Dr. Shaul

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to psychological and chronic pain assessments outside the Minor Injury Guideline (MIG).

The respondent denied the benefits, arguing the injuries were predominantly minor.

The Tribunal found the applicant failed to prove on a balance of probabilities that she suffered from chronic pain with a functional impairment or an accident-related psychological condition, noting compelling evidence of malingering from the respondent's psychological expert.

The application was dismissed, and claims for the assessments, a special award, and interest were denied.

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

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

The Licence Appeal Tribunal found that the applicant suffered minor soft tissue injuries and failed to provide compelling evidence of a psychological impairment or chronic pain that would warrant removal from the MIG.

The Tribunal relied on the respondent's section 44 medical assessments, which found the applicant had returned to work and normal activities, and noted a lack of corroborating clinical records for the applicant's self-reported symptoms.

The application was dismissed, and the treatment plans and interest were denied.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming he sustained a catastrophic impairment under criterion 7 of the Schedule.

The central dispute involved competing psychological assessments, with the applicant's expert assigning a 20% whole person impairment rating and the respondent's expert assigning 0%.

The Tribunal preferred the respondent's expert, finding that the assigned scores more accurately reflected the applicant's level of functioning and testimony regarding his return to work and socializing.

As a result, the applicant failed to meet the 55% threshold for catastrophic impairment.

The claims for various assessments, an award, and interest were consequently dismissed.

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

The respondent denied several treatment plans for chiropractic and psychological services.

The Tribunal found that the chiropractic treatment plans were reasonable and necessary to address the applicant's chronic pain, relying on the clinical notes of the applicant's family physician.

However, the Tribunal denied the psychological treatment plans because the applicant failed to provide evidence justifying the proposed hourly rates and the costs of the psychological materials.

The Tribunal also dismissed the applicant's claim for a special award, finding no evidence that the respondent unreasonably withheld or delayed benefits.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits for a chronic pain program, psychological services, and driving rehabilitation.

The insurer denied the treatment plans.

The Tribunal found that the applicant failed to meet the burden of proving the treatments were reasonable and necessary.

The applicant did not satisfy the AMA Guides criteria for chronic pain, and the objective medical evidence, including an insurer's examination, did not support a psychological impairment.

The application was dismissed, and claims for interest and a special award were denied.

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

The respondent denied various treatment plans and an income replacement benefit on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's physical injuries were soft tissue in nature and captured by the MIG.

The Tribunal rejected the applicant's claims of psychological impairment and chronic pain, noting inconsistent self-reporting and placing little weight on a chronic pain assessment conducted via videoconference without objective documentation.

As the applicant failed to prove her injuries warranted removal from the MIG and the $3,500 limit was exhausted, the disputed treatment plans were denied.

The claim for an income replacement benefit was also dismissed as the applicant provided no submissions on the issue.

The applicant sought statutory accident benefits following a motor vehicle accident, which were denied by the respondent insurer.

The Licence Appeal Tribunal reviewed multiple treatment plans for physical and psychological therapies, attendant care assessments, and assistive devices.

The Tribunal found the applicant was entitled to partial payment for several treatment plans, including massage, acupuncture, physiotherapy, and psychological treatment, as well as attendant care assessments.

The Tribunal also awarded a $450 special award under s. 10 of O. Reg. 664, finding the insurer unreasonably denied the psychological components of a treatment plan without addressing them in its denial or submissions.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits, medical and rehabilitation benefits, and the cost of various assessments.

The insurer denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to demonstrate that the claimed attendant care benefits were incurred or reasonable and necessary, given her self-reported independence with activities of daily living.

The Tribunal also found that the proposed psychological, chiropractic, and neurological assessments and treatments were not reasonable and necessary, preferring the evidence of the insurer's examiners.

As no benefits were payable, claims for interest and a special award were also dismissed.

The applicant sought a non-earner benefit and medical and rehabilitation benefits following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant did not suffer a complete inability to carry on a normal life and that the proposed treatments were not reasonable and necessary.

The Tribunal found that the applicant's pre-existing conditions were the primary cause of her ongoing complaints and that she was able to perform substantially all of her pre-accident activities of daily living.

The Tribunal dismissed the application, concluding the applicant failed to meet the test for a non-earner benefit and did not establish that the disputed treatment plans were reasonable and necessary.

The plaintiff, Ms. Emmanuel, sought general damages for injuries sustained in a motor vehicle accident.

A jury found her 75% at fault but awarded general damages and Family Law Act damages.

The court then conducted a threshold analysis under the Insurance Act to determine if Ms. Emmanuel's injuries constituted a permanent serious impairment of an important physical, mental, or psychological function.

