Dr. Moshiri

The applicant sought accident benefits following a motor vehicle accident, claiming she sustained a catastrophic impairment due to psychological issues.

The Tribunal found that the applicant's extensive pre-existing psychological conditions were the primary cause of her impairments, and the accident was not a necessary cause.

The Tribunal preferred the respondent's medical evidence, noting the applicant's self-reports were inconsistent with her medical records, which showed improvement post-accident.

The application for catastrophic impairment, non-earner benefits, and other medical benefits was dismissed.

The applicant requested a reconsideration of a Tribunal decision that denied her entitlement to a physiotherapy treatment plan and dismissed her motion to exclude the respondent's section 44 insurer examination reports.

The applicant argued the Tribunal breached procedural fairness and made errors of law and fact by admitting late documents, misapprehending medical evidence, and failing to find that pain relief is a reasonable goal of treatment.

The Tribunal dismissed the reconsideration request, finding no jurisdictional error, breach of procedural fairness, or errors of fact or law, noting that the reconsideration process is not an opportunity to re-litigate disagreements with the original decision or the weight assigned to evidence.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, claiming catastrophic impairment and entitlement to income replacement benefits, treatment plans, and a special award.

The respondent denied the benefits, arguing the applicant's impairments were caused by a prior 2015 accident, pre-existing conditions, and subsequent unrelated incidents.

The Tribunal found that the applicant failed to prove on a balance of probabilities that her injuries were caused by the 2017 accident, noting her failure to follow medical advice regarding the prolonged use of a knee brace.

Consequently, the Tribunal dismissed the claims for catastrophic impairment, income replacement benefits, treatment plans, and the special award.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to a chronic pain assessment and a chronic pain management program.

The Tribunal found the chronic pain assessment was not reasonable and necessary as it duplicated a previous assessment.

However, the Tribunal found the chronic pain management program was reasonable and necessary, awarding a portion of the outstanding balance, as the evidence showed the accident exacerbated the applicant's pre-existing chronic pain.

The claim for a special award under s. 10 of Regulation 664 was dismissed.

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

The respondent insurer denied certain medical benefits and disability certificate costs, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) $3,500 limit.

The Tribunal found that the applicant suffered from chronic pain and psychological impairments caused by the accident, meeting the AMA Guides criteria for chronic pain, which removed her from the MIG.

The Tribunal ordered the respondent to pay for the disputed chiropractic and physiotherapy treatment plans, the costs of two disability certificates, and applicable interest, finding the treatments reasonable and necessary.

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

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

The Licence Appeal Tribunal found that the applicant's ongoing chronic pain warranted removal from the MIG, entitling her to funding for physiotherapy, a physiatry assessment, an occupational therapy assessment, and a chronic pain assessment.

The Tribunal also awarded IRBs for the first 104 weeks post-accident, finding the applicant suffered a substantial inability to perform the essential tasks of her pre-accident employment as a cleaner.

However, the Tribunal denied IRBs beyond 104 weeks, as the applicant failed to prove a complete inability to engage in any suitable employment.

Claims for a psychological assessment and a special award for unreasonable delay were also dismissed.

The applicant sought various statutory accident benefits and a catastrophic impairment (CAT) designation following a 2016 motor vehicle accident.

The Licence Appeal Tribunal found that while the accident contributed to the applicant's psychological impairment, the applicant's self-reports were not credible due to significant inconsistencies regarding his pre-accident health and functional status.

The Tribunal concluded the applicant did not suffer a marked impairment in three spheres of functioning and therefore did not meet the CAT threshold.

All claims for income replacement benefits, attendant care, and medical benefits were dismissed as the applicant failed to prove they were reasonable, necessary, or incurred.

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

The respondent insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered from chronic pain and psychological impairments as a result of the accident, removing him from the MIG.

The Tribunal ordered the respondent to pay for several treatment plans for physical rehabilitation, a social work assessment, and a disability certificate, finding them reasonable and necessary.

However, the claim for a functional abilities evaluation was dismissed as the applicant had returned to work.

Interest was awarded on the overdue benefits.

The applicant sought statutory accident benefits for a physiotherapy treatment plan and the balance of a psychological assessment following a motor vehicle accident.

The Tribunal found that the physiotherapy treatment plan was not reasonable and necessary, preferring the respondent's expert who conducted an in-person examination and concluded the applicant had reached maximum medical recovery.

The Tribunal also denied the balance of the psychological assessment, preferring the respondent's expert who provided a more detailed and specific description of the time and cost necessary for the assessment.

The application was dismissed, and claims for interest and an award were denied.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to psychological treatment, physiotherapy treatment, a chronic pain assessment, and a driving reintegration assessment.

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

The Tribunal gave little to no weight to the applicant's expert reports, noting they were completed years after the accident and were inconsistent with the clinical notes and records of the applicant's family physicians, which showed minimal complaints and primarily degenerative changes.

