Dr. Kopansky-Giles

The applicant sought statutory accident benefits following a 2016 motor vehicle accident, specifically claiming costs for a chronic pain assessment and chiropractic treatment.

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

The Tribunal preferred the evidence of the respondent's section 44 assessors, noting a significant gap in the applicant's reports of accident-related pain to her family physician and a lack of objective evidence demonstrating functional impairment or the efficacy of past treatments.

As no benefits were payable, the claim for interest was also dismissed.

The applicant was injured in a motor vehicle accident and sought various treatment plans for physiotherapy and assessments under the Statutory Accident Benefits Schedule.

The respondent denied the plans.

The Tribunal found the applicant was entitled to a physiotherapy treatment plan of $2,418.00, a functional impairment assessment of $1,988.80, and a physiatry assessment of $2,000.00, noting the respondent failed to provide proper medical reasons for denying the assessments under s. 38(8) of the Schedule.

The Tribunal denied the remaining physiotherapy treatment plans, finding them not reasonable and necessary based on the insurer's examination reports.

The claim for an award under Regulation 664 was dismissed, but interest was awarded on overdue benefits.

The applicant sought a special award and interest under the Statutory Accident Benefits Schedule, alleging the respondent insurer unreasonably delayed and withheld payment of non-earner and medical benefits.

The Licence Appeal Tribunal found that while the insurer made adjusting errors, including a 44-day delay in initial payment and a 7-month delay in providing section 44 assessment reports, these errors did not amount to unreasonable withholding or delay of benefits.

The application was dismissed, and no award or additional interest was ordered.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for assistive devices and psychological treatment.

The insurer denied the treatment plans.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide medical evidence proving the assistive devices were reasonable and necessary, and failed to submit the psychological treatment plan into evidence to justify the disputed balance.

As no benefits were payable, the claim for interest was also dismissed.

The applicant sought payment for two treatment plans for chiropractic and massage therapy following a motor vehicle accident.

The respondent denied the plans on the basis that they were not reasonable and necessary, relying on an insurer's examination by a chiropractor.

The Tribunal found that the applicant failed to meet his burden of proving the treatment was reasonable and necessary, noting a lack of continuous medical records and the fact that the treatment plans were submitted 2.5 years after their creation.

The Tribunal accepted the respondent's expert evidence and dismissed the application, including the claim for an award for unreasonable delay.

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, injured in a motor vehicle accident, sought payment for two sets of assistive devices and a psychological assessment under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal denied the claims for assistive devices, finding the applicant failed to prove they were reasonable and necessary given her self-reported improvement and ability to perform daily tasks.

However, the Tribunal granted the request for a psychological assessment, noting the applicant's ongoing residual symptoms of anxiety and depressed mood, and awarded corresponding interest.

Both parties' requests for costs were denied.