Dr. Esmat Dessouki

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

The Licence Appeal Tribunal found the applicant failed to establish that his pre-existing right shoulder condition precluded recovery within the MIG, relying on an insurer's examination that found no residual impairment.

The Tribunal also rejected the chronic pain claim, noting the applicant continued to work and lacked functional impairment.

Finally, the Tribunal dismissed the psychological impairment claim, preferring the insurer's in-person assessments over the applicant's virtual assessment and self-reporting.

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

The applicant sought statutory accident benefits following a motor vehicle accident, including a determination of catastrophic impairment under Criterion 8 (mental and behavioural disorders), income replacement benefits, attendant care benefits, and various treatment plans.

The Tribunal found that the applicant did not meet the catastrophic impairment threshold, as she failed to establish a marked impairment in the sphere of social functioning, noting her ongoing close familial relationships and 18-month post-accident employment at a school.

The Tribunal also dismissed the claims for income replacement benefits, finding the respondent's medical experts persuasive that she did not suffer a substantial inability to perform her pre-accident employment tasks.

The claims for attendant care benefits and treatment plans were dismissed due to a lack of evidence demonstrating the expenses were incurred or reasonable and necessary.

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 due to a partial thickness tear in his left shoulder and chronic pain.

The Tribunal found that a partial tear is considered a strain under the Superintendent's Guideline and falls within the MIG.

The Tribunal also found insufficient medical evidence to establish chronic pain with functional impairment.

As the applicant was held to the MIG, the disputed treatment plans were not considered, and claims for interest and an award were dismissed.

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

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

The Tribunal found that the applicant sustained a psychological impairment that warranted removal from the MIG, relying on corroborating evidence from multiple psychological professionals over the respondent's section 44 assessor.

Consequently, the Tribunal approved the disputed psychological assessment and treatment plans as reasonable and necessary.

However, the Tribunal dismissed the claims for physiotherapy treatment plans, finding the physical injuries were minor and the plans were not proven reasonable and necessary.

Interest was awarded on overdue benefits.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's denial of treatment plans for physiotherapy, a social work assessment, and an orthopaedic assessment.

The applicant argued the insurer's denial notices were procedurally defective under s. 38(8) of the Schedule.

The Tribunal found the insurer's denial notices were compliant and properly relied on an Insurer's Examination report.

As the applicant failed to provide submissions on the substantive reasonableness and necessity of the plans, the application was dismissed.

The insurer's request for costs due to the inadvertent inclusion of a settlement document was also denied.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB) and numerous treatment plans.

The Tribunal held that the 'complete inability' test for IRBs applies 104 weeks after the accident, not after 104 weeks of cumulative disability, and found the applicant did not meet this standard as she transitioned between similar factory jobs.

The Tribunal approved several treatment plans for chiropractic and occupational therapy services based on ongoing physical pain, as well as a later social work plan, but denied others lacking evidentiary support.

Claims for a section 10 award and costs were dismissed.

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

The respondent denied several treatment plans and a non-earner benefit, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered from chronic pain with functional impairment, removing him from the MIG.

The Tribunal approved treatment plans for physiotherapy, a psychological assessment, and a chronic pain assessment, but denied a treatment plan for psychological services.

The claim for a non-earner benefit was barred because the applicant failed to submit an Election of Benefits form (OCF-10).

A claim for an award under s. 10 of O. Reg. 664 was dismissed.

The applicant, a law student who was struck by a vehicle while riding a bicycle, sought a determination of catastrophic impairment under Criterion 8 (mental and behavioural disorders) and entitlement to various treatment plans.

The Tribunal found that the applicant did not meet the threshold for catastrophic impairment, as he did not demonstrate a marked impairment in three of four functional domains.

Despite accident-related challenges, the applicant successfully completed law school, passed the bar, and maintained employment as a lawyer.

The Tribunal also dismissed the claims for the disputed treatment plans, finding that the applicant failed to prove they were reasonable and necessary.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing that his pre-existing lumbar back pain and a psychological impairment warranted removal from the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to provide compelling medical evidence that his pre-existing condition would prevent maximal recovery within the MIG limits.

Furthermore, the Tribunal preferred the respondent's psychological assessment, concluding that the applicant did not suffer a psychological impairment caused by the accident.

As the applicant's injuries were deemed predominantly minor and the full $3,500 MIG limit had already been approved, the disputed treatment plans and claims for interest were dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including attendant care benefits, non-earner benefits, and a treatment plan for physiotherapy.

The respondent denied the benefits, arguing the applicant's impairments were related to a severe pre-existing workplace injury.

The Tribunal found that the applicant failed to prove his need for attendant care and physiotherapy was caused by the accident, as his pre-accident medical records showed similar functional limitations.

The Tribunal also found the applicant did not suffer a complete inability to carry on a normal life.

However, the Tribunal awarded non-earner benefits for a brief two-week period due to the respondent's failure to pay following the submission of a completed disability certificate.

The application was otherwise dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of treatment plans for chiropractic services, a chronic pain assessment, and a psychological assessment.

The Tribunal found the applicant failed to prove the chiropractic and chronic pain treatment plans were reasonable and necessary, noting her failure to produce pre-accident and post-accident clinical notes from her family physician and the lack of objective evidence of impairment in the insurer's orthopaedic examination.

