Dr. Louis Weisleder

The self-represented applicant sought income replacement benefits (IRBs) following a motor vehicle accident.

The Tribunal admitted late-filed evidence from both parties, prioritizing a liberal interpretation of the rules and the consumer protection mandate of the Schedule.

While the Tribunal found that the applicant's shoulder injury caused a substantial inability to perform the essential tasks of his self-employment at a pizza restaurant, the application was ultimately dismissed.

The applicant failed to provide sufficient financial evidence or an accountant's report to prove the quantum of his accident-related income loss.

The applicant sought payment for a chiropractic treatment plan totaling $3,447.50 following a motor vehicle accident.

The applicant argued the respondent failed to comply with statutory notice requirements under the Schedule.

The Tribunal found the respondent's notices were compliant and provided sufficient medical reasons for requesting an insurer's examination.

Relying on the respondent's medical assessments, which concluded the applicant sustained uncomplicated soft tissue injuries and had reached maximum medical improvement, the Tribunal determined the proposed treatment was not reasonable and necessary.

The application was dismissed.

The applicant sought entitlement to statutory accident benefits for an orthopaedic assessment and physiotherapy following a 2015 motor vehicle accident.

The Licence Appeal Tribunal found that the orthopaedic assessment was duplicative of two prior assessments and therefore not reasonable and necessary.

The Tribunal also denied the physiotherapy treatment plan, noting the applicant had reached maximum medical improvement and failed to demonstrate how the treatment goals would be met.

Claims for interest and a special award were consequently dismissed.

The applicant sought statutory accident benefits for physiotherapy, chiropractic, and massage therapy following a 2018 motor vehicle accident.

The respondent denied the treatment plans.

The Tribunal found the applicant failed to prove the proposed treatments were reasonable and necessary, noting her extensive pre-existing conditions and lack of support from her treating physicians.

The application was dismissed, and claims for interest and a section 10 award were denied.

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

The respondent insurer limited the applicant to the Minor Injury Guideline (MIG) and denied several treatment plans.

The Tribunal found that the applicant suffered a right knee meniscus tear caused by the accident, which falls outside the MIG definition, and removed him from the MIG.

The Tribunal approved a $2,000 chronic pain assessment but denied other treatment plans for chiropractic services, a medical assessment, and a psychological assessment as they were either duplicative, premature, or not reasonable and necessary.

The applicant's claim for an award for unreasonable withholding of benefits was 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) and the $3,500 limit had been exhausted.

The applicant argued for removal from the MIG due to chronic pain, a psychological impairment, and a pre-existing injury from a prior accident.

The Tribunal found that the applicant suffered predominantly minor soft-tissue injuries and failed to substantiate the claims for chronic pain, psychological impairment, or a pre-existing condition that precluded recovery within the MIG.

The application was dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits for psychological services, a chronic pain management program, and physical therapy.

The respondent partially denied the psychological services and fully denied the other treatment plans.

The Tribunal found that the psychological services, to be provided by a registered psychotherapist, were reasonable and necessary, and that the respondent unreasonably withheld payment by applying the unregulated professional rate.

The Tribunal awarded the disputed amount for psychological services, plus a 25% award under s. 10 of Reg. 664 and interest.

The claims for the chronic pain management program and physical therapy were dismissed, as the Tribunal preferred the respondent's medical evidence that the applicant had reached maximum medical recovery and did not meet the criteria for chronic pain.

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

The adjudicator found the applicant was entitled to the disputed amount for a psychological services treatment plan, noting that psychotherapy is a regulated profession and the respondent failed to provide sufficient explanations for its partial denial.

The adjudicator dismissed the claims for a chronic pain management program and a physical therapy treatment plan, preferring the respondent's medical experts who opined the applicant had reached maximum medical recovery.

An award of 25% under s. 10 of Reg. 664 was granted for the respondent's unreasonable handling of the psychological services claim, along with interest.

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

The respondent denied several treatment plans, and the applicant argued the denials were procedurally defective under the Schedule.

The Tribunal found the respondent's initial notices for two psychological treatment plans were non-compliant, entitling the applicant to the outstanding balances incurred during the period of non-compliance.

However, the Tribunal dismissed the claims for chiropractic treatment and an attendant care assessment, finding the applicant failed to prove the chiropractic treatment was reasonable and necessary, and that the attendant care assessment was improperly incurred prior to the submission of the treatment plan.

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

The insurer denied a treatment plan for physiotherapy and chiropractic services, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's chronic musculoskeletal pain and resulting functional impairment warranted removal from the MIG.

However, the Tribunal dismissed the claim for the $2,675.00 treatment plan, finding the applicant failed to prove it was reasonable and necessary, particularly given medical evidence that facility-based treatment had provided no sustained benefit over four years.

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

The insurer denied several treatment plans, including physiotherapy, psychological and neurological assessments, and a chronic pain program.

