Dr. Ahmad Belfon

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

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

The applicant applied to the Licence Appeal Tribunal, arguing she should be removed from the MIG due to chronic pain syndrome and a mild traumatic brain injury.

The Tribunal found that the applicant's expert medical evidence was not corroborated by the clinical notes and records of her family physician.

The Tribunal concluded the applicant did not meet her burden to prove her injuries warranted removal from the MIG, and dismissed the application.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing her injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain and psychological impairments.

The Licence Appeal Tribunal found the applicant did not meet her burden to prove a functional impairment from chronic pain or a psychological impairment, placing weight on the respondent's independent medical and psychological evaluations which included objective testing.

As the applicant remained subject to the MIG, her claims for various treatment plans, interest, and an award for unreasonable delay were dismissed.

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

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

As a preliminary issue, the Tribunal exercised its discretion under s. 55(2) of the Schedule to allow the applicant to proceed with a claim for a psychological assessment despite her failure to attend scheduled insurer's examinations.

On the substantive issues, the Tribunal found that the applicant failed to establish chronic pain with functional impairment or a psychological condition sufficient to remove her from the MIG.

Consequently, the applicant was not entitled to the disputed treatment plans, interest, or an award under s. 10 of Reg. 664.

The application was dismissed.

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 based on pre-existing chronic pain and psychological conditions from a prior accident, as well as chronic pain resulting from the subject accident.

The Tribunal found insufficient medical evidence to prove the pre-existing conditions prevented maximal medical recovery within the MIG, or that the subject accident caused a chronic pain condition with functional impairment.

The application was dismissed.

The applicant sought an award under s. 10 of Reg. 664 and interest, arguing the respondent unreasonably delayed approving a treatment plan for chiropractic and massage therapy.

The respondent had initially denied the plan based on an insurer's examination but approved it shortly before the hearing.

The Tribunal found that the respondent was fulfilling its ongoing obligation to adjust the file and reasonably relied on its assessor's opinion when it initially denied the plan.

The Tribunal concluded the respondent's conduct was not imprudent, stubborn, inflexible, or unyielding, and dismissed the claims for an award and interest.

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) and the $3,500 limit had been exhausted.

The applicant argued for removal from the MIG due to chronic pain and psychological impairment.

The Tribunal found insufficient medical evidence to support chronic pain with functional impairment or a psychological impairment caused by the accident.

The application was dismissed, and the applicant remained subject to the MIG limits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and an orthopaedic assessment.

The respondent denied the benefits, initially relying on the Minor Injury Guideline (MIG), though the MIG was later conceded.

The Tribunal found the applicant entitled to the first physiotherapy treatment plan based on supportive clinical notes from his family physician.

However, the Tribunal dismissed the claims for subsequent physiotherapy plans and the orthopaedic assessment due to a lack of medical evidence demonstrating they were reasonable and necessary.

The claim for a special award under s. 10 of O. Reg. 664 was dismissed as the insurer's conduct did not rise to the level of being unreasonable, given the applicant's failure to provide requested medical documentation.

The Applicant sought entitlement to various treatment plans and an award under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Respondent denied the plans and sought repayment of $12,800 in income replacement benefits, alleging the Applicant wilfully misrepresented her post-accident employment status.

The Tribunal dismissed the Applicant's claims, finding she failed to meet her burden to establish the reasonableness and necessity of the treatment plans or justify higher hourly rates.

The Tribunal granted the Respondent's request for repayment, holding that the Applicant's failure to respond to a section 33 request regarding her return to work constituted wilful misrepresentation, thereby exempting the Respondent from the standard 12-month notice period for repayment.

The applicant was injured in a motor vehicle accident and sought payment for three treatment plans for chiropractic services, which the respondent insurer denied.

The respondent also sought to exclude the clinical notes and records of the applicant's family physician due to alleged late disclosure, which the Tribunal denied as the respondent had prior notice of them.

The Tribunal found the treatment plans reasonable and necessary, preferring the evidence of the applicant's assessors and treating physician over the respondent's insurer examinations.

The applicant was awarded the cost of the treatment plans and interest on overdue payments.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and treatment plans for orthopedic, neurological, and psychological assessments.

The adjudicator dismissed the application in its entirety.

The adjudicator found that the insurer's denial notices complied with section 36(4) of the Schedule and that the applicant failed to prove a complete inability to carry on a normal life.

Furthermore, the requested medical assessments were deemed not reasonable and necessary, and the applicant failed to justify an enhanced hourly rate for psychological services.

