Dr. John Heitzner

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit (NEB), medical benefits, and travel expenses.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that his pre-existing conditions were the primary cause of his impairments.

The Tribunal found the applicant was entitled to the NEB, relying on medical evidence that his physical and psychological impairments continuously prevented him from engaging in his pre-accident activities.

The Tribunal also approved the physiotherapy treatment plan and partial travel expenses, but denied the psychotherapy treatment plan, an award for unreasonable delay, and costs.

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 adjudicator found the applicant suffered from psychological conditions, including PTSD and Major Depressive Disorder, which removed her from the MIG.

The adjudicator approved a psychological services treatment plan and partially approved a physical therapy treatment plan, finding them reasonable and necessary.

Claims for a special award under s. 10 of Reg. 664 and costs were dismissed.

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

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that she suffered from chronic pain with a functional impairment.

Applying the AMA Guides as an analytical tool, the adjudicator noted the applicant did not rely heavily on prescription medication and maintained independence in her daily activities.

The Tribunal accepted the respondent's s. 44 physiatry assessment, concluding the injuries were predominantly minor.

The application for a $2,941.38 chiropractic treatment plan and interest was dismissed.

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

The Tribunal found the applicant was not entitled to the cost of personal protective equipment (PPE) in four partially approved physiotherapy treatment plans, as PPE is considered an administrative expense.

However, the Tribunal approved a subsequent physiotherapy treatment plan, a chronic pain assessment, and a physiatry assessment, finding them reasonable and necessary based on the applicant's ongoing complaints and the recommendations of his family doctor.

A proposed neurological assessment was denied.

The Tribunal also dismissed the applicant's claim for a special award under s. 10 of Reg. 664, finding the insurer's conduct was not unreasonable, and denied the respondent's request for costs.

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

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 documented pre-existing lower back and bilateral knee conditions precluded maximal medical recovery within the MIG, removing him from its limits.

The Tribunal approved treatment plans for chiropractic services, medical devices, and a functional ability assessment, finding them reasonable and necessary.

However, treatment plans for an attendant care assessment and a psychological assessment were denied for lack of compelling medical evidence.

The Tribunal also ordered the respondent to pay a special award of $1,714.36 under s. 10 of Regulation 664, finding that the insurer unreasonably withheld benefits by ignoring the pre-accident medical evidence.

The applicant was injured in a motor vehicle accident and sought post-104 income replacement benefits (IRBs) and funding for four treatment plans for chiropractic services.

The respondent denied the benefits.

The Tribunal found that the applicant met the test for post-104 IRBs, as her physical and psychological impairments resulted in a complete inability to engage in any employment for which she was reasonably suited.

The Tribunal also approved the four treatment plans, finding them reasonable and necessary for pain relief, and awarded interest on overdue payments.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, which were denied by the respondent insurer.

The applicant applied to the Licence Appeal Tribunal for entitlement to various treatment plans, an attendant care assessment, and the cost of an accounting report for an income replacement benefit calculation.

The Tribunal found that the applicant failed to prove on a balance of probabilities that the treatment plans and assessments were reasonable and necessary, noting a lack of supporting medical evidence and reliance on an insurer's examination that concluded the applicant had reached maximum medical recovery.

The Tribunal also denied the cost of the accounting report because the applicant had not submitted the required disability certificate to establish entitlement to income replacement benefits.

The application was dismissed.

The Applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs), attendant care benefits (ACBs), and various medical and rehabilitation treatment plans.

The Licence Appeal Tribunal found the Applicant was not entitled to IRBs because he failed to provide the insurer with requested information, and was not entitled to ACBs because they were neither reasonable and necessary nor incurred.

However, the Tribunal approved the treatment plans for chiropractic and psychological services, preferring the evidence of the Applicant's treating practitioners over the insurer's paper-review assessors.

Claims for occupational therapy and a special award under s. 10 of Regulation 664 were dismissed.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that removed the applicant from the Minor Injury Guideline (MIG) and awarded three treatment plans due to deficient denial notices.

The Tribunal granted the reconsideration in part.

It found an error of law in removing the applicant from the MIG based solely on procedural notice contraventions, and upon reviewing the medical evidence, concluded the applicant did not establish chronic pain or psychological impairments warranting removal.

The Tribunal upheld the entitlement to two occupational therapy plans because the initial denial notices were sent only via HCAI and not directly to the applicant.

However, it reversed the entitlement to a physiatry assessment plan, finding the deficient notice was cured before the expense was incurred.

The 25 per cent award was varied to apply only to the two upheld treatment plans.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, claiming costs for a gym membership, a personal trainer, and a chronic pain management program.

The respondent denied the benefits, arguing they were not reasonable or necessary.

The Tribunal dismissed the application, preferring the respondent's in-person medical assessment over the applicant's virtual assessments and noting the lack of contemporaneous evidence or referrals from the applicant's family doctor.

Claims for a special award and interest were also dismissed.

