Dr. Oleg Safir

The applicant sought a determination of catastrophic impairment and entitlement to attendant care benefits and hearing aids following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant was statute-barred from claiming attendant care benefits because she failed to dispute the insurer's denial within the two-year limitation period, and the justice of the case did not warrant an extension.

On the issue of catastrophic impairment, the Tribunal applied the AMA Guides to assess the applicant's physical and psychological impairments, ultimately finding a combined Whole Person Impairment (WPI) of 56%, which exceeds the 55% threshold under Criterion 7.

The Tribunal denied the claim for hearing aids because the applicant incurred the expense without first submitting a treatment plan, contrary to section 38(2) of the Schedule.

The claim for a special award was also dismissed as the insurer did not unreasonably withhold or delay benefits.

The applicant sought statutory accident benefits for optometric services, a functional abilities evaluation, and physiotherapy following a 2018 motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to meet his onus to prove the treatments were reasonable and necessary.

The Tribunal drew an adverse inference from the applicant's failure to produce agreed-upon medical and employment records.

The Tribunal preferred the respondent's expert evidence, which indicated the applicant had reached maximum medical recovery and that the proposed vision therapy was not a recognized treatment.

The applicant was injured in a motor vehicle accident and sought a non-earner benefit and five physiotherapy treatment plans under the Statutory Accident Benefits Schedule.

The respondent denied the benefits, relying on section 44 insurer's examinations.

The Tribunal found that the applicant failed to demonstrate a complete inability to carry on a normal life, as the medical evidence indicated she could resume a substantial amount of her pre-accident activities.

The Tribunal also found the applicant failed to prove the physiotherapy treatment plans were reasonable and necessary, noting the lack of evidence showing how treatment goals were being met and the section 44 assessor's conclusion that she had reached maximum medical recovery from facility-based rehabilitation.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought post-104-week income replacement benefits (IRBs).

The respondent denied the benefits, arguing the applicant did not suffer a complete inability to engage in any employment for which she was reasonably suited.

The Tribunal found that the applicant's physical impairments, specifically complex regional pain syndrome (CRPS) in her right arm, along with psychological impairments, prevented her from engaging in suitable employment, even on a part-time basis.

The Tribunal ordered the respondent to pay IRBs of $400 per week from September 1, 2022, plus interest.

The applicant's claim for an award under s. 10 of Regulation 664 for unreasonable withholding of benefits was dismissed.

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

The Tribunal found that the applicant's injuries were predominantly minor and subject to the $3,500 Minor Injury Guideline (MIG) limit, as he failed to prove chronic pain with functional impairment.

The applicant's claim for a non-earner benefit was dismissed because the insurer's denial was compliant and there was no obligation to provide an election of benefits when the applicant was not eligible for multiple specified benefits.

However, the Tribunal ordered the insurer to pay for three chiropractic treatment plans pursuant to s. 38(11) of the Schedule, finding that the insurer's denial notices were insufficiently detailed and failed to comply with s. 38(8).

A claim for a psychological assessment was denied, and the request for an award for unreasonable delay was dismissed.

The applicant sought various statutory accident benefits following a motor vehicle accident, including attendant care, chiropractic, psychological, and occupational therapy services, as well as the cost of a catastrophic impairment assessment.

The Licence Appeal Tribunal found that the insurer failed to provide timely notice of denial for one chiropractic treatment plan, rendering it payable for the period of delay under s. 38(11) of the Schedule.

The Tribunal also approved an in-home assessment.

However, the Tribunal dismissed the claims for attendant care benefits and the remaining treatment plans, finding the applicant failed to prove they were reasonable and necessary, largely preferring the objective findings of the insurer's examiners over the applicant's subjective complaints.

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

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

The respondent denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that the applicant failed to attend an insurer's examination.

The Tribunal found the applicant was not barred from proceeding because the respondent's notices of examination were defective.

On the substantive issues, the Tribunal held the applicant's injuries were predominantly minor and subject to the MIG limit.

The applicant was not entitled to a non-earner benefit.

However, three treatment plans for chiropractic services were payable because the respondent's denial notices failed to comply with s. 38(8) of the Schedule.

A claim for an award under s. 10 of Reg. 664 was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a catastrophic impairment.

The Licence Appeal Tribunal assessed her physical and psychological impairments under Criteria 7 and 8 of the Schedule.

The Tribunal found the applicant's Whole Person Impairment rating was 41%, falling short of the 55% threshold, and that she suffered only moderate, not marked or extreme, psychological impairments.

Claims for a non-earner benefit, attendant care benefits, and various treatment plans were also dismissed due to insufficient evidence and failure to meet the respective legal tests.

The application was dismissed in its entirety.

The applicant sought entitlement to a $2,460 treatment plan for an orthopedic assessment following a motor vehicle accident.

The insurer denied the plan based on insurer's examinations (IEs) concluding the applicant's injuries fell within the Minor Injury Guideline and the assessment was not reasonable and necessary.

The Tribunal dismissed the application, finding the applicant failed to provide contemporaneous medical records supporting ongoing complaints and gave little weight to the applicant's expert who conducted a virtual assessment based solely on self-reporting.

The Tribunal accepted the in-person IE assessments which found only minor soft tissue injuries.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing her injuries warranted removal from the Minor Injury Guideline (MIG) due to a pre-existing back condition and chronic pain syndrome.

