Dr. Michael Ko

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, which the respondent insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's injuries warranted removal from the MIG due to chronic pain with functional limitations and psychological injuries, preferring the evidence of the applicant's treating professionals over the insurer's assessors.

The Tribunal ordered the respondent to pay for the disputed chiropractic services, psychological assessment, and psychological treatment, finding them reasonable and necessary.

The claims for physiatry and orthopedic assessments were dismissed as the applicant had already been diagnosed with chronic pain and failed to prove their necessity.

Interest was awarded on overdue payments.

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

The Licence Appeal Tribunal found that the applicant failed to establish chronic pain with functional impairment or a psychological condition warranting removal from the MIG, preferring the respondent's section 44 multidisciplinary assessments over the applicant's expert reports.

As the applicant remained subject to the MIG, the disputed treatment plan was not considered, and claims for interest and a section 10 award were dismissed.

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

The Tribunal found that the applicant sustained an accident-related concussion, removing him from the Minor Injury Guideline.

However, the claim for an income replacement benefit was dismissed because the applicant failed to establish the essential tasks of his employment or a substantial inability to perform them.

The Tribunal approved treatment plans for a concussion assessment and a neurological assessment, but denied plans for a driving evaluation, a psychological assessment, and a second concussion assessment.

The claim for a bad faith award was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing for removal from the Minor Injury Guideline (MIG) on the basis of chronic pain.

The Licence Appeal Tribunal found that the applicant failed to provide objective medical evidence of a functional impairment accompanying the chronic pain.

Relying on the respondent's section 44 multidisciplinary assessments, which concluded the applicant had reached maximum medical recovery, the Tribunal held the applicant to the MIG.

Consequently, the disputed treatment plans were not assessed for reasonableness and necessity, and claims for interest and a section 10 award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's denial of treatment plans for chiropractic services, an occupational therapy assessment, and neurological assessments.

The insurer argued the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant suffered a concussion and ongoing impairments, removing her from the MIG.

The Tribunal granted the chiropractic treatment plans and one neurological assessment, finding them reasonable and necessary, but denied the occupational therapy assessment and a second neurological assessment due to lack of evidence or duplication.

Interest was awarded on the overdue benefits.

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

The respondent denied the benefits, arguing that the applicant's ongoing complaints were not caused by the subject accident, as she had been involved in multiple subsequent incidents, including a bus accident, a slip and fall, and being crushed by subway doors.

The Tribunal applied the 'but for' test for causation and found that the applicant failed to prove her chronic pain and psychological impairments were caused by the subject accident.

The Tribunal concluded the applicant's injuries were predominantly minor and dismissed the claims for treatment plans, interest, and an award.

The applicant sought entitlement to multiple treatment plans for physical therapy, psychological services, and various multidisciplinary assessments following a motor vehicle accident.

The Licence Appeal Tribunal found the applicant was entitled to a chronic pain assessment and the HST portion of a partially approved psychological assessment, but denied the remaining treatment plans due to insufficient medical evidence.

The Tribunal also held the applicant was statute-barred from disputing a neuropsychological assessment because she failed to attend a scheduled insurer's examination without reasonable explanation.

The claim for an award under s. 10 of O. Reg. 664 was dismissed as the insurer's denials were not unreasonable.

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

The respondent denied a treatment plan 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 she should be removed from the MIG due to chronic pain and psychological injuries.

The Tribunal found that the applicant's injuries were predominantly minor, preferring the in-person assessments of the respondent's experts and the clinical notes of the applicant's family physician over the virtual assessment of the applicant's expert.

The Tribunal concluded the applicant failed to demonstrate chronic pain with functional impairment or a psychological injury, and dismissed the application.

The applicant sought various statutory accident benefits following a motor vehicle accident, including chiropractic services, occupational therapy, and assistive devices.

The respondent denied the treatment plans on the basis that they were not reasonable and necessary.

The Tribunal dismissed the application, finding that the applicant failed to meet her burden of proof.

The Tribunal preferred the respondent's insurer's examinations and surveillance evidence, which demonstrated that the applicant had reached maximum medical improvement and was functioning independently in her activities of daily living, over the applicant's evidence.

The applicant sought payment for a chronic pain program following a motor vehicle accident, which the respondent insurer partially denied.

The Tribunal found the physical rehabilitation sessions were reasonable and necessary based on the applicant's established chronic pain syndrome and the recommendations of her family physician and orthopaedic surgeon.

However, the applicant failed to prove the necessity of the remaining proposed services, including educational procedures and transportation costs.

The Tribunal awarded $5,785.50 for the physical rehabilitation sessions with interest, but declined to order a special award, finding the insurer did not act unreasonably in its handling of the claim.