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

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

The Licence Appeal Tribunal found that the applicant failed to prove his injuries warranted removal from the MIG, preferring the respondent's insurer examination reports over the applicant's limited medical evidence.

As the MIG limit was exhausted, the treatment plans were denied.

Claims for a section 10 award, interest, and costs were also dismissed.

The applicant sought $1,678.10 for a physiotherapy treatment plan following a motor vehicle accident.

The Tribunal excluded a portion of the applicant's submissions for exceeding the mandated page limit.

On the merits, the Tribunal found the applicant failed to meet the burden of proving the treatment was reasonable and necessary, as no expert evidence or detailed analysis was provided.

The Tribunal accepted the respondent's physiatrist assessment that the applicant had reached maximum medical recovery.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought approval for a physiotherapy treatment plan costing $3,927.98, which the respondent insurer denied.

The respondent relied on an insurer's examination report suggesting the applicant had not responded to facility-based treatment.

The Tribunal found the treatment plan reasonable and necessary, preferring the recommendations of the applicant's treating practitioners and independent assessor who supported ongoing physical treatment.

The Tribunal ordered the respondent to pay for the treatment plan along with applicable interest.

The applicant sought entitlement to various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident, including a massaging bathtub, a lightweight vacuum cleaner, physiotherapy, massage therapy, and a BrainEx group therapy program.

The respondent denied the treatment plans on the basis that they were not reasonable and necessary.

The Tribunal dismissed the application, finding that the applicant failed to meet her burden of proof.

The Tribunal preferred the objective medical evidence of the respondent's assessors, noting that the applicant's ongoing symptoms were largely attributable to pre-existing conditions such as fibromyalgia and chronic migraines, and that the requested treatments were either excessive in cost, unsupported by medical evidence, or unnecessary given the applicant's medical history.

The applicant sought a non-earner benefit and a medical benefit for chiropractic services following a motor vehicle accident.

The adjudicator found that the applicant did not meet the test for a non-earner benefit, as video surveillance and medical assessments demonstrated she had resumed most of her pre-accident activities, including caring for her children, driving, and household chores.

The adjudicator also denied the medical benefit for chiropractic services, finding it was not reasonable and necessary because the applicant had reached a plateau in her recovery and was successfully participating in an independent exercise program.

Claims for an award under Ontario Regulation 664 and interest were consequently dismissed.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) for 104 weeks.

The respondent terminated IRBs on the basis that the applicant did not meet the post-104 week test of a complete inability to engage in any suitable employment.

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

The Tribunal found the applicant's evidence regarding his pain levels to be unreliable, noting evidence of symptom exaggeration and malingering from the respondent's expert assessors.

The Tribunal concluded the applicant failed to prove he suffered a complete inability to engage in suitable employment and dismissed the claims for IRBs, interest, and a special award.

The applicant sought entitlement to an income replacement benefit, medical benefits for physiotherapy, and the costs of psychological and orthopaedic assessments following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the claims for the income replacement benefit, physiotherapy, and orthopaedic assessment, finding insufficient medical evidence for the IRB and noting that the treatment plans for physiotherapy and orthopaedics were improperly delivered to the wrong insurer.

However, the Tribunal granted the cost of the psychological assessment, finding the respondent's denial unreasonable as it relied on an unhelpful and generalized independent examination report that failed to adequately address the applicant's psychological symptoms.

The applicant was injured in a motor vehicle accident and sought ongoing income replacement benefits (IRBs) and payment for various medical/rehabilitation treatment plans and assessments after the respondent insurer terminated them.

The Tribunal found that the applicant's radiculopathy and disc herniation were caused by the accident, rejecting the insurer's argument of an intervening event.

The Tribunal concluded the applicant met both the pre-104 week and post-104 week tests for IRBs, establishing a complete inability to engage in suitable employment.

However, the applicant failed to meet her burden to prove that the disputed treatment plans and assessments were reasonable and necessary.

The application was granted in part, with ongoing IRBs awarded.

The applicant sought a non-earner benefit following a 2013 motor vehicle accident, claiming it exacerbated her pre-existing psychiatric issues and chronic pain.

The insurer denied the benefit, arguing her activities of daily living had not substantially changed.

The arbitrator found that the applicant's normal life had changed due to a prior 2011 accident and family conflicts, not the 2013 accident.

Despite an aggravation of her chronic pain, she continued to engage in substantially all her pre-accident activities, such as attending workshops, driving, and socializing.

The application was dismissed, and expenses were awarded to the insurer.

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

The parties settled the claims for income replacement and medical benefits, leaving only the issue of whether the applicant was entitled to a Special Award under s. 282(10) of the Insurance Act for the insurer's initial denial of benefits.

The arbitrator found that the insurer acted reasonably at all relevant times based on the medical information available, which supported a theory that the applicant's impairments were due to pre-existing degenerative disc disease rather than the accident.

The claim for a Special Award was dismissed.