Dr. Michael Gofeld

The applicant, a cyclist injured in a motor vehicle accident, sought funding for a physical treatment plan and a chronic pain assessment under the Statutory Accident Benefits Schedule.

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

The Tribunal noted the physical treatment plan lacked support from treating practitioners at the time it was submitted, and the applicant did not meet the criteria for chronic pain syndrome under the AMA Guides to warrant a chronic pain assessment.

The respondent insurer requested a reconsideration of a previous Tribunal decision that awarded the applicant various medical and rehabilitation benefits, including physical therapy, a chronic pain assessment, a chronic pain program, and a disability certificate.

The insurer alleged several factual and legal errors, including the Tribunal's treatment of expert evidence and the legal test applied.

The adjudicator dismissed the request, finding that while there were minor errors in the original decision, none were significant enough that they would have likely led to a different result.

The adjudicator also clarified that under s. 25(1) of the Schedule, an insurer is not required to request a disability certificate before it becomes payable.

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

The respondent insurer suspended the IRBs after the applicant failed to attend a scheduled orthopaedic insurer's examination (IE).

The applicant argued the IE was not reasonably necessary and sought payment of the withheld IRBs, an award, and interest.

The Tribunal found that the requested orthopaedic IE was reasonably necessary given new medical evidence (an MRI showing an annular tear) and that the applicant failed to provide a reasonable explanation for his non-attendance.

Consequently, the insurer was not required to pay IRBs for the period of non-compliance.

However, the Tribunal awarded the applicant $250 in costs due to the insurer's unreasonable and bad faith conduct in evading service of a summons for its adjuster.

The insurer's request for costs was denied.

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.