The adjudicator found the applicant failed to provide compelling medical evidence that her pre-existing condition precluded recovery within the MIG, preferring the respondent's section 44 assessors over the applicant's pain specialist.

The adjudicator also found insufficient evidence of functional impairment to support a chronic pain diagnosis.

As the applicant remained within the MIG, her claims for treatment plans exceeding the limit, an award, and interest were dismissed.

The applicant sought entitlement to six treatment plans for chiropractic services, massage therapy, and physical therapy following a 2019 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to provide sufficient corroborating medical evidence to prove the disputed treatments were reasonable and necessary, noting a lack of objective improvement in range of motion.

The Tribunal accepted the respondent's orthopaedic independent medical examinations, which concluded that only active therapies were reasonable and that the applicant had reached maximal medical recovery from facility-based treatment.

The Tribunal also found the respondent's denial letters complied with section 38(8) of the Schedule.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought non-earner benefits, medical benefits for physiotherapy, an attendant care assessment, an award, and interest.

The respondent denied the benefits.

The Tribunal found that the applicant did not meet the test for a non-earner benefit, as medical evidence showed he had resumed most pre-accident activities shortly after the accident.

The Tribunal also denied the physiotherapy treatment plan, preferring the respondent's orthopaedic assessment which found no objective evidence of significant impairment.

The attendant care assessment was denied because it was incurred before the treatment plan was submitted, contrary to s. 38(2) of the Schedule.

Claims for an award and interest were consequently dismissed.

The applicant sought statutory accident benefits for physiotherapy, psychological services, and occupational therapy assessments following a 2017 motor vehicle accident.

The respondent denied the treatment plans.

The adjudicator found that the applicant was precluded from claiming entitlement to two treatment plans submitted more than five years after the accident, pursuant to s. 20(1)(a) of the Schedule.

For the remaining plans, the adjudicator concluded the applicant failed to prove they were reasonable and necessary, noting conflicting evidence regarding the applicant's recovery from a prior 2015 accident and subsequent workplace injuries.

The adjudicator also found the respondent's denial notices were compliant with s. 38(8) of the Schedule.

The application was dismissed.

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 Tribunal found that the applicant failed to prove her psychological impairments, pre-existing conditions, or chronic pain warranted removal from the MIG.

Claims for non-earner benefits and attendant care benefits were dismissed as the applicant did not suffer a complete inability to carry on a normal life.

However, the Tribunal ordered the insurer to pay $3,704.97 for assistive devices because the insurer's denial letter breached the notice requirements under s. 38(8) of the Schedule, triggering the payment consequences of s. 38(11).

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to an Income Replacement Benefit (IRB) and four treatment plans.

The Licence Appeal Tribunal found that while the applicant's physical impairments did not meet the threshold for an IRB, his accident-related psychological impairments, specifically driving anxiety and a specific phobia, caused a substantial inability to perform the essential tasks of his pre-accident employment as a forklift driver.

The Tribunal awarded the IRB and interest on overdue payments, but denied the treatment plans as the applicant failed to prove they were reasonable and necessary.

The applicant sought removal from the Minor Injury Guideline (MIG) and payment for a psychological assessment and a functional abilities evaluation following a motor vehicle accident.

The applicant argued that psychological impairments and chronic pain warranted removal from the MIG.

The Tribunal found that the applicant failed to provide sufficient evidence of a psychological impairment or chronic pain syndrome, preferring the respondent's section 44 insurer examination reports which concluded the applicant suffered only minor sprains and strains.

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

The applicant sought accident benefits following a motor vehicle accident, disputing the respondent's determination that her injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the medical evidence, including orthopedic and psychological assessments, demonstrated only soft tissue injuries and no psychological impairment.

The applicant failed to prove a complete inability to carry on a normal life, as she had returned to her pre-accident housekeeping activities.

Consequently, the claims for removal from the MIG, non-earner benefits, a disputed treatment plan, and interest were all dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a physiatry assessment and chiropractic services.

The respondent insurer denied the treatment plans based on insurer's examinations indicating the applicant had reached maximum medical recovery and that his shoulder issues stemmed from a pre-existing hockey injury.

The Tribunal applied the 'but for' test for causation and accepted the medical evidence that the applicant's ongoing impairments were not caused by the accident.

The Tribunal found the proposed treatment plans were neither reasonable nor necessary.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, psychological services, an occupational therapy assessment, and out-of-pocket expenses.

The Tribunal found that the applicant was not entitled to the non-earner benefit because she failed to provide sufficient evidence comparing her pre- and post-accident activities to establish a complete inability to carry on a normal life.

The Tribunal also denied the psychological treatment plans because the applicant failed to justify the service providers charging rates higher than those prescribed for psychotherapists in the Professional Services Guideline, and failed to justify transportation costs.

The requests for an occupational therapy assessment, a massage chair, and a flight cancellation fee were also dismissed as not reasonable and necessary or not payable under the Schedule.

Claims for an award and interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including ongoing non-earner benefits and two physiotherapy treatment plans.

The insurer had paid non-earner benefits for six months but sought to retroactively terminate them, while also denying the treatment plans.

The Licence Appeal Tribunal found that the applicant did not meet the test for ongoing non-earner benefits after November 2015, given her level of post-accident activity, but refused to retroactively terminate the benefits already paid.

The Tribunal granted the two physiotherapy treatment plans, finding them reasonable and necessary due to the close connection between the applicant's physical pain and her psychological conditions, including post-traumatic stress disorder and depression.