Dr. Alfonso Marino

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).

The applicant argued for removal from the MIG based on chronic pain and psychological impairments.

The Tribunal found the applicant's injuries were predominantly minor, preferring the insurer's medical and psychological assessments which indicated no functional impairment and no accident-related psychological diagnosis.

As the applicant remained within the MIG, the disputed treatment plans were not payable.

Claims for an award and interest were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the denial of a physiotherapy treatment plan and the partial denial of psychological treatment plans.

The Tribunal dismissed the claim for physiotherapy, finding the applicant failed to provide contemporaneous corroborating medical evidence to establish it was reasonable and necessary.

However, the Tribunal granted the disputed amounts for the psychological treatment plans, ruling that a registered psychotherapist providing cognitive behavioural therapy under the direct supervision of a psychologist should be compensated at the same hourly rate as a psychologist under the Professional Services Guideline.

The claim for a special award was dismissed as the insurer's conduct was not unreasonable.

The applicant sought entitlement to a non-earner benefit, various treatment plans for physiotherapy and psychological services, an attendant care assessment, and an award under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Tribunal found the applicant failed to establish a complete inability to carry on a normal life, as there was insufficient evidence comparing his pre- and post-accident activities.

The Tribunal also dismissed the claims for the treatment plans, preferring the respondent's insurer examination reports which indicated the applicant had returned to his activities of daily living and sustained only minor injuries.

The application was dismissed in its entirety.

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

The respondent denied the claims, relying on section 44 assessments which found no significant functional or psychological impairments.

The Tribunal found the applicant's self-reported limitations inconsistent with physical examinations and preferred the respondent's comprehensive psychological assessment over the applicant's provisional phone-based diagnosis.

The Tribunal concluded the applicant's injuries fell within the MIG and dismissed the claims for additional treatment plans and interest.

The applicant was involved in a motor vehicle accident and sought an income replacement benefit (IRB) from the respondent insurer.

The Tribunal found that the applicant sustained an accident-related psychological impairment that caused a substantial inability to perform the essential tasks of her pre-accident employment as a grocery store cashier.

Furthermore, the Tribunal determined that this impairment caused a complete inability to engage in any reasonably suited employment past the 104-week mark, but that this complete inability resolved by June 2, 2023, when she was ready to return to work.

The applicant was awarded an IRB of $400 per week from October 4, 2020, to June 2, 2023, plus interest on overdue payments.

The applicant sought statutory accident benefits following a 2013 motor vehicle accident.

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

The Tribunal found that the applicant's right shoulder pain had developed into a chronic pain condition, satisfying three criteria under the AMA Guides, thereby warranting removal from the MIG.

The Tribunal approved treatment plans for a psychological assessment and for massage and chiropractic services, finding them reasonable and necessary.

However, a proposed chronic pain assessment was denied as the applicant was already under the care of a pain specialist.

Interest was awarded on the overdue benefits.

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

The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to provide objective medical evidence that his physical or psychological injuries were non-minor or that pre-existing conditions precluded his recovery within the MIG.

The Tribunal accepted the respondent's insurer's examinations, which concluded the applicant suffered no psychological impairments and only minor physical injuries.

As the MIG limits had been exhausted, the proposed treatment plans were deemed not reasonable and necessary, and the application was dismissed.

The applicant sought income replacement benefits and approval for various treatment plans following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove on a balance of probabilities that he suffered a substantial inability to perform the essential tasks of his employment or a complete inability to engage in any employment.

The Tribunal preferred the respondent's medical evidence, noting inconsistencies in the applicant's expert reports and relying on the applicant's successful completion of a three-month accounting work placement.

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

The applicant sought statutory accident benefits following a motor vehicle accident, claiming chronic pain and psychological impairments warranted removal from the Minor Injury Guideline (MIG).

The respondent denied the treatment plans, arguing the injuries were minor.

The Tribunal found the applicant's medical evidence, consisting primarily of application forms and self-reported symptoms, insufficient to establish chronic pain or psychological impairment.

Preferring the respondent's multidisciplinary assessments, the Tribunal concluded the applicant's injuries were minor and dismissed the claims for treatment plans outside the MIG limit.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, claiming catastrophic impairment due to psychological disorders.

The Licence Appeal Tribunal found that while the applicant suffered from accident-related post-traumatic stress disorder and major depressive disorder, these resulted in only moderate impairments in the activities of daily living and social functioning.

