Dr. Leon Steiner

The applicant sought a determination of catastrophic impairment and entitlement to attendant care benefits and hearing aids following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant was statute-barred from claiming attendant care benefits because she failed to dispute the insurer's denial within the two-year limitation period, and the justice of the case did not warrant an extension.

On the issue of catastrophic impairment, the Tribunal applied the AMA Guides to assess the applicant's physical and psychological impairments, ultimately finding a combined Whole Person Impairment (WPI) of 56%, which exceeds the 55% threshold under Criterion 7.

The Tribunal denied the claim for hearing aids because the applicant incurred the expense without first submitting a treatment plan, contrary to section 38(2) of the Schedule.

The claim for a special award was also dismissed as the insurer did not unreasonably withhold or delay benefits.

The applicant, who was 14 years old at the time of the motor vehicle accident, sought statutory accident benefits including non-earner benefits (NEBs) and various treatment plans.

The adjudicator found that the applicant demonstrated a complete inability to carry on a normal life due to chronic pain and psychological impairments, entitling her to NEBs of $185 per week for the disputed period.

A treatment plan for psychological services was also approved as reasonable and necessary.

However, the adjudicator denied plans for an attendant care assessment and driving reintegration services, finding insufficient evidence to support them.

The claim for an award for unreasonable delay was dismissed, but interest was awarded on the payable benefits.

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).

The applicant claimed his psychological injuries and hearing loss warranted removal from the MIG.

The Tribunal found the applicant failed to establish that his psychological condition or hearing loss removed him from the MIG, noting a lack of objective evidence and causation issues.

However, the Tribunal ordered the respondent to pay for two assessments because it failed to provide timely notices of denial under s. 38(8) of the Schedule.

The applicant's request for an award for unreasonable delay was dismissed.

The applicant was involved in a motor vehicle accident in 2019 and subsequently died of a drug and alcohol overdose in 2022.

Her estate claimed Death and Funeral Benefits, arguing the accident caused a psychological downward spiral leading to her death.

The Licence Appeal Tribunal applied the 'but for' test for causation and reviewed the applicant's medical and counselling records.

The Tribunal found that while the applicant suffered an initial psychological impairment from the accident, her condition had improved significantly by mid-2021, and her subsequent relapse into substance abuse was unrelated to the accident.

The application for benefits and a special award was dismissed.

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, disputing the insurer's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed entitlement to non-earner benefits and funding for psychological services, relying on a psychological assessment diagnosing him with major depressive disorder and PTSD.

The Tribunal found that the applicant failed to provide corroborating medical evidence, such as clinical notes and records, to establish non-minor physical or psychological impairments.

The Tribunal accepted the respondent's psychological assessment, which found the applicant's symptoms did not meet DSM-5 criteria.

The claim for non-earner benefits was also dismissed due to a lack of evidence regarding the applicant's pre-accident activities and objective medical evidence demonstrating a complete inability to carry on a normal life.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The insurer denied an income replacement benefit (IRB) and two treatment plans.

On a rehearing, the Tribunal found the applicant was entitled to the IRB, as medical evidence supported a substantial inability to perform the essential tasks of his pre-accident employment due to chronic pain and a right shoulder impairment.

The Tribunal denied the April 11, 2022 treatment plan as it was submitted while the applicant was in the Minor Injury Guideline (MIG) and duplicated an approved OCF-23.

The September 21, 2022 treatment plan was approved as reasonable and necessary.

The Tribunal denied the applicant's request for a special award, finding the insurer's reliance on its assessors' reports was not unreasonable.

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

The Tribunal found that the applicant sustained a psychological condition as a result of the accident, warranting removal from the Minor Injury Guideline (MIG).

The applicant was denied funding for five chiropractic treatment plans and a psychological assessment due to insufficient evidence.

However, the Tribunal approved a treatment plan for a chronic pain assessment, finding reasonable grounds based on family doctor records.

The applicant was awarded interest on overdue benefits but denied a special award under s. 10 of Reg. 664.

The applicant requested reconsideration of a Licence Appeal Tribunal decision that denied his claims for an income replacement benefit and treatment plans following a motor vehicle accident.

The Vice-Chair found that the original adjudicator made significant factual errors by overlooking a key letter from the applicant's treating physician that connected his injuries to the accident, and by failing to explicitly consider the applicant's psychological expert evidence.

These errors were found to likely have impacted the outcome of the decision.

The request for reconsideration was granted, the original decision was cancelled, and the matter was ordered to be reheard by a new adjudicator based on the existing written record.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit, an attendant care assessment, and chiropractic services.

The Licence Appeal Tribunal dismissed the claims for the non-earner benefit and the attendant care assessment, finding the applicant failed to provide sufficient medical evidence or a detailed comparison of pre- and post-accident activities to establish a complete inability to carry on a normal life.