The applicant sought entitlement to statutory accident benefits for various treatment and assessment plans following a motor vehicle accident.

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

The Tribunal preferred the evidence of the respondent's independent medical examiners, who found no substantial impairment and concluded the applicant had reached maximum medical improvement, over the applicant's medical evidence which lacked contemporaneous support.

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 she sustained a concussion, chronic pain, and psychological impairments warranting removal from the MIG.

The Tribunal found insufficient evidence to support a concussion diagnosis and rejected the applicant's chronic pain assessment as internally inconsistent and contradicted by insurer examinations.

The Tribunal also found the applicant's psychological symptoms did not meet the threshold for a formal diagnosis.

Consequently, the Tribunal held the applicant's injuries were predominantly minor, and she was not entitled to the disputed treatment plans or interest.

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

The respondent denied several treatment plans and assessments on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that a pre-existing condition from a pedestrian accident days prior, as well as chronic pain, warranted removal from the MIG.

The Tribunal found the applicant failed to provide compelling medical evidence that her pre-existing conditions precluded maximal recovery within the MIG, or that she suffered from chronic pain with functional impairment.

The application was dismissed, and the respondent's request for costs was denied due to non-compliance with the Tribunal's rules.

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 argued that pre-existing shoulder and back conditions, as well as chronic pain with functional impairment, warranted removal from the MIG.

The Licence Appeal Tribunal found that the applicant failed to provide compelling medical evidence that his pre-existing conditions precluded maximal recovery within the MIG.

Furthermore, relying on independent medical examinations, the Tribunal concluded there was insufficient evidence of chronic pain causing functional impairment.

As the applicant remained within the MIG, the disputed treatment plans were not assessed, and claims for an award and interest were dismissed.

The respondent's request for costs was also denied due to procedural non-compliance.

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

The respondent denied the treatment plans, arguing they were not reasonable and necessary.

The Tribunal excluded the applicant's submissions beyond the 10-page limit set by a prior order.

On the merits, the Tribunal found that while the applicant's goal of pain reduction was reasonable, she failed to provide medical evidence demonstrating the specific treatment plans were necessary.

The Tribunal preferred the respondent's insurer's examinations, which concluded the treatments were not reasonable and necessary due to a lack of objective impairments.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to physiotherapy, psychological treatment, and an attendant care assessment.

The Licence Appeal Tribunal dismissed the application, finding that the applicant had reached maximum medical recovery for her soft tissue injuries and that her psychological complaints were pre-existing and not accident-related.

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

The applicant was injured in a motor vehicle accident and sought a Non-Earner Benefit (NEB) and medical benefits for physical therapy and a chronic pain program.

The insurer denied the benefits, arguing the applicant did not suffer a complete inability to carry on a normal life and that his injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's pre-accident life was already significantly restricted by a pre-existing intestinal condition, and the accident did not continuously prevent him from engaging in substantially all of his pre-accident activities.

Furthermore, the Tribunal concluded that the applicant's physical and psychological injuries, including mild chronic pain, were predominantly minor and subject to the $3,500 limit.

The application was dismissed.

The applicant sought statutory accident benefits for physiotherapy and chiropractic treatment following a 2015 motor vehicle accident.

The respondent denied the treatment plans.

The Licence Appeal Tribunal found that the applicant failed to prove the May 8, 2018 treatment plan was reasonable and necessary due to a lack of compelling contemporaneous medical evidence.

However, the Tribunal awarded $800 for eight sessions of physiotherapy under the January 17, 2019 treatment plan, as it was supported by recommendations from the applicant's family physician and a chronic pain clinic.

The remainder of the 2019 treatment plan was denied.

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

The respondent denied several treatment and assessment plans, arguing they were not reasonable and necessary.

The Tribunal found that while the applicant's pre-existing degenerative disc disease and chronic pain syndrome removed her from the Minor Injury Guideline, she had reached maximum medical improvement from her accident-related injuries.

Relying on the respondent's medical examinations, the Tribunal concluded that further facility-based treatment would not yield substantial improvement.

The application for benefits, interest, and a special award was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRB) and medical benefits.

The insurer terminated the IRB claim, alleging the applicant wilfully misrepresented her employment status by working after the accident while claiming to be disabled.

The arbitrator found that while the applicant did wilfully misrepresent that she had not worked on several specific days, the misrepresentation was not 'material' enough to justify terminating all benefits, as the insurer could simply deduct the earnings from the IRB.

The arbitrator awarded the IRB (less a deduction for days worked) and a medical benefit, but denied an attendant care assessment.

A special award of $2,000 was also ordered against the insurer for unreasonably withholding benefits, though the amount was tempered due to the applicant's own deceitful conduct.