Dr. G. Karmy

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

The insurer classified his injuries under the Minor Injury Guideline (MIG) and denied various treatment plans and income replacement benefits (IRBs).

The Licence Appeal Tribunal found that the applicant developed a chronic pain condition, removing him from the MIG.

The Tribunal approved a chronic pain assessment plan but denied a psychological assessment and a chronic pain treatment plan, finding them not reasonable and necessary.

The claim for IRBs was also dismissed as the applicant failed to prove a substantial inability to perform the essential tasks of his employment as a cabinet maker.

The applicant was injured in a motor vehicle accident and sought medical benefits for psychological and neurological assessments.

The respondent insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and its $3,500 funding limit.

The Licence Appeal Tribunal found that the applicant did not sustain a concussion, psychological injury, or chronic pain as a result of the subject accident, noting that any ongoing symptoms were likely attributable to a subsequent accident.

The Tribunal concluded the applicant sustained a minor injury subject to the MIG, dismissed the claims for the disputed assessment plans, and denied claims for an award and interest.

The applicant sought medical benefits for physiotherapy and a bone growth stimulator following a motor vehicle accident.

The respondent denied the benefits and sought repayment of an income replacement benefit overpayment.

The Tribunal found that the treatment plans were not reasonable and necessary, relying on insurer's examination reports and surveillance indicating the applicant had reached maximum medical improvement.

The Tribunal also denied the respondent's request for repayment, finding that the formal request was made outside the 12-month statutory limitation period under section 52 of the Schedule.

The application was dismissed in its entirety.

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

The respondent denied various treatment and assessment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The adjudicator found that the applicant's physical and psychological injuries were predominantly minor and that she failed to establish that pre-existing conditions or chronic pain warranted removal from the MIG.

As the $3,500 MIG limit had been exhausted, the disputed treatment plans were deemed not reasonable and necessary, and the application was dismissed.

Both parties requested reconsideration of a decision regarding entitlement to statutory accident benefits following a motor vehicle accident.

The Applicant argued the Tribunal violated procedural fairness by admitting college records and failing to address a costs request, and made errors of fact and law in weighing medical evidence.

The Respondent argued the Tribunal erred in its interpretation of the Schedule regarding assessment fee limits.

The Tribunal granted the Applicant's request in part to address the omitted costs request, which was ultimately denied, and dismissed all other grounds for reconsideration, finding no significant errors of law or fact that would have changed the outcome.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

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

The applicant argued they suffered from chronic pain syndrome and psychological impairments that removed them from the MIG.

The Tribunal found that the applicant's injuries were predominantly minor, noting that the applicant returned to regular work duties shortly after the accident and did not demonstrate functional impairment.

The Tribunal preferred the evidence of the insurer's examination assessors over the applicant's pain specialist, who relied heavily on self-reporting during a virtual assessment.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

The respondent insurer determined the injuries fell within the Minor Injury Guideline (MIG) and denied several treatment plans.

The Tribunal found that the applicant suffered from chronic pain with functional impairment as a result of the accident, removing him from the MIG and its $3,500 funding limit.

The Tribunal approved five treatment plans for chiropractic and physical therapy services as reasonable and necessary, but denied two assessment plans for lack of supporting medical evidence.

The applicant sought entitlement to two treatment plans for chiropractic services and interest under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent denied the plans based on an insurer's examination which concluded the applicant sustained only uncomplicated soft tissue injuries.

The Tribunal found that the applicant failed to meet her burden of proving the treatment plans were reasonable and necessary, preferring the respondent's medical evidence over the applicant's chronic pain assessment, which relied heavily on subjective reporting.

The application was dismissed, and the respondent's request for costs due to late disclosure was denied.

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

The respondent insurer denied several treatment and assessment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been exhausted.

The applicant applied to the Licence Appeal Tribunal, arguing that pre-existing knee pain, chronic pain, and psychological injuries warranted removal from the MIG.

The Tribunal found no compelling evidence that the pre-existing condition precluded recovery, and preferred the respondent's medical assessors over the applicant's assessors regarding chronic pain and psychological injuries.

The Tribunal concluded the applicant sustained predominantly minor injuries, was subject to the MIG, and was not entitled to the disputed treatment plans as the funding limit was exhausted.

The applicant sought a section 10 award and costs, arguing the insurer unreasonably delayed removing him from the Minor Injury Guideline (MIG) and approving treatment plans following a motor vehicle accident.