The Licence Appeal Tribunal found that the applicant continued to suffer from significant accident-related pain and granted entitlement to the physiotherapy, neurological assessment, disability certificate, chronic pain assessment, chronic pain program, and a portion of the shockwave therapy.

Claims for further psychological assessment and treatment were denied as duplicative or unnecessary given previously approved funding.

The Tribunal declined to order a special award or costs, finding the insurer's adjusting of the file was reasonable.

The applicant sought a weekly non-earner benefit following a rear-end motor vehicle accident.

The insurer denied the claim.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered a complete inability to carry on a normal life.

The applicant did not provide sufficient evidence comparing his pre- and post-accident activities, and the medical evidence submitted by both parties lacked the necessary comparative analysis.

The application was dismissed.

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

The respondent insurer denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 limit.

The applicant argued for removal from the MIG based on a pre-existing knee condition, chronic pain, and psychological impairments.

The Tribunal found insufficient evidence that the pre-existing condition would prevent maximal recovery.

Relying on the respondent's independent medical examinations, the Tribunal concluded the applicant did not suffer from chronic pain or a psychological impairment caused by the accident.

The injuries were deemed predominantly minor, and the claims for chiropractic services were denied.

The applicant was injured in a motor vehicle accident and sought a medical benefit of $10,600 for a chronic pain treatment program, which the respondent insurer denied.

The Licence Appeal Tribunal found that the applicant proved on a balance of probabilities that the treatment plan was reasonable and necessary, preferring the evidence of the applicant's experts who diagnosed chronic pain over the respondent's assessors who did not specifically evaluate for chronic pain.

The Tribunal ordered the respondent to pay for the treatment plan and interest on overdue amounts, but denied the applicant's request for a special award under Ontario Regulation 664, finding no evidence that the insurer unreasonably withheld or delayed payment.

The applicant sought statutory accident benefits for physiotherapy and an orthopaedic assessment following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove her left knee impairment was caused or aggravated by the accident, as medical evidence indicated pre-existing osteoarthritis.

Consequently, most of the treatment plans were deemed not reasonable and necessary.

However, the Tribunal ordered the respondent to pay for one physiotherapy treatment plan because the respondent failed to provide a sufficient explanation of benefits (notice of denial) as required by section 38 of the Schedule.

The claims for an award and interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of non-earner benefits and four treatment plans.

The adjudicator found that the applicant's claim for non-earner benefits was time-barred under section 56(1) of the Schedule, as the application was filed more than five years after the respondent's clear refusal to pay.

Regarding the treatment plans, the adjudicator concluded that the applicant failed to prove his physical or psychological injuries fell outside the Minor Injury Guideline (MIG).

The adjudicator placed little weight on the applicant's psychological assessment conducted nearly five years post-accident, noting a lack of contemporaneous complaints to his family physician.

As the applicant had exhausted the $3,500 MIG cap, the disputed treatment plans were denied.

The respondent's request for costs was also dismissed.

The applicant sought medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The adjudicator found the applicant was entitled to $1,070 for assistive devices, as they were reasonable and necessary to treat accident-related pain, despite the applicant's concurrent pregnancy.

Claims for a cast and crutches were dismissed as abandoned, and a claim for chiropractic services was dismissed because the applicant had several unexhausted approved treatment plans for similar physical therapies.

Interest was awarded on the overdue payment for the assistive devices.

The applicant was seriously injured in a motorcycle accident and received income replacement benefits until the insurer terminated them in March 2010.

The applicant sought ongoing benefits, arguing he was completely unable to engage in suitable employment until he completed computer repair training.

The insurer relied on surveillance and medical assessments to argue he could return to light sedentary work.

The arbitrator found that the applicant's completion of high school equivalency and demonstrated ability to sit for extended periods during commutes and classes indicated he was capable of resuming sedentary office work by September 2012.

Income replacement benefits were awarded for the closed period from March 2010 to September 2012.

The claim for a special award was dismissed, as the insurer's reliance on surveillance to terminate benefits was reasonable.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for caregiving and housekeeping expenses.

The insurer terminated these benefits based on in-home assessments and independent medical examinations indicating the applicant was not substantially disabled.

The applicant submitted invoices for services allegedly provided by her sister and a neighbour.

The arbitrator found the invoices to be unreliable and fabricated, noting they contradicted the applicant's own statements to assessors and the testimony of the service providers.

The application for benefits and a special award was dismissed, and the insurer was awarded its expenses of the arbitration proceeding.

The applicant, a plumber, was injured in a motor vehicle accident and sought income replacement benefits (IRBs) after the insurer terminated them.

The arbitrator found that the accident aggravated the applicant's pre-existing back condition, causing a substantial inability to perform the essential tasks of his job, particularly driving long distances and working in awkward positions.

The applicant was awarded IRBs for the disputed period, along with interest.

Claims for medical assessment expenses and an MRI were dismissed as they were either arbitration expenses or not properly claimed under the Schedule.

The claim for a special award was also dismissed, as the insurer had a justifiable basis for terminating benefits based on a DAC report.