Dr. Bob Karabatsos

The respondent insurer requested a reconsideration of a Tribunal decision that found the applicant catastrophically impaired based on a 55% whole person impairment rating.

The respondent argued the Tribunal provided insufficient reasons, reversed the burden of proof regarding psychiatric impairments, and erred in its assessment of musculoskeletal and headache impairments.

The Vice-Chair dismissed the request, finding that the original panel provided comprehensive, logical reasons for preferring the applicant's medical experts and correctly applied the AMA Guides.

No errors of law, fact, or procedural fairness were established.

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

The insurer denied a treatment plan for chiropractic services, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that the applicant was barred from proceeding for failing to attend an insurer's examination.

The Tribunal found the notice of examination was non-compliant, so the applicant was not barred.

However, the Tribunal concluded the applicant failed to prove his injuries warranted removal from the MIG, as he did not establish chronic pain with functional impairment caused by the accident, noting subsequent workplace injuries.

The application was dismissed.

The applicant sought a determination of catastrophic impairment based on a mental and behavioural disorder (Criterion 8) following a 2019 motor vehicle accident.

The applicant relied on the opinions of an ABI specialist and an orthopaedic surgeon, neither of whom performed formal catastrophic impairment testing.

The respondent presented surveillance evidence showing the applicant performing activities of daily living unassisted, contradicting her self-reports, and a psychiatric assessment concluding she suffered only moderate impairments.

The Tribunal found the applicant failed to meet her burden of proving a catastrophic impairment, noting inconsistencies in her reporting and the lack of qualified psychological or psychiatric assessments supporting her claim.

The application was 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 injuries were predominantly minor and did not meet the threshold for chronic pain that would remove him from the MIG.

However, because the respondent failed to provide proper notice under s. 38(8) of the Schedule for a chiropractic treatment plan, it was ordered to pay any incurred expenses for that plan.

The respondent also conceded payment for a chronic pain assessment due to late notice.

The applicant's claim for a special award under O. Reg. 664 was dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits for chiropractic treatment under the Statutory Accident Benefits Schedule.

The respondent insurer initially denied the benefits under the Minor Injury Guideline, but later conceded the applicant's injuries were non-minor based on a psychological assessment.

The applicant argued that pre-existing lower back pain and chronic pain syndrome necessitated further chiropractic care.

The adjudicator found that the applicant failed to provide objective medical evidence to support the treatment plans, noting that her own treating physicians recommended physiotherapy rather than chiropractic treatment.

The application for medical benefits, interest, and costs was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic and massage treatment.

The insurer denied the treatment plan, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that she had reached maximum recovery.

The arbitrator found that the applicant suffered from chronic pain syndrome exacerbated by pre-existing arthritis and osteoporosis, placing her injuries outside the MIG.

The arbitrator preferred the evidence of the applicant's family physician over the insurer's orthopaedic assessor, finding the treatment plan reasonable and necessary.

The insurer was ordered to pay the disputed medical benefits with interest.

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

The Licence Appeal Tribunal found that while the applicant's physical injuries were minor, her psychological impairments, including depression and anxiety, placed her outside the MIG.

The Tribunal denied five treatment plans for facility-based physical rehabilitation, finding the applicant had reached maximal recovery for her physical injuries.

However, the Tribunal approved the cost of a social work assessment up to the $2,000 statutory limit, finding it reasonable and necessary to address her ongoing psychological impairments.

Both parties' requests for costs were denied.