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 sought funding for a pain management assessment and a psychological assessment, arguing that chronic pain and psychological impairments warranted removal from the MIG.

The Licence Appeal Tribunal found that the medical evidence did not support a diagnosis of functionally disabling chronic pain or a clinically significant psychological impairment, noting the applicant's own self-reporting contradicted the severity of his alleged psychological issues.

The Tribunal concluded the applicant sustained predominantly minor injuries, and because the MIG limits were exhausted, the disputed treatment plans were not reasonable and necessary.

The applicant sought payment for a psychological assessment and a special award following a motor vehicle accident.

The adjudicator found that the psychological assessment was not reasonable and necessary, as the applicant's family physician records showed a scarcity of psychological complaints and the respondent's psychological assessor concluded she did not suffer from a formal psychological condition.

The adjudicator also dismissed the claim for a special award, finding that although the respondent was late in denying the treatment plan, its conduct did not warrant an award.

The application was dismissed.

The applicant sought medical benefits for psychological and chiropractic services following a motor vehicle accident.

The respondent insurer denied the treatment plans.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary.

The psychological treatment plan lacked necessary details about the providers, and the applicant failed to provide requested information.

The chiropractic treatment plan was not supported by medical evidence, and the Tribunal preferred the evidence of the respondent's orthopaedic surgeon who found no objective signs of impairment.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

Following a reconsideration decision that removed the applicant from the Minor Injury Guideline, a rehearing was held to determine entitlement to disputed treatment plans and assessments.

The Tribunal found the applicant was entitled to three physiotherapy treatment plans and a psychological assessment, as the medical evidence, including reports from an orthopaedic surgeon and the respondent's own psychological assessor, established they were reasonable and necessary.

Claims for an attendant care assessment and a TMJ assessment were dismissed due to insufficient medical evidence linking the conditions to the accident or demonstrating necessity.

The applicant's request for a special award was denied as the respondent had not unreasonably withheld or delayed payments.

The applicant was injured in a motor vehicle accident and sought payment for psychological and physiotherapy assessments and treatments under the Statutory Accident Benefits Schedule.

The insurer denied portions of the claims based on independent medical examinations suggesting the costs were excessive or the treatments unnecessary.

The Licence Appeal Tribunal found the applicant's proposed treatment plans and assessments were reasonable and necessary, rejecting the insurer's independent examiners' conclusions as incomplete or unpersuasive.

The Tribunal ordered the insurer to pay the disputed amounts with interest, but denied the applicant's request for a special award.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule after being removed from the Minor Injury Guideline.

The insurer denied treatment plans for a cognitive assessment, chiropractic and massage treatments, and the remaining cost of a partially approved psychological assessment.

The Tribunal found the cognitive assessment and physical treatments were reasonable and necessary given the applicant's reported concussion symptoms and ongoing chronic pain.

However, the Tribunal dismissed the claim for the remaining cost of the psychological assessment, finding the applicant failed to prove why the additional time and cost were necessary beyond the insurer's partial approval.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits for psychological treatment and a chronic pain program.

The insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline.

The Tribunal found that the applicant suffered from chronic pain and was entitled to partial payment for both treatment plans.

The rehabilitative components and psychological services were deemed reasonable and necessary, while transportation costs, social work, education elements, and additional progress reports were denied.

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

The respondent insurer denied the treatment plans for physiotherapy, assistive devices, psychological treatment, and chiropractic treatment based on its insurer's examinations.

The Licence Appeal Tribunal found the respondent's expert opinions unpersuasive and insufficiently explained, preferring the evidence of the applicant and her treating practitioners.

The Tribunal ordered the respondent to pay all disputed treatment plans and overdue interest.

Furthermore, the Tribunal granted a maximum special award of 50% under Regulation 664, finding that the respondent unreasonably delayed or withheld payments by providing reasons for denial inconsistent with its actual reasons and failing to consider medical records on file.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, including psychological testing, psychological services, and physiotherapy.

The insurer partially approved the psychological treatment plans based on independent medical examinations and denied the physiotherapy plans.

The Tribunal found the applicant failed to prove the unapproved portions of the psychological plans were reasonable and necessary.

However, the Tribunal approved one of the two identical physiotherapy treatment plans to determine if further passive modalities could provide tangible benefit.

The claim for an award for unreasonable delay was dismissed.

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

The Licence Appeal Tribunal found that the applicant's pre-existing knee impairments were not worsened by the accident and that he did not meet the test for a substantial or complete inability to work.

Consequently, the claims for ongoing IRBs and physical treatment plans were dismissed.

However, the Tribunal found that the insurer had unreasonably delayed payment of the initial IRBs and failed to pay interest.

The Tribunal ordered the insurer to pay interest on the delayed payments along with a 20% special award under O. Reg. 664.

Both parties' requests for costs were denied.