The court found insufficient objective medical evidence to support permanence of physical injuries and no sufficient evidence for psychological injuries beyond 2017, especially considering her post-accident activities and lack of consistent treatment.

Consequently, the court dismissed the action, finding that Ms. Emmanuel did not meet the statutory threshold for non-pecuniary damages.

The applicant sought statutory accident benefits following a motor vehicle accident, including treatment plans for physiotherapy, a chronic pain assessment, assistive devices, and psychological services.

The Tribunal dismissed the claims for physiotherapy, chronic pain assessment, and psychological services, finding the applicant's evidence inconsistent and relying on surveillance showing her performing activities she claimed she could not do.

The Tribunal granted the treatment plan for assistive devices, as both parties' occupational therapists recommended them.

Claims for a special award and costs were dismissed.

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

The respondent denied various treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) limit of $3,500, which had been exhausted.

The Tribunal found that the applicant failed to meet his onus to prove his physical or psychological injuries warranted removal from the MIG.

The adjudicator preferred the respondent's insurer examination reports over the applicant's assessors, noting significant inconsistencies in the applicant's evidence, particularly his failure to report any accident-related complaints to his family doctor for over two years.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, which the respondent insurer denied.

The applicant applied to the Licence Appeal Tribunal.

The adjudicator found that the applicant was entitled to a psychological assessment and psychological services, as the evidence supported that she suffered from accident-related psychological impairments warranting removal from the Minor Injury Guideline (MIG).

However, the adjudicator denied the claims for physical treatments, functional abilities evaluation, and chronic pain programs, finding insufficient objective medical evidence to establish they were reasonable and necessary.

The adjudicator also awarded a 5% special award under s. 10 of O. Reg. 664 and $200 in costs against the respondent due to its unreasonable 16-month delay in removing the applicant from the MIG after its own assessor recommended it.

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 payment of $503.90, representing the denied balance of a $2,200.00 psychological assessment proposed following a motor vehicle accident.

The respondent had partially approved the treatment plan based on a paper review by its psychological expert, who opined that the proposed cost was excessive and that the assessment could be completed for $1,696.10.

The Tribunal found that the applicant failed to discharge the onus of proving the full amount claimed was reasonable and necessary, as no particulars were provided to justify the maximum fee.

The application was dismissed, along with claims for interest and an award.

The applicant sought a non-earner benefit and various medical and assessment costs following a motor vehicle accident.

The adjudicator found that the applicant did not meet the test for a non-earner benefit, as video surveillance and independent medical examinations demonstrated he had returned to most activities of daily living and his ongoing impairments were largely attributable to pre-existing cancer and chemotherapy.

The claims for psychological treatment, attendant care assessment, and chronic pain assessment were dismissed as not reasonable and necessary.

The adjudicator approved the balance of a psychological assessment and dismissed the claim for a special award.

The applicant sought statutory accident benefits, including an income replacement benefit and medical/rehabilitation benefits, following a 2015 motor vehicle accident.

The Licence Appeal Tribunal found the applicant failed to prove a substantial inability to perform the essential tasks of his employment, noting he returned to work for over a year post-accident and his work stoppage coincided with the sale of his employer's business.

The Tribunal also denied the claimed medical benefits, finding the applicant's shoulder and knee issues were degenerative or unrelated to the accident, and the psychological assessment lacked evidentiary weight.

The application was dismissed in its entirety.

The applicant sought non-earner benefits and medical benefits following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant was barred from claiming non-earner benefits because she failed to submit a completed disability certificate supporting her claim, as required by s. 36(2) of the Schedule.

Furthermore, the Tribunal found that the applicant failed to establish that she suffered a complete inability to carry on a normal life, noting that her pre-accident medical records contradicted her testimony regarding her pre-accident activity levels.

The claim for a psychological pre-screening assessment was also dismissed as not reasonable and necessary, and no award or costs were granted.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident, including funding for chiropractic treatment, a social work assessment, and a neurological assessment.

The Licence Appeal Tribunal found the chiropractic treatment plan to be reasonable and necessary, relying on the respondent's own assessors who acknowledged the applicant's chronic pain and potential benefit from facility-based treatment.

However, the Tribunal denied the social work and neurological assessments, finding them duplicative and unsupported by the medical evidence.

Claims for an award for unreasonably withheld benefits and costs were also dismissed.

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

The respondent denied certain treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been reached.

The applicant argued that pre-existing back pain, chronic pain, and psychological impairment removed him from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence of a pre-existing condition that would prevent maximal recovery within the MIG limits.

Furthermore, the Tribunal concluded that the applicant did not prove on a balance of probabilities that he suffered from chronic pain or a psychological impairment as a result of the accident.

Consequently, the applicant's injuries were deemed minor, and his claims for additional medical benefits and interest were dismissed.