Dr. Dinesh Kumbhare

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.

The Tribunal found the applicant failed to provide sufficient medical evidence demonstrating functional impairment or disability to support a chronic pain diagnosis.

Consequently, the applicant's injuries were deemed predominantly minor, and the claims for a $1,908.72 chiropractic treatment plan, an award, and interest were dismissed.

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

The Tribunal found the applicant was not entitled to the cost of personal protective equipment (PPE) in four partially approved physiotherapy treatment plans, as PPE is considered an administrative expense.

However, the Tribunal approved a subsequent physiotherapy treatment plan, a chronic pain assessment, and a physiatry assessment, finding them reasonable and necessary based on the applicant's ongoing complaints and the recommendations of his family doctor.

A proposed neurological assessment was denied.

The Tribunal also dismissed the applicant's claim for a special award under s. 10 of Reg. 664, finding the insurer's conduct was not unreasonable, and denied the respondent's request for costs.

The applicant sought statutory accident benefits for medical marijuana and a physiatry assessment following a motor vehicle accident.

The Tribunal found that the medical marijuana was not reasonable and necessary, as the applicant had used it for an extended period without meaningful improvement in pain, sleep, or psychological symptoms.

Consequently, the physiatry assessment to review the treatment plan was also not payable.

The application was dismissed.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident, specifically claiming costs for an attendant care assessment and a physiatry assessment.

The respondent denied the benefits, arguing the applicant's knee issues were pre-existing and not accident-related.

The Tribunal found that while the accident was a necessary cause of the applicant's knee pain, the requested assessments were not reasonable and necessary.

The medical evidence and surveillance did not support ongoing accident-related functional impairments that would justify the assessments years after the accident.

The application was dismissed.

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

The respondent denied several treatment plans for physiotherapy, massage, chiropractic services, and a worksite assessment.

The Tribunal found that the respondent's denial notices for the treatment plans were non-compliant with s. 38(8) of the Schedule because they lacked adequate medical reasons.

Applying the Divisional Court's decision in Suarez, the Tribunal held that the treatment plans were payable once incurred.

The Tribunal also found the worksite assessment to be reasonable and necessary based on the applicant's consistent reporting of back pain aggravated by prolonged sitting.

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

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that removed the applicant from the Minor Injury Guideline (MIG) and awarded three treatment plans due to deficient denial notices.

The Tribunal granted the reconsideration in part.

It found an error of law in removing the applicant from the MIG based solely on procedural notice contraventions, and upon reviewing the medical evidence, concluded the applicant did not establish chronic pain or psychological impairments warranting removal.

The Tribunal upheld the entitlement to two occupational therapy plans because the initial denial notices were sent only via HCAI and not directly to the applicant.

However, it reversed the entitlement to a physiatry assessment plan, finding the deficient notice was cured before the expense was incurred.

The 25 per cent award was varied to apply only to the two upheld treatment plans.

The appellant appealed a Licence Appeal Tribunal decision finding she was not catastrophically impaired under s. 3.1(1) 2. iii of the Statutory Accident Benefits Schedule.

The appellant suffered a severe and permanent alteration of the structure of her leg, but her functional mobility impairment (measured by the SCIM) was only temporary.

The Divisional Court upheld the adjudicator's interpretation that the SABS requires both the structural and functional alterations to be permanent to meet the catastrophic impairment threshold.

The appeal was dismissed.

The applicant sought entitlement to a social work assessment and occupational therapy services following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the treatment plans were reasonable and necessary.

The Tribunal preferred the respondent's psychological assessment over the applicant's physiatry report regarding the need for a social work assessment, and found insufficient evidence to support the disputed duration of occupational therapy sessions.

The applicant sought a medical benefit of $6,103.09 for a physiotherapy treatment plan following a motor vehicle accident.

The respondent insurer denied the plan, arguing the applicant had reached maximum medical recovery and the treatment was not reasonable and necessary given her pre-existing chronic back pain and the length of time since the accident.

The adjudicator found that the applicant failed to prove the proposed treatment was reasonable and necessary, noting that after 3.5 years of similar treatment, there was no evidence showing how further facility-based treatment would achieve the stated goals.

The application was dismissed and no interest was payable.

The applicant was injured in a motor vehicle accident and sought a medical benefit of $10,600 for a chronic pain treatment program, which the respondent insurer denied.

The Licence Appeal Tribunal found that the applicant proved on a balance of probabilities that the treatment plan was reasonable and necessary, preferring the evidence of the applicant's experts who diagnosed chronic pain over the respondent's assessors who did not specifically evaluate for chronic pain.

The Tribunal ordered the respondent to pay for the treatment plan and interest on overdue amounts, but denied the applicant's request for a special award under Ontario Regulation 664, finding no evidence that the insurer unreasonably withheld or delayed payment.

The applicant sought statutory accident benefits, including non-earner benefits, medical benefits for psychological services, chronic pain treatment, physiotherapy, and assessments, following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove her entitlement to the benefits.

The Tribunal gave substantial weight to the respondent's insurer's examination reports, noting that the applicant's self-reporting to her own experts was inconsistent with her statements to the respondent's assessors, undermining her claims of complete inability to carry on a normal life, psychological impairment, and chronic pain syndrome.

The applicant's requests for interest and a special award were also denied.

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

The insurer argued that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant, who had been an active amateur hockey player and weightlifter, claimed he developed chronic back pain as a result of the accident, which prevented him from continuing his athletic pursuits.

The arbitrator reviewed conflicting medical evidence from orthopaedic surgeons and other experts.

The arbitrator accepted the applicant's evidence and the medical opinions supporting a chronic pain diagnosis, finding that the ongoing sharp back pain constituted an injury beyond the scope of the MIG.

The arbitrator concluded that the applicant's injuries do not fall within the Minor Injury Guideline and awarded expenses to the applicant.

The appellant insurer appealed a jury verdict awarding the respondent damages for injuries sustained in a motor vehicle accident.

The appellant argued the trial judge erred by refusing to grant a mistrial after the respondent's counsel made improper comments during his closing address, by giving an inadequate correcting instruction, by allowing an expert to testify beyond his report, and by refusing to order an assignment of statutory accident benefits.

The Court of Appeal dismissed the appeal, finding the trial judge's correcting instruction adequately addressed the improper comments, the evidentiary ruling was fair, and the appellant failed to prove the jury's future care award mirrored the respondent's uncertain accident benefits entitlement.

The appellant insurer appealed a trial judgment awarding the respondent insured statutory accident benefits and $25,000 in damages for mental distress following a motor vehicle accident.

The insurer had terminated housekeeping and transportation benefits based on a superficial independent medical examination, ignoring its own occupational therapist's recommendations.

The Court of Appeal upheld the awards for housekeeping benefits, s. 24 assessments, and mental distress, finding that peace of mind is a reasonably contemplated object of an automobile insurance contract.

The court allowed the appeal only to reduce the quantum of transportation benefits from $7,500 to $2,280 due to a lack of evidence supporting the higher amount.