Dr. P. Jugnundan

The worker appealed the denial of initial entitlement for non-ischemic dilated cardiomyopathy (NIDC), which he alleged was caused by myocarditis arising from an occupationally compulsory COVID-19 vaccination.

The Appeals Resolution Officer reviewed conflicting medical opinions, including those from treating cardiologists, a general practitioner, and an occupational medicine consultant.

The Officer found that while there was a temporal relationship between the vaccination and the onset of symptoms, the objective medical evidence did not confirm a diagnosis of myocarditis according to CDC criteria.

As the diagnosis of myocarditis was not objectively confirmed, the appeal was dismissed and initial entitlement was denied.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming lost educational expenses and a physiotherapy treatment plan.

The Licence Appeal Tribunal found the applicant was entitled to $6,968.70 for lost educational expenses because accident-related soft tissue injuries impaired her ability to sit for prolonged periods, preventing her from completing her university examinations.

However, the Tribunal denied the $1,297.25 physiotherapy plan, preferring the insurer's examination report which found no need for further facility-based treatment.

A late request by the applicant to add two additional issues was denied on procedural fairness grounds.

The applicant was injured in a motor vehicle accident and sought $2,230.64 for a chiropractic treatment plan under the Statutory Accident Benefits Schedule.

The respondent insurer denied the claim.

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

The Tribunal relied on the insurer's expert medical examination, which concluded the applicant suffered only minor soft-tissue injuries and would not benefit from the proposed treatment.

The applicant's medical evidence, consisting primarily of clinical notes from his family physician, was insufficient to establish entitlement.

The application was dismissed.

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

The respondent insurer denied portions of treatment plans for chiropractic and physiotherapy, as well as a chronic pain assessment.

The Tribunal found that the respondent failed to provide a proper denial with medical and other reasons for the first treatment plan, triggering the consequences of s. 38(11) of the Schedule.

For the remaining treatment plan and assessment, the Tribunal preferred the applicant's medical evidence, finding the respondent's independent medical examination contained internal contradictions.

The Tribunal concluded the treatment and assessment were reasonable and necessary, ordering the respondent to pay the disputed amounts plus interest.

The applicant sought medical benefits for chiropractic services and a chronic pain assessment following a motor vehicle accident.

The respondent insurer denied the claims.

The Tribunal found that the applicant sustained uncomplicated soft tissue injuries and that ongoing physical therapy beyond May 2019 was not reasonable and necessary, relying on the opinions of the respondent's medical assessors.

The Tribunal awarded the first two treatment plans for chiropractic care totaling $5,006.42 plus interest, but denied the remaining plans and the chronic pain assessment as duplicative and unnecessary.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, which the respondent insurer denied.

The Licence Appeal Tribunal found that the applicant suffered from ongoing post-concussion symptoms that caused a substantial inability to perform the essential tasks of her pre-accident employment, entitling her to income replacement benefits.

The Tribunal also approved treatment plans for an attendant care assessment, a functional abilities assessment, and a portion of a psychological treatment plan, finding them reasonable and necessary.

The Tribunal dismissed a claim for physical therapy services.

Finally, the Tribunal ordered a 25% award against the respondent under Ontario Regulation 664, finding that the insurer unreasonably withheld the attendant care and functional abilities assessments by failing to properly investigate the applicant's concussion symptoms and relying on flawed independent medical examinations.

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

The respondent insurer determined the injuries fell within the Minor Injury Guideline (MIG) and refused to fund several treatment and assessment plans.

The applicant applied to the Licence Appeal Tribunal, arguing that rotator cuff tendinopathy, psychological injuries, and chronic pain removed her from the MIG.

The Tribunal found that the rotator cuff injury met the definition of a minor injury and that there was insufficient evidence of psychological injuries or chronic pain, preferring the insurer's examination reports over the applicant's orthopaedic assessment.

The Tribunal concluded the applicant sustained predominantly minor injuries, making the disputed treatment plans and interest not payable as they exceeded the $3,500 funding limit.

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

The respondent denied funding for attendant care benefits and various treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's injuries, particularly chronic pain, removed him from the MIG.

The Tribunal partially approved the treatment plans for physical therapy and assistive devices, and approved the cost of a chronic pain assessment.

However, claims for attendant care benefits, psychological treatment, psychological assessment, and a special award were dismissed.

Interest was awarded on overdue payments.