However, the Tribunal approved the psychological assessment, as the respondent conceded it was reasonable and necessary based on its own psychological examination.

The Tribunal also ordered the respondent to pay interest and a special award under section 10 of O. Reg. 664 solely in relation to the delayed payment for the psychological assessment.

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

The Tribunal found that the applicant demonstrated a psychological impairment, removing her from the MIG, and approved two psychological treatment plans as reasonable and necessary.

However, the Tribunal dismissed the applicant's claim for chronic pain, finding she did not meet the criteria under the AMA Guides, and denied two chiropractic treatment plans.

The Tribunal also dismissed the applicant's claim for a special award, finding the insurer's conduct in handling the file was not excessive or imprudent.

Interest was awarded on the approved psychological benefits.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries fell outside the Minor Injury Guideline (MIG) due to pre-existing chronic lower back pain and accident-related psychological impairments.

The Tribunal found the applicant failed to provide objective medical evidence of a pre-existing condition that would preclude recovery within the MIG, preferring the respondent's orthopedic assessment.

The Tribunal also accepted the respondent's psychological assessment, finding insufficient evidence of a diagnosable psychological condition.

As the injuries were deemed minor and the MIG limits were exhausted, the proposed treatment plans, an award for unreasonable delay, and interest were denied.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits, removal from the Minor Injury Guideline, and payment for several treatment plans.

The Tribunal found that the applicant failed to prove a substantial inability to perform the essential tasks of his employment as a self-employed painter, relying on medical evidence showing mostly normal physical function and no significant psychological impairment.

The Tribunal also concluded that the applicant's injuries were predominantly minor soft-tissue sprains and strains, keeping him within the Minor Injury Guideline.

Because the $3,500 limit had been exhausted, the claims for additional treatment plans and an award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including several chiropractic treatment plans, a cognitive assessment, and a chronic pain assessment.

The Tribunal found that the applicant was removed from the Minor Injury Guideline during a prior case conference.

However, the applicant failed to provide sufficient medical evidence to prove that the disputed treatment plans were reasonable and necessary.

The application was dismissed.

The applicant sought a medical benefit for chiropractic services following a motor vehicle accident.

The respondent denied the treatment plan on the basis that it was submitted during a period when the applicant was entitled to treatment under the Minor Injury Guideline (MIG).

The Tribunal found that the respondent was permitted to refuse the treatment plan under s. 38(5) of the Schedule and that this refusal was final and not subject to review under s. 38(6).

Furthermore, the applicant failed to provide compelling medical evidence to demonstrate that the chiropractic services were reasonable and necessary.

The application was dismissed, and claims for a section 10 award and interest were also denied.

The applicant was injured in a motor vehicle accident in 2016, sustaining a severe right elbow fracture.

He received income replacement benefits (IRBs) for the first 104 weeks, after which the respondent denied further IRBs.

The applicant applied to the Licence Appeal Tribunal, claiming a complete inability to engage in any suitable employment due to physical pain, fear of reinjury, and psychological impairments including depression and anxiety.

The adjudicator dismissed the application, finding that the applicant's physical injuries had healed and his psychological issues were primarily related to boredom and lack of motivation rather than a complete inability to work.

The adjudicator preferred the respondent's expert evidence, which demonstrated the applicant retained the functional capacity and vocational aptitude for alternative employment.

The appellants, minors injured in a motor vehicle accident, appealed an Arbitrator's decision dismissing their claim for a special award and ordering them to pay the insurer's expenses.

The Director's Delegate found that the Arbitrator breached natural justice by failing to provide reasons for the expenses award, rescinding that portion of the order and remitting it for a re-hearing.

However, the Delegate upheld the dismissal of the special award claim, finding the Arbitrator correctly concluded there was insufficient evidence that the insurer unreasonably withheld or delayed payments.

The Delegate also held that while the Arbitrator may have erred in applying witness notice rules to a party, the exclusion of the appellant's testimony had no bearing on the outcome.

The applicant was injured in a motor vehicle accident and sought accident benefits from the insurer.

The insurer argued that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant, who had been an active amateur hockey player and weightlifter, claimed he developed chronic back pain as a result of the accident, which prevented him from continuing his athletic pursuits.

The arbitrator reviewed conflicting medical evidence from orthopaedic surgeons and other experts.

The arbitrator accepted the applicant's evidence and the medical opinions supporting a chronic pain diagnosis, finding that the ongoing sharp back pain constituted an injury beyond the scope of the MIG.

The arbitrator concluded that the applicant's injuries do not fall within the Minor Injury Guideline and awarded expenses to the applicant.

The applicant sought income replacement benefits (IRBs) and non-earner benefits (NEBs) following two motor vehicle accidents.

The insurer denied the benefits and sought repayment of $42,402.58 in IRBs previously paid, alleging material misrepresentation regarding the applicant's employment and income.

The arbitrator dismissed the applicant's claims, finding that his pain complaints were long-standing and pre-existing, and he failed to prove a substantial inability to perform his employment tasks or a complete inability to carry on a normal life.

The arbitrator also dismissed the insurer's claim for repayment, concluding there was insufficient evidence to prove the applicant wilfully misrepresented his employment or committed fraud.