Dr. Gaurav Gupta

The applicant, who was deemed catastrophically impaired following a 2015 motor vehicle accident, sought payment for several treatment plans denied by the respondent insurer.

The Licence Appeal Tribunal found that the proposed physiotherapy services were not reasonable and necessary, as the applicant had reached maximum medical recovery and previous treatment yielded no functional gains.

The Tribunal partially approved the psychological services plan for the OCF-18 completion fee but denied administrative and planning costs.

The Tribunal approved the occupational therapy and case management plans, finding the requested hours for documentation and planning to be reasonable.

The applicant's claim for a special award was dismissed, as the insurer's conduct was not found to be unreasonable.

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 sought statutory accident benefits following a motor vehicle accident, specifically a $1,696.00 treatment plan for physiotherapy.

The respondent denied the plan, arguing the applicant sustained minor soft tissue injuries that had healed.

The Tribunal found the treatment plan reasonable and necessary, preferring the applicant's physiatrist's evidence that the treatment provided pain relief for ongoing musculoskeletal injuries.

The Tribunal ordered the respondent to pay for the treatment plan plus interest, but declined to order an award under s. 10 of Reg. 664 as the applicant provided no submissions to justify it.

The applicant sought various medical and rehabilitation benefits following a 2018 motor vehicle accident.

The Licence Appeal Tribunal found the applicant was entitled to a treatment plan for cognitive behaviour therapy, a plan for cognitive therapy and concussion-focused counseling, and a psychiatric assessment, as these were supported by medical evidence or previously approved by the respondent.

Claims for a new mattress, optometric services, an EMG assessment, a sleep study, and expenses submitted on OCF-6 forms were denied for lack of contemporaneous medical support or because they were incurred prior to approval.

The Tribunal also ordered the respondent to pay a 25% special award under s. 10 of Regulation 664 for its stubborn and inflexible conduct in failing to pay for the CBT and psychiatric assessment plans that it had already approved.