Dr. Ahmed Jwely

The applicant sought a determination of catastrophic impairment under Criterion 8 (mental or behavioural disorder) following a 2015 motor vehicle accident.

The Tribunal reviewed expert evidence and the applicant's self-reported functioning.

The Tribunal found the applicant's self-reports unreliable and inconsistent with his academic, employment, and social history.

The Tribunal concluded the applicant did not sustain a marked impairment in social functioning or adaptation, and therefore did not meet the threshold for a catastrophic impairment.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, claiming catastrophic impairment (CAT) based on mental and behavioural disorders, and entitlement to a post-104-week income replacement benefit (IRB).

The Licence Appeal Tribunal found that while the applicant sustained psychological impairments from the accident, she did not meet the Criterion 8 threshold for CAT, as she demonstrated only moderate impairments across the four spheres of functioning.

The Tribunal also dismissed the claim for an IRB, finding the applicant failed to prove a complete inability to engage in suitable employment, preferring the respondent's multi-disciplinary assessment.

The application was dismissed in its entirety.

The applicant was injured in a motor vehicle accident and sought a non-earner benefit and five physiotherapy treatment plans under the Statutory Accident Benefits Schedule.

The respondent denied the benefits, relying on section 44 insurer's examinations.

The Tribunal found that the applicant failed to demonstrate a complete inability to carry on a normal life, as the medical evidence indicated she could resume a substantial amount of her pre-accident activities.

The Tribunal also found the applicant failed to prove the physiotherapy treatment plans were reasonable and necessary, noting the lack of evidence showing how treatment goals were being met and the section 44 assessor's conclusion that she had reached maximum medical recovery from facility-based rehabilitation.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming catastrophic impairment under criteria 7 and 8, attendant care benefits, and physiotherapy services.

The Tribunal found the applicant was not catastrophically impaired, preferring the respondent's medical assessors and surveillance evidence which demonstrated the applicant maintained an active lifestyle and had significant pre-existing psychiatric conditions that were not properly accounted for by his own assessors.

The Tribunal also dismissed the claims for attendant care and physiotherapy, finding the applicant was capable of managing his daily activities independently and had reached maximum therapeutic benefit from prior treatments.

The applicant sought a determination of catastrophic impairment and various medical, rehabilitation, and attendant care benefits following a 2016 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant did not meet the threshold for catastrophic impairment under either Criterion 7 (55% whole person impairment) or Criterion 8 (marked impairment due to mental or behavioural disorder).

The Tribunal preferred the evidence of the respondent's assessors, finding the applicant's impairments were primarily physical and did not significantly impede her useful functioning.

Claims for attendant care, occupational therapy, and physiotherapy were dismissed as not reasonable and necessary, while a small claim for prescription medication was allowed with interest.

The applicant was injured in a motor vehicle accident and sought post-104-week income replacement benefits (IRBs).

The respondent denied the benefits, arguing the applicant did not suffer a complete inability to engage in any employment for which she was reasonably suited.

The Tribunal found that the applicant's physical impairments, specifically complex regional pain syndrome (CRPS) in her right arm, along with psychological impairments, prevented her from engaging in suitable employment, even on a part-time basis.

The Tribunal ordered the respondent to pay IRBs of $400 per week from September 1, 2022, plus interest.

The applicant's claim for an award under s. 10 of Regulation 664 for unreasonable withholding of benefits was dismissed.

The applicant sought various statutory accident benefits following a 2019 motor vehicle accident.

The respondent denied the claims.

The Tribunal considered procedural issues regarding late expert reports and submissions, ultimately admitting them to ensure procedural fairness.

On the merits, the Tribunal found the applicant was not entitled to the disputed physiotherapy, assistive devices, personal training, or psychological therapy, as she failed to prove they were reasonable and necessary, or they were barred by the Schedule's timing provisions.

However, the Tribunal granted entitlement to a $2,200 psychological assessment, finding it was submitted within the five-year limitation period and supported by medical evidence.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits, occupational therapy, a home modification assessment, and psychological services.

