Dr. Lexier

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain.

The applicant also argued the insurer was barred from relying on the MIG due to alleged non-compliance with the 10-day notice requirement under s. 38(8) of the Schedule.

The Tribunal found the insurer had complied with the notice requirements.

Furthermore, relying on medical assessments from both parties' experts which showed largely normal findings, the Tribunal concluded the applicant did not meet the AMA Guides criteria for chronic pain.

The application was dismissed as the injuries were predominantly minor and the $3,500 limit had been exhausted.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits from the respondent insurer under the Statutory Accident Benefits Schedule.

The insurer denied several treatment plans on the basis that they were not reasonable and necessary, relying on section 44 assessments.

The Tribunal found that the applicant was entitled to $338.61 for a therapeutic pool membership and $2,359.99 for chiropractic treatment, as these were reasonable, necessary, and incurred.

However, the Tribunal dismissed the claims for the remaining treatment plans, finding that the applicant failed to meet her burden of proving they were reasonable and necessary, particularly given the lack of substantive analysis and the inclusion of excessive ancillary fees.

Interest was awarded on the overdue benefits.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to optometry services, prescription eyewear, and physiotherapy for a rotator cuff tear.

The Licence Appeal Tribunal denied the claims for optometry services and eyewear, finding insufficient evidence that the applicant's pre-existing vision issues were exacerbated by the accident.

However, the Tribunal granted the claim for physiotherapy, finding that the rotator cuff tear was caused by the accident and that the applicant was not required to exhaust OHIP-funded physiotherapy before seeking accident benefits.

Interest was awarded on the overdue physiotherapy benefits.

Following an arbitration where the applicant's claims for statutory accident benefits were dismissed, the insurer sought its expenses of approximately $35,000.

The arbitrator declined to order the applicant's counsel to personally pay the expenses, finding no evidence of frivolous claims or unreasonable delay attributable to counsel.

The arbitrator found the insurer was entitled to its expenses from the applicant as the successful party.

However, the arbitrator reduced the claimed fees and disbursements, noting the case was not particularly complex and disallowing costs for transcripts and excessive expert preparation time.

The applicant was ordered to pay $15,000 in expenses to the insurer.

The applicant sought statutory accident benefits following a motor vehicle accident, including medical benefits and income replacement benefits (IRBs).

The insurer denied the claims on the basis that the applicant's impairments fell within the Minor Injury Guideline (MIG) and that he did not meet the disability test for IRBs.

The arbitrator dismissed all of the applicant's claims, finding significant credibility issues due to inconsistent reporting of pre-accident medical history, post-accident employment, and income.

The arbitrator concluded that the applicant's impairments were predominantly minor injuries and that he failed to prove a substantial inability to perform the essential tasks of his pre-accident employment, noting that he had worked in physically demanding jobs post-accident.

The applicant was injured in a motor vehicle accident and received income replacement benefits for two years.

The insurer terminated benefits based on an orthopaedic surgeon's opinion that the applicant could work, despite contrary evidence from its own vocational expert and the applicant's treating physicians.

The arbitrator found the insurer's reliance on the surgeon's opinion to be unreasonable and a breach of its duty of good faith.

The arbitrator awarded a special award of 40% of the outstanding benefits and interest, noting the applicant's vulnerability and the foreseeable harm caused by the termination.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits, physiotherapy expenses, travel expenses, and the cost of a medical assessment report.

The arbitrator dismissed the claims for income replacement benefits and physiotherapy, finding the applicant's evidence lacked credibility and noting inconsistencies in his testimony regarding his job duties and post-accident conduct.

The arbitrator awarded $52 for travel expenses and $963 for the cost of a physiatry report, finding those expenses reasonable and necessary.

The claim for a special award was dismissed as the insurer's cautious approach was justified given the credibility concerns.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them based on medical assessments indicating he could return to his pre-accident employment as a machine operator.

The arbitrator found that the insurer's assessments relied on a flawed ergonomic report that incorrectly classified the applicant's job as sedentary to light.

The arbitrator accepted the applicant's evidence that his job required significant standing, bending, and lifting, which he could no longer perform for a full shift due to ongoing knee pain and swelling.

The applicant was awarded ongoing income replacement benefits and supplementary medical benefits for physiotherapy, while the insurer's claims for repayment and a special award were dismissed.