Dr. Cook

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for psychological services and an attendant care assessment.

The respondent partially denied the psychological services and fully denied the attendant care assessment.

The Licence Appeal Tribunal found the applicant was entitled to 90-minute psychological sessions but not the higher hourly rate requested for a psychotherapist.

The Tribunal also granted the attendant care assessment based on the applicant's ongoing vertigo symptoms.

The applicant's request for a section 10 award for unreasonable delay was dismissed.

The applicant sought a determination that she sustained a catastrophic impairment due to a mental or behavioural disorder following a motor vehicle accident.

The respondent argued that the applicant was actively magnifying her symptoms and that her actual functional limitations were minor.

The Tribunal found that the applicant's symptom magnification was itself a symptom of her somatic symptom disorder and pre-existing mental health vulnerabilities.

The Tribunal concluded that the applicant sustained a marked impairment in the domain of adaptation, thereby meeting the definition of catastrophic impairment under the Schedule.

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

The insurer initially deemed her catastrophically impaired but later reversed its decision based on an addendum report.

The applicant disputed the denial of several treatment plans submitted during the period she was deemed catastrophically impaired.

The Licence Appeal Tribunal held that the insurer could not retroactively apply its decision to revoke the catastrophic impairment designation, as the Schedule is consumer protection legislation.

The Tribunal found the applicant was entitled to apply for enhanced catastrophic policy coverage during that period.

The Tribunal partially approved two psychological treatment plans and two physical therapy treatment plans, finding them reasonable and necessary, but denied the remaining treatment plans and the request for an award.

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

The respondent denied the benefits, arguing the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG).

The applicant argued her pre-existing conditions, including chronic pain and psychological impairments, were exacerbated by the accident and prevented recovery under the MIG.

The Tribunal found the applicant failed to provide compelling medical evidence that her physical or psychological injuries fell outside the MIG or that her pre-existing conditions precluded recovery within the MIG limits.

The application was dismissed.

The applicant sought payment for two psychological treatment plans, a special award, and interest following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, noting that the treating psychologist's reports were boilerplate and did not reflect the applicant's reported improvements or lack of functional difficulties.

The Tribunal preferred the respondent's section 44 assessor's report, which recommended a ramp down in treatment.

The application was dismissed, and no interest or award was payable.

The applicant was injured in a motor vehicle accident and sought medical benefits for optometric services and an occupational therapy assessment under the Statutory Accident Benefits Schedule.

The respondent denied the benefits, arguing the applicant's impairments were caused by a pre-existing brain aneurysm and other life stressors rather than the accident.

The Tribunal applied the 'but-for' test for causation and found the accident was a necessary cause of the applicant's increased symptoms.

The Tribunal preferred the evidence of the applicant's treating practitioners over the respondent's assessor, concluding the proposed treatment plans were reasonable and necessary.

The applicant was awarded the claimed benefits.

The applicant was injured in a motor vehicle accident and sought a non-earner benefit, medical and rehabilitation benefits, and the cost of an examination from the respondent insurer.

The adjudicator found that the applicant failed to prove a complete inability to carry on a normal life, as she continued to engage in her pre-accident activities of daily living.

The adjudicator also preferred the insurer's medical assessments, concluding that the proposed treatment plans and assessments were not reasonable and necessary.

The application was dismissed.

The applicant sought statutory accident benefits for chiropractic treatment following a motor vehicle accident.

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

The Licence Appeal Tribunal found that the applicant failed to provide objective evidence of functional improvement or recommendations from her family doctor to support the need for further chiropractic treatment.

The Tribunal also dismissed the applicant's argument that the respondent failed to comply with the timelines in s. 38 of the Schedule, finding insufficient evidence of non-compliance.

The application was dismissed.

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

The insurer denied treatment plans for chiropractic and psychological services, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that while the physical injuries were predominantly minor, the applicant demonstrated on a balance of probabilities that she sustained psychological impairments removing her from the MIG.

The Tribunal ordered payment for the psychological assessment and treatment plans, along with interest, but denied the chiropractic treatment plan as not reasonable and necessary.

The applicant sought statutory accident benefits for chiropractic, psychological, and occupational therapy services following a 2006 motor vehicle accident.

The insurer denied the treatment plans and raised a preliminary issue that the plans were initially unsigned.

The Tribunal held that the insurer waived the signature requirement by failing to raise it in the initial denial letters.

On the merits, the Tribunal found the chiropractic and occupational therapy plans were reasonable and necessary to address the applicant's chronic pain, though mileage expenses for the occupational therapist were excluded.

The psychological treatment plans were denied due to insufficient evidence of ongoing psychological distress and the applicant's failure to attend previously approved sessions.

A motion was brought under s. 19 of the Health Care Consent Act, 1996 seeking authorization to administer antipsychotic and mood stabilizing medication to an involuntary psychiatric patient pending the disposition of an appeal from a Consent and Capacity Board decision.

The court accepted evidence that the patient was incapable of consenting to treatment and that several statutory criteria under s. 19(2) were satisfied.

However, the court was not persuaded that the patient's condition required immediate treatment before the appeal could be heard and determined, which was scheduled within several weeks.

Because the urgency requirement under s. 19(2)(d) was not met, the requested interim treatment authorization was refused.