However, the Tribunal granted the treatment plans for chiropractic services, concluding that the medical evidence supported the necessity of physical therapy for the applicant's accident-exacerbated bilateral shoulder and knee impairments.

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

The insurer denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and she did not qualify for a non-earner benefit.

The Licence Appeal Tribunal found the applicant failed to prove her pre-existing psychological condition prevented maximal recovery within the MIG.

The Tribunal also dismissed the claim for a non-earner benefit, finding the medical evidence demonstrated the applicant continued to engage in her pre-accident activities and did not suffer a complete inability to carry on a normal life.

The application was dismissed.

The applicant sought a determination of catastrophic impairment and entitlement to attendant care benefits and income replacement benefits following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant did not meet the criteria for catastrophic impairment under either Criterion 7 (55% whole person impairment) or Criterion 8 (mental and behavioural disorders).

The Tribunal preferred the evidence of the respondent's experts, noting significant validity concerns and sub-maximal effort during the applicant's assessments.

Consequently, the applicant was not entitled to enhanced attendant care benefits, having exhausted her non-catastrophic limits.

The Tribunal also dismissed the claim for income replacement benefits, finding the applicant failed to prove a substantial inability to perform the essential tasks of her pre-accident employment as a personal support worker.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on a pre-existing right-leg fracture and an accident-related psychological impairment.

The Tribunal found that the applicant failed to provide compelling medical evidence that her pre-existing condition prevented maximal recovery within the MIG.

Furthermore, the Tribunal afforded little weight to the applicant's psychological assessment due to a lack of corroborating medical records and reliability issues.

As the applicant remained within the MIG, her claims for disputed treatment plans, interest, and an award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits and medical benefits beyond the Minor Injury Guideline (MIG) due to psychological impairments.

The Tribunal found that the applicant failed to establish a psychological impairment warranting removal from the MIG, preferring the respondent's expert evidence which noted credibility issues and inconsistent effort during testing.

The Tribunal also dismissed the claim for income replacement benefits, finding insufficient medical evidence to prove a substantial inability to perform the essential tasks of the applicant's pre-accident employment as a window packer.

All claims, including those for disputed treatment plans and interest, were dismissed.

The applicant sought accident benefits following a motor vehicle accident, arguing for removal from the Minor Injury Guideline (MIG) due to chronic pain and psychological impairments.

The Tribunal found the medical evidence, including clinical notes from the family doctor and a sports medicine physician, supported soft tissue injuries rather than accident-related chronic pain with functional impairment.

The Tribunal preferred the respondent's psychological assessment over the applicant's, concluding there was no accident-related psychological diagnosis.

The applicant was found to remain within the MIG, and claims for a psychological assessment, an award, interest, and costs were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and costs for psychological assessments and services.

The Licence Appeal Tribunal found that the applicant did not meet the test for a non-earner benefit, as he failed to demonstrate a complete inability to carry on a normal life.

However, the Tribunal granted the costs for the psychological assessment and services, finding that the additional hours billed for interpretation services and planning due to the applicant's language barrier were reasonable and necessary.

The applicant's claim for a special award under section 10 of Regulation 664 was dismissed, as the insurer's conduct was not found to be unreasonable.

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

In a prior 2024 decision, the Tribunal determined the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant filed a second application seeking removal from the MIG based on new treatment plans and medical reports.

The respondent raised the preliminary issue of res judicata.

The Tribunal found that the three preconditions for issue estoppel were met and that the new medical reports did not constitute fresh, previously unavailable evidence that would impeach the original result.

The application was dismissed as barred by res judicata.

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 Tribunal found that the applicant sustained a psychological impairment that warranted removal from the MIG, relying on corroborating evidence from multiple psychological professionals over the respondent's section 44 assessor.

Consequently, the Tribunal approved the disputed psychological assessment and treatment plans as reasonable and necessary.

However, the Tribunal dismissed the claims for physiotherapy treatment plans, finding the physical injuries were minor and the plans were not proven reasonable and necessary.

Interest was awarded on overdue benefits.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB), medical and rehabilitation benefits for physiotherapy and psychological services, and an award for unreasonable delay.

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal found the applicant failed to prove a substantial inability to perform the essential tasks of her employment, preferring the respondent's expert evidence over the applicant's experts.

The Tribunal also found the applicant failed to prove the disputed treatment plans were reasonable and necessary.

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

The Tribunal found the applicant's evidence insufficient to establish a psychological injury or chronic pain with functional impairment, preferring the respondent's assessments.

The Tribunal also rejected the applicant's arguments that the respondent's denial notices contravened section 38 of the Schedule.

The application was dismissed, and the applicant was held to the MIG limits.