Dr. Pravesh Jugnundan

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 argued for removal from the MIG based on chronic pain and psychological injuries.

The Tribunal found that the applicant failed to provide sufficient medical evidence to establish chronic pain with functional impairment or a psychological injury.

The Tribunal also rejected the applicant's procedural arguments regarding the insurer's compliance with notice requirements under sections 38 and 44 of the Schedule.

As the applicant remained within the MIG, the disputed treatment plans for physiotherapy and a psychological assessment were not payable.

The application was dismissed.

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

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

The Tribunal found the applicant demonstrated a chronic pain condition with functional impairment, satisfying the AMA Guides criteria, and removed him from the MIG.

The Tribunal approved the disputed treatment plans for chiropractic services, psychological services, and various assessments, finding them reasonable and necessary based on the treating practitioners' records and s. 25 assessments.

The claim for a special award under s. 10 of Reg. 664 was dismissed, as the respondent reasonably relied on its expert reports.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically a treatment plan for chiropractic services, massage, and acupuncture.

The respondent denied the benefits and brought a preliminary motion to exclude late-produced clinical notes from the applicant's family doctor.

The Tribunal admitted the late records, finding them highly relevant and necessary to avoid prejudice to the applicant, noting the applicant had made timely efforts to obtain them.

On the merits, the Tribunal found the applicant partially entitled to the treatment plan, approving the massage and acupuncture based on the family doctor's recommendations, but denying the chiropractic treatment as it was never recommended.

The claim for an award for unreasonable delay was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her injuries, including a shoulder impingement and chronic pain, warranted removal from the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor and subject to the $3,500 MIG limit, as she failed to provide sufficient medical evidence of functional impairment or chronic pain.

Consequently, her claims for two physiotherapy treatment plans, interest, and an award for unreasonable delay were dismissed.

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

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

The applicant claimed she suffered from chronic pain, but provided only emergency room records from the day of the accident showing a normal X-ray.

The Tribunal found the applicant failed to meet her burden of proving chronic pain with functional impairment to warrant removal from the MIG.

As the applicant remained within the MIG, the disputed treatment plans were not considered, and the application was dismissed.

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

The respondent insurer partially approved the treatment plan for the applicant's shoulder but denied coverage for the knee, relying on an independent medical examination that attributed the knee pain to pre-existing osteoarthritis.

The adjudicator found the unapproved physiotherapy reasonable and necessary, noting that the respondent's own medical expert acknowledged the applicant's knee pain worsened when treatment stopped.

The claim for the unapproved amount and interest was granted, but the request for an award for unreasonable delay was dismissed as the insurer had acted in good faith.

The applicant requested a reconsideration of a Tribunal decision that denied his entitlement to a post-104 week Income Replacement Benefit (IRB) and found that the quantum for his pre-104 week IRB could not be determined.

The Vice-Chair dismissed the request to admit new tax documents to determine the IRB quantum, finding the applicant failed to show the evidence could not have been obtained previously.

However, the Vice-Chair found the original adjudicator committed an error of law by failing to explicitly engage with the expert evidence regarding the post-104 week IRB test.

Upon reviewing the evidence, the Vice-Chair concluded the applicant suffers from a complete inability to engage in reasonably suited employment due to chronic pain and cognitive struggles.

The decision was varied to find entitlement to the post-104 week IRB, though no benefit is currently payable as the quantum remains undetermined.

The applicant sought a non-earner benefit and payment for vision therapy and chiropractic services following a motor vehicle accident.

The respondent denied the benefits.

The applicant argued that the respondent failed to comply with the procedural requirements of the Schedule, rendering the benefits payable.

The Tribunal found that the respondent provided compliant denials and that the applicant failed to establish substantive entitlement to the benefits.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming chronic pain and psychological impairments warranted removal from the Minor Injury Guideline (MIG).

The Tribunal found the applicant failed to prove on a balance of probabilities that his injuries fell outside the MIG.

The Tribunal preferred the respondent's insurer's examinations over the applicant's assessments, noting a lack of contemporaneous medical evidence supporting chronic pain or psychological impairment.

The application for disputed treatment plans, interest, and an award was dismissed.

The applicant sought entitlement to statutory accident benefits for an occupational therapy assessment, social worker counselling, and chiropractic services following a motor vehicle accident.

The applicant argued the respondent's denial notices were procedurally defective under s. 38(8) of the Schedule.

The Tribunal found that while one denial was late, the applicant failed to prove the expenses were incurred during the period of non-compliance.

The Tribunal concluded the respondent's notices provided clear medical reasons for the denials, relying on insurer's examinations.

As the applicant made no submissions on the substantive reasonableness and necessity of the treatment plans, the application was dismissed.

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

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

The applicant applied to the Licence Appeal Tribunal, arguing that his injuries, including a shoulder injury, psychological impairments, and chronic pain, warranted removal from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence to establish a non-minor physical injury, a psychological impairment, a pre-existing condition, or chronic pain with functional limitations.

