Dr. Pravesh Jugnundan

The applicant sought statutory accident benefits for various treatment plans and assessments following a motor vehicle accident.

The respondent denied the benefits.

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

Crucially, the applicant failed to submit the actual treatment plans (OCF-18s) into evidence, making it impossible for the Tribunal to assess them.

Furthermore, the Tribunal preferred the respondent's medical evidence, including multiple insurer examinations, which concluded the applicant had reached maximum medical improvement and did not require the disputed treatments.

The applicant sought medical benefits for chiropractic, massage, acupuncture, and shockwave therapy following a motor vehicle accident.

The adjudicator found that the applicant failed to prove the proposed treatment plans were reasonable and necessary, as her family physician had not recommended such facility-based treatments and the insurer's examination concluded they would not be beneficial.

However, the adjudicator found that the insurer's initial denials of the treatment plans were defective under s. 38(8) of the Statutory Accident Benefits Schedule for failing to provide medical reasons.

Consequently, the insurer was ordered to pay for any expenses incurred during the period of non-compliance, along with interest.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs), medical benefits, and cost of examinations.

The respondent denied the benefits, arguing the applicant had returned to work and suffered only minor injuries.

The Tribunal found the applicant was entitled to IRBs up to June 2018, but made no order for payment as the applicant failed to provide post-accident income information.

The Tribunal also found the applicant was entitled to various medical benefits, including physiotherapy, psychological services, shockwave therapy, and a chronic pain program, as the evidence demonstrated she suffered from chronic pain caused by the accident.

The claims for cost of examinations and a Regulation 664 award were dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) after the insurer terminated them.

The Tribunal found that the applicant, a self-employed painter and contractor, suffered a substantial inability to perform the essential tasks of his pre-accident employment within 104 weeks of the accident, primarily due to a specific phobia of driving.

For the post-104-week period, the Tribunal found the applicant was completely unable to engage in any employment for which he was reasonably suited by education, training, or experience, due to a combination of physical and psychological impairments caused by the accident.

The applicant was awarded ongoing IRBs and interest, but his claim for a special award under Regulation 664 was dismissed.

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

The respondent denied several treatment plans for chiropractic and psychological care on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant sustained predominantly minor soft tissue injuries and failed to establish that he suffered from chronic pain or a psychological impairment that would remove him from the MIG.

As the $3,500 MIG funding limit had been exhausted, the claims for additional medical benefits were dismissed, along with claims for interest and an award for unreasonable withholding of benefits.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and funding for chiropractic services and a chronic pain assessment.

The Licence Appeal Tribunal dismissed the claim for a non-earner benefit, finding that surveillance evidence and inconsistencies in the applicant's self-reporting undermined her claim of a complete inability to carry on a normal life.

However, the Tribunal granted the medical benefits, concluding that the applicant suffered from an accident-related pain condition and that the proposed treatments were reasonable and necessary to address her physical and psychological impairments.

The respondent's request for costs was denied.

The 79-year-old applicant sought non-earner benefits following a motor vehicle accident.

The insurer paid benefits until January 28, 2017, but terminated them based on multidisciplinary assessments indicating the applicant no longer suffered a complete inability to carry on a normal life.

The Tribunal applied the Heath framework and found that, due to successful physiotherapy and psychotherapy, the applicant had recovered sufficiently to engage in substantially all of his pre-accident activities.

The Tribunal also found the applicant non-compliant for failing to attend a scheduled insurer examination in September 2018, providing an independent basis for termination.

The application was dismissed.

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

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

The Licence Appeal Tribunal found that the medical evidence established the applicant suffered predominantly minor soft tissue injuries.

The applicant failed to provide compelling medical evidence of a pre-existing condition that would prevent maximal recovery under the MIG cap.

The application for medical benefits and examination costs beyond the $3,500 limit was dismissed.

The applicant was struck by a truck's mirror while riding her bicycle and sought statutory accident benefits.

The respondent denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered a concussion, which falls outside the MIG, based on consistent reporting of symptoms and elevated SACT-2 scores.

The Tribunal also determined that the disputed physiotherapy treatment plans were reasonable and necessary to address the applicant's accident-related impairments.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy, chiropractic services, and an orthopaedic assessment.

The respondent insurer denied the treatment plans, arguing the applicant suffered only soft tissue injuries and had reached maximum medical recovery.

The Tribunal found the treatment plans reasonable and necessary, noting the accident aggravated the applicant's pre-existing chronic pain and arthritis, and accepting the diagnosis of chronic pain syndrome by the applicant's orthopaedic expert.

The Tribunal awarded the medical benefits and the cost of the orthopaedic assessment (capped at $2,000 plus HST), but denied the cost of a redundant OCF-3 and a special award under s. 10 of O. Reg. 664.

The applicant, an elderly woman, was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy, chiropractic services, psychological services, and an orthopaedic assessment.

The respondent insurer denied most of the treatment plans, arguing the injuries were minor soft-tissue injuries and the applicant had received sufficient treatment.

The Licence Appeal Tribunal found the treatment plans for physical and psychological therapy, as well as the orthopaedic assessment, to be reasonable and necessary, accepting the applicant's diagnosis of chronic pain syndrome and severe psychological impairments.

The Tribunal ordered the respondent to pay the disputed medical benefits and assessment costs, along with interest, but denied the request for a special award and the cost of a redundant disability certificate.