought various accident benefits, arguing the accident caused increased stress that led to the heart attack.

The Tribunal dismissed the application, finding the applicant failed to meet the 'but for' causation test.

Relying on medical evidence of advanced pre-existing coronary artery disease and the lack of documented stress complaints immediately post-accident, the Tribunal concluded the accident was not a necessary cause of the cardiac arrest.

The applicant's physical injuries were deemed soft-tissue in nature and subject to the Minor Injury Guideline.

The applicant was injured in a motor vehicle accident and sought medical benefits and the cost of a chronic pain assessment from the respondent insurer.

The insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The Tribunal found that the applicant failed to provide compelling evidence of chronic pain or a psychological impairment that would remove him from the MIG.

The application was dismissed.

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

The respondent insurer denied several treatment plans for chiropractic and massage services on the basis that the applicant's injuries fell within the Minor Injury Guidelines (MIG).

The applicant argued that chronic pain and pre-existing conditions removed her from the MIG.

The Tribunal found that the applicant failed to establish functional impairment from chronic pain, noting inconsistencies in her self-reported symptoms and a lack of supporting employment records.

Furthermore, the applicant's pre-existing conditions were not disclosed to assessors and did not prevent maximal recovery within the MIG.

The Tribunal concluded the injuries were minor, dismissing the claims for treatment plans and interest.

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

The insurer denied treatment plans for physiotherapy and a functional abilities evaluation, arguing the injuries fell within the Minor Injury Guideline.

Just prior to the arbitration hearing, the insurer approved the treatment plans with interest.

The applicant sought a special award under s. 282(10) of the Insurance Act for unreasonable delay.

The arbitrator found that the insurer unreasonably withheld benefits by failing to provide complete medical information to its assessors and selectively relying on reports that supported termination.

A special award of $2,510.98, representing 25% of the entitled amount, was ordered.