Dr. Isa Mohammed

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits (IRB) and treatment plans outside the Minor Injury Guideline (MIG) due to chronic pain.

The Licence Appeal Tribunal found that the applicant failed to prove his injuries fell outside the MIG, as the medical evidence did not support a diagnosis of accident-related chronic pain with functional impairment.

The Tribunal also dismissed the claim for IRB, finding the applicant had returned to work and failed to establish a substantial inability to perform the essential tasks of his pre-accident employment.

The application was dismissed.

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

The respondent denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and sought repayment of $4,000 in Income Replacement Benefits (IRBs) alleging wilful misrepresentation of employment status.

The Tribunal found the applicant was removed from the MIG because medical evidence established he suffered a concussion.

The Tribunal dismissed the respondent's claim for IRB repayment, finding insufficient evidence that the applicant was working during the specific period the benefits were paid.

The applicant was awarded treatment plans for occupational therapy and psychological assessments, as they were deemed reasonable and necessary.

The claim for a special award under s. 10 of Regulation 664 was dismissed, as the respondent's reliance on its assessors was not unreasonable.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy, a concussion assessment, and a psychological assessment.

The respondent denied the benefits, initially relying on the Minor Injury Guideline (MIG).

The Tribunal found the applicant proved the physiotherapy and concussion assessment were reasonable and necessary based on clinical notes documenting pain and headaches.

The Tribunal partially approved the concussion assessment and fully approved the physiotherapy plans.

The claim for a psychological assessment balance was dismissed for lack of submissions.

The Tribunal denied the applicant's request for a special award under s. 10 of Reg. 664, finding the insurer's reliance on its medical assessors was reasonable, but awarded interest on overdue payments.

The applicant sought statutory accident benefits for two chiropractic treatment plans following a 2019 motor vehicle accident.

The respondent insurer denied the plans based on insurer examinations concluding the applicant had reached maximum medical improvement from soft tissue injuries.

The Tribunal found the applicant failed to prove the treatment was reasonable and necessary, noting that her own treating practitioners had not recommended chiropractic treatment and the chronic pain specialist's report was given limited weight.

The claims for the treatment plans, interest, and a special award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of multiple treatment and assessment plans, medication expenses, and parking costs.

The Tribunal found that the applicant failed to prove on a balance of probabilities that the proposed in-home, attendant care, neurological, concussion, chiropractic, physiotherapy, and psychological plans were reasonable and necessary, preferring the objective findings of the respondent's assessors over the subjective reporting relied upon by the applicant's assessors.

The Tribunal awarded the cost of one prescription medication and interest on overdue payments, but denied the remaining expenses and the claim for a special award under s. 10 of Reg. 664.

The applicant sought entitlement to 13 treatment plans for chiropractic, psychological, and assessment services following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the treatment plans were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's insurer's examinations, which indicated the applicant's soft tissue injuries had healed and his psychological condition had improved, over the applicant's evidence.

The applicant sought payment for various medical and rehabilitation benefits, including psychotherapy, chiropractic, acupuncture, massage, and occupational therapy expenses, following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application.

The Tribunal found the applicant was not entitled to the OCF-6 expenses because she failed to submit OCF-18 treatment plans prior to incurring the costs, as required by s. 38(2) of the Schedule.

The claim for chiropractic services was denied as the applicant failed to prove they were reasonable and necessary, with the Tribunal preferring the respondent's s. 44 assessment.

Finally, the claim for occupational therapy services related to provider travel time was dismissed because provider travel time is not an authorized transportation expense under s. 15(2)(c) of the Schedule.

The respondent insurer requested a reconsideration of a previous Tribunal decision that found the applicant entitled to various treatment plans, including chiropractic treatment, an attendant care assessment, a chronic pain assessment, and a psychological assessment.

The insurer argued that the Tribunal erred in law by applying incorrect tests to determine whether the treatment plans were reasonable and necessary, relying too heavily on the applicant's subjective reporting.

The adjudicator dismissed the request for reconsideration, finding that the Tribunal had properly applied the Statutory Accident Benefits Schedule, considered the evidence in its totality (including objective medical evidence), and made no errors of law or fact that would have changed the outcome.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, which the respondent insurer denied.

The applicant applied to the Licence Appeal Tribunal for dispute resolution.

The adjudicator found that the applicant was entitled to a comprehensive chiropractic treatment plan, an attendant care assessment, a chronic pain assessment, and a psychological assessment, as they were reasonable and necessary given the applicant's ongoing pain and psychological impairments.

However, two duplicative chiropractic treatment plans were denied.

The adjudicator also awarded interest on overdue payments but denied the applicant's requests for a special award and costs, finding no evidence of unreasonable conduct by the respondent.