Consequently, the applicant did not meet the threshold for catastrophic impairment under Criterion 8.

The Tribunal also dismissed claims for attendant care benefits, finding them not reasonable and necessary based on orthopedic evidence of normal range of motion.

Claims for an attendant care assessment and various treatment plans were dismissed because the applicant had exhausted the $65,000 non-catastrophic funding limit.

The applicant sought various statutory accident benefits following a 2017 motor vehicle accident, including attendant care benefits, occupational therapy, assistive devices, and assessments.

The Licence Appeal Tribunal found that the applicant's ongoing impairments were caused by pre-existing degenerative conditions rather than the accident, relying on the respondent's orthopaedic assessment.

The Tribunal denied further attendant care benefits and most treatment plans, but approved a psychological assessment, an attendant care assessment, and an inner bathmat.

The claim for a special award was dismissed as the respondent did not act unreasonably or in bad faith.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to treatment plans for chiropractic services, a psychological assessment, and a chronic pain assessment.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the policy limits were exhausted.

The Tribunal found that the applicant failed to prove her chronic pain and psychological impairments were accident-related or severe enough to warrant removal from the MIG.

As the MIG limits were exhausted, the claims for treatment plans, a section 10 award, and interest were dismissed.

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

The respondent denied several treatment plans 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 predominantly minor soft tissue injuries, relying on the assessments of medical physicians over the applicant's chiropractor.

The Tribunal also found insufficient evidence of a psychological impairment that would warrant removal from the MIG.

As the applicant's injuries were subject to the $3,500 MIG limit, which had largely been exhausted, the disputed treatment plans were not payable.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain, psychological impairments, and pre-existing conditions.

The Licence Appeal Tribunal found that the applicant failed to provide compelling medical evidence to support removal from the MIG.

The Tribunal preferred the respondent's medical assessments, which concluded the physical injuries were soft tissue in nature and that there was no psychological impairment.

Consequently, the applicant was not entitled to the disputed treatment plans, interest, or an award.

The applicant sought medical 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 that the applicant suffered from an accident-related psychological impairment, removing him from the MIG.

However, while the Tribunal ordered payment for a psychological assessment, it denied the claims for physical therapy and psychological services, finding the physical therapy had plateaued and the psychological services were reasonably available through OHIP.

The applicant sought reconsideration of a Licence Appeal Tribunal decision that found her subject to the Minor Injury Guideline (MIG) and denied several disputed medical benefits.

The applicant argued the Tribunal erred in its application of s. 38 of the Statutory Accident Benefits Schedule, violated procedural fairness by admitting expert reports without cross-examination, and incorrectly assessed her physical and psychological impairments.

The adjudicator dismissed the request for reconsideration in full, finding no significant errors of law or fact, and concluding that the admission of the expert reports was an appropriate exercise of the Tribunal's procedural powers.

The adjudicator also affirmed that the applicant's injuries, including TMJ dysfunction and psychological distress, were properly classified as minor injuries or clinically associated sequelae.

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

The insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that she sustained psychological impairments that removed her from the MIG.

The adjudicator found that the applicant's self-reporting and medical evidence did not support a finding of significant psychological impairment attributable to the accident.

The adjudicator concluded that the applicant's injuries fell within the MIG, and since the $3,500 limit had been exhausted, the disputed treatment plans were not payable.

Claims for a disability certificate, interest, and an award for unreasonable withholding of benefits were also dismissed.

The applicant sought medical benefits following a motor vehicle accident, arguing her physical and psychological injuries, including TMJ disorder and driving anxiety, warranted removal from the Minor Injury Guideline (MIG).

The Tribunal found the applicant's injuries were predominantly minor and subject to the $3,500 MIG limit.

The Tribunal also rejected the argument that the insurer's failure to comply with the section 38(8) timeline permanently barred it from relying on the MIG.

The insurer was ordered to pay the remaining $465.97 under the MIG limit for incurred physiotherapy, but the claims for TMJ and psychological assessments, as well as a claim for an award, were dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) beyond the date the insurer terminated them.

The adjudicator found that the applicant suffered a substantial inability to perform the essential tasks of his pre-accident employment as a gas station owner/operator, as his accident-related impairments prevented him from working the required hours.

The applicant was awarded IRBs for the disputed period, subject to a deduction of 70% of his post-accident employment income.

The insurer was entitled to a repayment of overpaid IRBs based on this deduction, and the applicant was awarded interest on overdue payments.