Claims for a section 10 award and interest were also dismissed.

The applicant sought payment for a $1,463.52 physiotherapy treatment plan following a motor vehicle accident.

The respondent insurer denied the plan based on insurer examinations indicating the applicant's soft tissue injuries had substantially resolved.

The Tribunal found that the applicant failed to prove the treatment was reasonable and necessary, as there was no current medical evidence supporting the need for ongoing facility-based therapy.

Claims for an award for unreasonable delay and interest were also dismissed.

The applicant sought accident benefits following a motor vehicle accident, which the respondent denied on the basis that her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG due to a pre-existing traumatic brain injury and chronic pain with functional impairment.

The Tribunal found that the applicant failed to establish that her pre-existing condition prevented maximal recovery within the MIG, noting medical evidence that she had reached maximum medical recovery.

The Tribunal also found insufficient evidence of chronic pain or functional impairment, as the applicant had resumed driving and work duties.

Consequently, the applicant was held to be subject to the MIG, and her claims for physiotherapy treatment plans and interest were dismissed.

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

The Tribunal found the applicant was barred from claiming an income replacement benefit due to the expiry of the two-year limitation period, as the insurer's denial was clear and unequivocal.

The Tribunal determined the applicant's injuries fell within the Minor Injury Guideline (MIG) as there was insufficient evidence of physical or psychological impairments warranting removal.

However, several treatment plans were deemed payable because the insurer's denial notices failed to comply with the specificity requirements of s. 38(8) of the Schedule.

Claims for other treatment plans and an award were dismissed.

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

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

The Tribunal found that the applicant's injuries were not predominantly minor, as medical evidence established he suffered from chronic pain with functional impairment.

The Tribunal approved a treatment plan for psychological services, finding it reasonable and necessary to address the applicant's ongoing psychological symptoms.

However, the Tribunal denied treatment plans for a chronic pain assessment and a psychological assessment, concluding that their stated goals were therapeutic rather than diagnostic.

The applicant was awarded interest on overdue benefits.

The applicant sought entitlement to statutory accident benefits for chiropractic services and a neurological assessment following a 2018 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, noting a lack of corroborating clinical notes from her family physician and accepting the respondent's independent medical examination reports.

The application was dismissed, and no award for unreasonable delay was granted.

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

The respondent denied a treatment plan for a psychological assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG due to a psychological condition and chronic pain.

The Tribunal found the applicant's psychological evidence lacked objective testing and a diagnosis, preferring the respondent's psychological assessment which found no impairment.

The Tribunal also found insufficient evidence of chronic pain causing functional impairment.

The application was dismissed, and the applicant was held to the MIG limits.

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 Tribunal found the applicant suffered from chronic pain with functional impairment, meeting the criteria under the AMA Guides, and removed him from the MIG.

However, the applicant failed to provide the treatment plans or sufficient submissions to prove they were reasonable and necessary.

The claims for the treatment plans, interest, and an award were dismissed.

The applicant sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent insurer denied portions of several treatment plans for physiotherapy, occupational therapy, and psychological services, as well as transportation expenses.

The adjudicator found that the respondent's denial notices were compliant with section 38(8) of the Schedule.

The applicant failed to prove that the disputed physiotherapy, occupational therapy, and transportation expenses were reasonable and necessary.

However, the adjudicator found that the proposed psychological services were reasonable and necessary based on the treating psychologist's evidence of ongoing symptoms.

The claim for an award for unreasonable delay was dismissed.

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

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

The applicant argued she should be removed from the MIG due to chronic pain with functional impairment and a psychological condition.

The Tribunal found the applicant did not meet the burden of proving chronic pain with functional impairment or a psychological condition, relying on the respondent's insurer examinations.

The Tribunal also reviewed the respondent's denial letters for compliance with s. 38(8) of the Schedule.

It found one denial letter non-compliant and ordered the respondent to pay for the associated physiotherapy treatment plan once incurred.

The remaining treatment plans and the claim for an award under s. 10 of Reg. 664 were dismissed.

The applicant sought entitlement to statutory accident benefits for an orthopaedic assessment and physiotherapy services following a motor vehicle accident.

The adjudicator found that the applicant failed to meet her burden of proving the treatment plans were reasonable and necessary, noting that she did not submit the plans into evidence or provide specific submissions on their goals.

Relying on insurer examination reports which indicated the applicant had uncomplicated soft tissue injuries and was working 13 hours a day without restrictions, the adjudicator dismissed the claims for treatment, interest, and a special award.