Dr. Moolla

The applicant was injured in a 2021 motor vehicle accident and sought statutory accident benefits for psychological services, a catastrophic impairment assessment, and physiotherapy.

The respondent insurer denied the benefits, arguing the psychological issues stemmed from prior 2017 accidents and the physical injuries had resolved.

The Licence Appeal Tribunal found the applicant entitled to the psychological services and the catastrophic impairment assessment under Criterion 8, as the evidence showed the subject accident exacerbated his pre-existing psychological conditions.

However, the Tribunal denied the physiotherapy treatment plan, preferring the respondent's physiatrist's opinion that the soft tissue injuries had resolved and further formal treatment was not warranted.

Claims for a special award were dismissed, but interest was awarded on the overdue benefits.

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

The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG due to a pre-existing anxiety condition, a new psychological impairment, and chronic pain.

The Tribunal found insufficient evidence that the pre-existing condition prevented recovery or that the accident caused a psychological impairment or chronic pain, preferring the respondent's medical assessments.

The Tribunal also found the respondent's denial notices compliant with the Schedule.

The application was dismissed.

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

The insurer initially denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

After the applicant was removed from the MIG following an insurer examination, the Tribunal assessed the disputed treatment plans.

The Tribunal found that the psychological assessment, psychological services, and two medical services plans were reasonable and necessary, relying on evidence of chronic pain and adjustment disorder.

However, the Tribunal denied a transportation expense claim because the applicant failed to prove the distance exceeded 50 kilometres, and denied a chiropractic services plan because the applicant failed to submit a signed OCF-18.

Interest was awarded on the overdue payments.

The applicant sought entitlement to various treatment and assessment plans for psychological and chiropractic services following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove on a balance of probabilities that the proposed plans were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's section 44 assessors, who concluded that the applicant suffered only minor physical strains and did not meet the criteria for a psychological diagnosis, over the applicant's self-reported complaints and the reports of his treating practitioners.

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

The respondent denied several treatment and assessment plans, including chiropractic services, cognitive devices, a driving reintegration assessment, a chronic pain assessment, and a fitness membership assessment.

The Tribunal found that the applicant failed to prove on a balance of probabilities that the proposed plans were reasonable and necessary, preferring the respondent's section 44 examination reports which found no objective evidence of impairment and concluded the applicant had reached maximal medical recovery.

The application was dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

The respondent denied various treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing for removal from the MIG due to chronic pain and psychological impairments.

The Tribunal found that the applicant failed to meet the burden of proving chronic pain with a functional impairment under the AMA Guidelines, noting normal physical exams and lack of compelling evidence of functional decline.

The Tribunal also found insufficient evidence of a psychological condition, citing multiple assessments indicating symptom exaggeration and malingering.

The application was dismissed, and the applicant remained subject to the $3,500 MIG limit.

The applicant sought non-earner benefits and funding for two physiotherapy treatment plans following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove a complete inability to carry on a normal life, as he returned to work post-accident and provided insufficient evidence of his pre-accident activities.

The Tribunal also denied the physiotherapy treatment plans, noting the applicant's back impairments likely resulted from two subsequent accidents and that he failed to demonstrate the proposed treatment was reasonable and necessary.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, arguing that chronic pain warranted removal from the Minor Injury Guideline (MIG).

The Tribunal preferred the respondent's section 44 medical examination, which diagnosed myofascial strain injuries treatable within the MIG, over the applicant's expert reports, which were found to be unsupported by objective medical evidence and the applicant's functional abilities.

The Tribunal concluded the applicant did not meet the burden of proving his injuries fell outside the MIG.

The disputed treatment plans were deemed not reasonable and necessary, and the application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming costs for an attendant care assessment and a chronic pain assessment.

The respondent denied the benefits on the basis of the Minor Injury Guideline and because they were not reasonable and necessary.

The Tribunal found that the applicant failed to meet her burden of proof, as she submitted no medical evidence to support her claims and did not rebut the respondent's medical reports.

The application was dismissed, and no benefits or interest were awarded.

The applicant sought attendant care benefits, chiropractic treatment, and a psychological assessment following a motor vehicle accident.

The adjudicator found the applicant was not entitled to attendant care benefits beyond the 104-week mark as she had not been deemed catastrophically impaired.

The chiropractic treatments and psychological assessment were deemed not reasonable and necessary based on section 44 assessments and the applicant's pre-existing conditions.

The application was dismissed.

The applicant sought various medical benefits, transportation expenses, and assessment costs under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent denied the claims.

The Tribunal found the applicant's evidence lacked credibility due to inconsistent self-reports regarding the accident details and his functional limitations.

Relying on the respondent's independent medical examinations, which found the applicant had recovered and returned to his normal activities, the Tribunal concluded the applicant failed to prove the disputed treatment plans and assessments were reasonable and necessary.

The application was dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

The respondent insurer denied certain medical and attendant care benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's physical and psychological injuries were predominantly minor and did not warrant treatment beyond the MIG limits.

As the applicant had exhausted the $3,500 MIG limit, the disputed treatment plans and attendant care benefits were not payable.

The application was dismissed, and the claim for a special award was denied.