The Tribunal concluded that the applicant's injuries were predominantly minor and dismissed the application for the disputed treatment plans, interest, and an award.

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

The Tribunal found the applicant failed to prove her injuries fell outside the Minor Injury Guideline (MIG), rejecting claims of chronic pain syndrome and psychological impairment.

However, the Tribunal held that the insurer failed to provide compliant denial notices under section 38(8) of the Schedule for both a physiotherapy treatment plan and a chronic pain assessment.

As a result, the insurer was prohibited from relying on the MIG for the periods of non-compliance and ordered to pay the incurred costs plus interest.

The applicant's claim for a special award was dismissed.

The applicant sought various statutory accident benefits following a motor vehicle accident, including psychological assessments, chronic pain assessments, chiropractic services, and a gym membership.

The respondent insurer denied the benefits and argued the applicant was barred from proceeding because she failed to attend a neurology insurer's examination.

The adjudicator found the neurology examination was not reasonably necessary, allowing the application to proceed.

However, the adjudicator dismissed all claims for benefits, finding the applicant failed to meet her onus to prove the treatment plans were reasonable and necessary, as she did not provide sufficient medical evidence linking her complaints to the accident or showing the goals of the treatment plans could reasonably be met.

The applicant sought payment for two chiropractic treatment plans following a motor vehicle accident.

The respondent denied the plans, arguing the injuries fell within the Minor Injury Guideline and the treatments were not reasonable and necessary.

The Tribunal found a lack of compelling and contemporaneous medical evidence to support the applicant's claim, noting that her knee pain was related to pre-existing degenerative changes and she had made no accident-related complaints to her family doctor for several months.

The Tribunal preferred the evidence of the respondent's s. 44 assessor and dismissed the application.

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

The respondent denied the benefits and argued the applicant was barred from proceeding with several treatment plans due to her failure to attend scheduled insurer's examinations (IEs).

The Tribunal found the applicant failed to provide a reasonable explanation for her non-attendance and was therefore statute-barred under s. 55(1)2 of the Schedule from proceeding with those claims.

For the remaining treatment plans, the Tribunal found the applicant failed to adduce sufficient objective medical evidence to prove they were reasonable and necessary, preferring the evidence of the respondent's IE assessors.

The application was dismissed.

The applicant sought entitlement to several treatment plans for injuries allegedly sustained in a motor vehicle accident, as well as an award and interest.

The respondent denied the plans based on Insurer's Examinations (IEs) which concluded the injuries were either minor, resolved, or attributable to a prior accident.

The Tribunal found that the applicant failed to meet her burden of proving the treatment plans were reasonable and necessary, often relying on brief clinical notes that did not address causation or adequately contradict the detailed IE reports.

The application was dismissed in its entirety.

The applicant sought entitlement to statutory accident benefits for chiropractic services, assistive devices, a chronic pain assessment, and a neurological assessment following a 2019 motor vehicle accident.

The respondent insurer denied the benefits and requested the exclusion of late-filed medical records, which the Tribunal allowed into evidence as the delay was minimal and non-prejudicial.

Ultimately, the Tribunal dismissed the application, finding that the applicant failed to meet her burden of proving the treatment plans were reasonable and necessary.

The Tribunal preferred the objective medical evidence from the respondent's multiple insurer's examinations, which consistently found normal ranges of motion and no objective signs of accident-related impairments warranting the disputed treatments.

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

The respondent denied certain claims, including a chronic pain assessment and treatment, arguing the injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit was exhausted.

The Tribunal found the applicant failed to prove on a balance of probabilities that her injuries fell outside the MIG due to chronic pain or psychological impairment.

The Tribunal dismissed the application, finding the disputed assessment and treatment plans were not payable as the MIG limit had been exhausted.

The appellant appealed an Arbitrator's decision finding that he was not catastrophically impaired and dismissing his claims for statutory accident benefits.

The appellant argued that the Arbitrator erred in relying on surveillance evidence and the respondent's medical experts rather than his own presentation at the hearing and his family's testimony.

The Director's Delegate dismissed the appeal, finding that the Arbitrator made no errors of law.

The Arbitrator was entitled to weigh the evidence, including surveillance videos showing the appellant engaging in complex activities that contradicted his family's testimony and his presentation to his own medical experts.

The Applicant sought accident benefits for physiotherapy and massage therapy following a rear-end motor vehicle collision.

The Insurer denied the claims on the basis that the Applicant's injuries fell within the Minor Injury Guideline (MIG) and the treatment plans were unsigned.

The Arbitrator dismissed the Applicant's claims, finding that the Applicant failed to sign the OCF-18 treatment plans as required by section 38(3) of the SABS.

Furthermore, the Arbitrator accepted the Insurer's expert medical evidence that the Applicant's soft tissue injuries were treatable within the MIG and that the Applicant did not suffer from chronic pain.

The Insurer was awarded its expenses for the arbitration.