Dr. Pathak

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, claiming catastrophic impairment, income replacement benefits, attendant care benefits, and various treatment plans.

The Licence Appeal Tribunal found that the applicant did not meet the threshold for catastrophic impairment under Criterion 7 (55% whole person impairment) or Criterion 8 (mental and behavioural disorders).

The Tribunal preferred the respondent's medical evidence, noting the applicant's pre-existing conditions and post-accident functioning, including international travel.

Claims for income replacement and attendant care benefits were dismissed as the applicant failed to prove a substantial inability to perform his pre-accident employment and the benefits had expired past the 260-week mark.

The application was dismissed in its entirety.

The applicant was injured in a motor vehicle accident and sought various treatment plans for physiotherapy and assessments under the Statutory Accident Benefits Schedule.

The respondent denied the plans.

The Tribunal found the applicant was entitled to a physiotherapy treatment plan of $2,418.00, a functional impairment assessment of $1,988.80, and a physiatry assessment of $2,000.00, noting the respondent failed to provide proper medical reasons for denying the assessments under s. 38(8) of the Schedule.

The Tribunal denied the remaining physiotherapy treatment plans, finding them not reasonable and necessary based on the insurer's examination reports.

The claim for an award under Regulation 664 was dismissed, but interest was awarded on overdue benefits.

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

The insurer denied two treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained predominantly minor injuries and failed to provide compelling evidence of pre-existing conditions, psychological impairment, or chronic pain that would warrant exclusion from the MIG.

The Tribunal denied the $3,948.91 treatment plan as not reasonable and necessary, but partially approved the $1,315.02 treatment plan in the amount of $509.26 for home exercise equipment and instruction, as recommended by the insurer's own assessor.

The applicant sought medical and rehabilitation benefits for physiotherapy following a motor vehicle accident.

The respondent denied the treatment plan on the basis that the applicant's injuries fell within the Minor Injury Guideline, relying on an insurer's examination.

However, a prior binding arbitration decision had already determined that the applicant suffered from chronic pain syndrome and did not have minor injuries.

The Tribunal found the treatment plan reasonable and necessary.

Furthermore, the Tribunal awarded a 50% special award under section 10 of O. Reg. 664, finding that the respondent acted unreasonably and in bad faith by stubbornly maintaining that the injuries were minor despite the binding arbitration decision to the contrary.

The applicant, who was visiting Canada from India on a visitor's visa, was injured in a motor vehicle accident and claimed caregiver benefits for looking after her grandson.

The insurer suspended her benefits after she failed to attend a rescheduled insurer's examination because she had returned to India.

The arbitrator found that the insurer properly suspended the benefits under section 37(7) of the Schedule.

Furthermore, the arbitrator held that the applicant was not entitled to caregiver benefits because her temporary visitor status meant she was not 'residing with' her grandson, she was not the primary caregiver, and she failed to establish a substantial inability to engage in pre-accident caregiving activities.

Claims for a special award and interest were consequently dismissed.