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal found the applicant's credibility was significantly impacted by his failure to disclose a pre-existing right knee impairment to assessors.

Surveillance evidence and inconsistent self-reports further undermined his claims for attendant care and occupational therapy.

The Tribunal also found the applicant had not utilized previously approved psychological treatment, failing to prove the necessity of additional sessions.

Claims for interest and a special award were consequently dismissed.

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

In a previous Licence Appeal Tribunal decision, it was determined that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant filed a second application seeking removal from the MIG and payment for new treatment plans.

The respondent raised the preliminary issue of res judicata.

The Tribunal found that the three preconditions for issue estoppel were met and that there was no fresh, new evidence to warrant waiving the doctrine.

The Tribunal dismissed the application as barred by res judicata and declined to award costs to the respondent.

The applicant was injured in a snowmobile accident and sought a determination that he sustained a catastrophic impairment due to a mental or behavioural disorder.

The respondent disputed the catastrophic impairment designation and denied several treatment plans and assessments.

The adjudicator found that the applicant sustained a catastrophic impairment, concluding he had marked impairments in activities of daily living, social functioning, and adaptation, despite the respondent's reliance on social media posts showing the applicant travelling.

The adjudicator awarded the disputed treatment plans at the catastrophic impairment rates and awarded HST on the assessments, but capped the assessment fees at the $2,000 statutory maximum.

Claims for a special award and costs were dismissed.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident.

The Licence Appeal Tribunal considered whether the applicant was entitled to treatment plans for psychological services, an MRI, and a chronic pain program, as well as an award under s. 10 of Regulation 664.

The Tribunal found the psychological services reasonable and necessary, relying on expert evidence that the accident exacerbated the applicant's pre-existing psychological issues.

However, the Tribunal denied the MRI request because the applicant failed to demonstrate why it could not be obtained through OHIP.

The chronic pain treatment was also denied, as the Tribunal found the supporting medical reports relied heavily on self-reporting and failed to account for the applicant's significant pre-accident impairments.

The claim for an award was dismissed, but interest was granted on the overdue psychological benefits.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed entitlement to treatment plans for psychological services and chronic pain assessments, arguing that psychological impairments and chronic pain warranted removal from the MIG.

The Tribunal found that the applicant failed to establish on a balance of probabilities that he suffered from a psychological condition or chronic pain with functional impairment that would preclude recovery within the MIG limits.

Relying on the respondent's psychiatric and physical assessments, the Tribunal concluded the applicant's injuries were predominantly minor.

The application for the disputed treatment plans and interest was dismissed.

The applicant sought a determination that she sustained a catastrophic impairment under s. 3.1(1)8 of the Statutory Accident Benefits Schedule following a motor vehicle accident.

The parties agreed the applicant had a Class 3 impairment in activities of daily living and a Class 4 impairment in adaptation.

The dispute centered on whether she had Class 4 impairments in social functioning and concentration, persistence, and pace.

The Tribunal preferred the respondent's psychiatric evidence, finding the applicant maintained close family relationships and could sustain focus for daily tasks.

The Tribunal concluded the applicant suffered only Class 3 impairments in the disputed spheres and therefore did not meet the criteria for catastrophic impairment.

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

The Tribunal found the applicant sustained a catastrophic impairment due to marked impairments in activities of daily living, concentration, persistence and pace, and adaptation.

The Tribunal approved three treatment plans for Botox injections, an attendant care assessment, and psychotherapy/social worker counselling, but denied thirteen other plans.

Claims for a special award and costs were dismissed, but interest was awarded on overdue benefits.

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

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

The Tribunal found that while the applicant's physical and psychological injuries did not warrant removal from the MIG, her accident-related chronic pain condition caused functional impairment justifying removal.

The Tribunal awarded an income replacement benefit for the first 104 weeks post-accident, finding the applicant suffered a substantial inability to perform her duties as a personal support worker.

However, post-104 week benefits were denied as she did not demonstrate a complete inability to engage in any suitable employment.

Various treatment plans and assessments were approved in part, and interest was awarded on overdue payments.