Dr. Costa El-Hage

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits and medical/rehabilitation benefits outside the Minor Injury Guideline (MIG) due to chronic pain and psychological injuries.

The Tribunal found the applicant's injuries were predominantly minor, as the evidence did not support a diagnosis of chronic pain or psychological impairment sufficient to remove him from the MIG.

Because the MIG limits were exhausted, the disputed treatment plans were not payable.

The claim for income replacement benefits was also dismissed for lack of evidence regarding the applicant's inability to perform essential employment tasks.

The applicant sought income replacement benefits following a motor vehicle accident.

The adjudicator found that the applicant failed to establish a substantial inability to perform the essential tasks of his pre-accident employment as a forklift driver.

The medical evidence, including insurer's examinations, indicated normal physical function and independence in daily activities.

Furthermore, the applicant had declared to the Canada Revenue Agency that he stopped working due to the COVID-19 pandemic and received government benefits, undermining his claim that his inability to work was accident-related.

The application was dismissed.

The applicant, a minor who sustained a catastrophic brain injury in a motor vehicle accident, sought statutory accident benefits to fund private school tuition for her twin brother.

The applicant argued that her brother's presence at the school was a necessary rehabilitative tool that significantly improved her communication and social engagement after traditional treatments failed.

The adjudicator found the treatment plans to be reasonable and necessary, rejecting the respondent's insurer examination report which speculated about potential harm to the brother.

However, the adjudicator dismissed the claim for payment because the applicant incurred the expenses before submitting the treatment plans, violating section 38(2) of the Schedule.

Claims for interest and a special award were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits and various treatment plans.

The respondent denied the claims.

The Tribunal found that the applicant failed to prove she suffered a complete inability to carry on a normal life, noting inconsistencies in her self-reporting and preferring the evidence of the respondent's assessors.

The Tribunal also found the disputed treatment plans were not reasonable and necessary.

The application was dismissed, and no award or costs were granted.

The applicant sought statutory accident benefits for medical treatments and examinations following a 2011 motor vehicle accident.

The respondent denied the benefits, arguing that the applicant's impairments were related to pre-existing degenerative conditions and a subsequent 2017 accident, rather than the 2011 accident.

The Tribunal applied the 'but for' test for causation and found that the applicant failed to prove the 2011 accident was a necessary cause of his impairments.

The Tribunal relied on the lack of contemporaneous medical evidence of injury, the applicant's extensive pre-existing health history, and surveillance evidence that contradicted the claimed impairments.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including physiotherapy, assistive devices, and costs of examinations for driving anxiety, functional abilities, and chronic pain.

The respondent denied the benefits, relying on an orthopedic assessment that placed the applicant in the Minor Injury Guideline.

The Tribunal found that the preponderance of medical evidence, including the applicant's OHIP claims history and clinical notes, supported the reasonableness and necessity of the disputed treatment plans and assessments.

The Tribunal ordered the respondent to pay the claimed benefits and interest, but denied the applicant's claim for a special award, finding no evidence of unreasonable delay or withholding.