The insurer had initially denied the plans based on section 44 examinations but later approved them upon receiving updated medical information.

The Tribunal found the insurer's initial reliance on its medical examinations was permissible and its subsequent approval of benefits demonstrated a continual assessment of the file, not unreasonable conduct.

The claims for an award and costs were dismissed.

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

The insurer denied a treatment plan for a chronic pain assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered from chronic pain syndrome and related psychological impairments, removing him from the MIG.

The Tribunal preferred the evidence of the applicant's chronic pain specialist over the insurer's physiatrist, who failed to address the psychological components of the pain.

The Tribunal also found the insurer failed to comply with the procedural requirements of section 38 of the Schedule by responding to the treatment plan almost a year late.

The applicant was awarded the cost of the assessment and interest.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs) and various medical treatment plans.

The insurer initially placed the applicant in the Minor Injury Guideline (MIG) and denied several treatment plans, later removing her from the MIG for psychological impairments but terminating IRBs based on insurer examinations.

The Licence Appeal Tribunal found that the applicant was not entitled to further IRBs, as she did not suffer a substantial inability to perform her essential tasks as an Uber driver, noting she was enrolled in a full-time massage therapy program.

The Tribunal upheld the insurer's denial of most treatment plans under s. 38(5) of the Schedule, but approved one physiotherapy plan and the balance of a psychological assessment.

Claims for an award for unreasonable delay were dismissed.

The applicant sought income replacement benefits and a physiotherapy treatment plan following a motor vehicle accident.

The Tribunal found that the applicant did not suffer a substantial inability to perform the essential tasks of her pre-accident employment within 104 weeks of the accident, nor a complete inability to engage in any employment thereafter.

The Tribunal preferred the respondent's multidisciplinary insurer examination reports over the applicant's expert reports, noting that the applicant's experts relied heavily on uncorroborated self-reporting and failed to address her pre-accident job duties.

The claim for the physiotherapy treatment plan, an award under Regulation 664, and interest were also dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and medical benefits from her insurer.

The insurer initially classified her injuries under the Minor Injury Guideline (MIG) and denied several treatment plans, later removing her from the MIG for psychological impairments but terminating IRBs based on insurer examinations.

The Licence Appeal Tribunal found that the applicant was not entitled to further IRBs, as she failed to prove a substantial inability to perform her essential tasks as an Uber driver, noting she was enrolled in a full-time massage therapy program.

The Tribunal upheld the insurer's denial of early treatment plans under section 38(5) of the Schedule but approved one physiotherapy plan and the balance of a psychological assessment, along with applicable interest.

The claim for an award for unreasonable delay was dismissed.

The applicant sought a non-earner benefit following a motor vehicle accident.

The insurer initially paid the benefit but terminated it following insurance examinations.

The applicant argued the termination notice was deficient under the Schedule.

The Tribunal found that while the notice lacked medical reasons, this did not automatically entitle the applicant to ongoing benefits.

On the merits, the Tribunal found the applicant failed to prove a complete inability to carry on a normal life, noting inconsistencies in his self-reporting, pre-existing conditions from a prior workplace accident, and evidence that he had returned to work.

The application was dismissed.

The applicant sought statutory accident benefits following a minor motor vehicle accident, including income replacement benefits (IRBs) and various medical benefits for physiotherapy, psychological, and chronic pain assessments.

The adjudicator dismissed the application in its entirety.

The adjudicator found that the applicant did not suffer a substantial inability to perform the essential tasks of her pre-accident employment, preferring the respondent's insurer's examination reports over the applicant's expert, who relied heavily on self-reporting and failed to review prior assessments.

The requested medical benefits were deemed not reasonable and necessary, as the evidence indicated the applicant's injuries fell within the Minor Injury Guidelines and she demonstrated the ability to perform her pre-accident duties and activities of daily living.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision.

The respondent insurer 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 diagnosed psychological injury (Adjustment Disorder) removed them from the MIG, despite the applicant's reported disinterest in psychological treatment.

While the Tribunal approved the psychological assessment and treatment plans, it denied the physiotherapy, assistive devices, and chronic pain plans, finding them not reasonable and necessary based on the medical evidence.

The Tribunal also ordered the respondent to pay an award of $1,110.95 under O. Reg. 664 for unreasonably withholding the psychological benefits by misinterpreting the Schedule.