Dr. T. Getahun

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 sought removal from the MIG on the basis of chronic pain and psychological impairments.

The Tribunal found that the applicant did not suffer from chronic pain with functional impairment, noting the lack of evidence regarding functional limitations and the limited value of a virtual assessment.

The Tribunal also preferred the respondent's psychological assessment, which found the applicant's self-reporting invalid, over the applicant's assessment.

The Tribunal concluded the injuries were predominantly minor, dismissed the claims for treatment plans, and denied any interest or award.

The applicant was struck by a vehicle as a pedestrian and sought statutory accident benefits, including non-earner benefits and various medical and rehabilitation treatment plans.

The Licence Appeal Tribunal dismissed the claim for non-earner benefits, finding that the applicant's functionality had improved and he did not suffer a complete inability to carry on a normal life, as evidenced by his return to post-secondary education and independence with self-care.

The Tribunal approved treatment plans for a chronic pain assessment and a functional abilities evaluation, finding them reasonable and necessary to investigate ongoing impairments.

The remaining claims for treatment plans and an award for unreasonable delay were dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs), medical benefits, and accounting expenses.

The Licence Appeal Tribunal found the applicant entitled to IRBs for a limited period (February 3, 2020, to March 11, 2020) based on the disability certificate, but denied ongoing IRBs as the applicant failed to prove a substantial inability to perform his pre-accident employment as a union labourer.

The Tribunal preferred the evidence of the insurer's multidisciplinary assessors over the applicant's late-retained expert.

Claims for various treatment and assessment plans were dismissed as not reasonable and necessary.

The applicant was awarded the cost of an accounting report despite calculation errors, along with interest on overdue benefits, but a claim for a special award was denied.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain with functional impairment and pre-existing conditions.

The Tribunal found that the applicant's accident-related pain resolved shortly after the accident and that a subsequent workplace incident caused his ongoing back issues.

Furthermore, the applicant failed to demonstrate that his pre-existing conditions impeded his recovery within the MIG limits.

As the MIG limits were exhausted, the application for further treatment plans and interest was dismissed.

The applicant, an international student who was struck by a vehicle while cycling, sought income replacement benefits, medical benefits, and lost educational expenses from the respondent insurer.

The adjudicator dismissed the applicant's claims, finding that he failed to establish his pre-accident employment and income, and did not provide compelling medical evidence of disability.

The claims for medical benefits were dismissed because the applicant had exhausted the $65,000 non-catastrophic funding limit.

Furthermore, the adjudicator ordered the applicant to repay $10,513.56 in overpaid income replacement benefits, concluding that the applicant committed wilful misrepresentation by failing to disclose his return to work and post-accident earnings.

The applicant sought statutory accident benefits following an accident involving an all-terrain vehicle.

The insurer denied benefits, including income replacement benefits, attendant care benefits, and a determination of catastrophic impairment.

The Tribunal found the applicant was excluded from receiving income replacement benefits because he was operating an uninsured vehicle without a valid license.

The Tribunal also dismissed the claims for catastrophic impairment and other benefits, finding the applicant's self-reporting to medical assessors was unreliable and contradicted by video surveillance showing a higher level of functioning than reported.

The applicant sought statutory accident benefits following a motor vehicle accident while working as an Uber driver.

The insurer denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that he was not entitled to an income replacement benefit (IRB).

The Tribunal found that the applicant's physical injuries were predominantly minor and that he failed to prove a psychological impairment, noting inconsistencies in his self-reporting and surveillance video showing him performing various physical tasks.

The Tribunal also dismissed the claim for IRBs, finding no medical evidence that the applicant suffered a substantial inability to perform the essential tasks of his employment.

As the MIG limits were exhausted, the claims for further treatment plans and assessments were dismissed.

The applicant sought medical benefits for physiotherapy, a TMJ assessment, and an orthopedic assessment following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove the proposed treatments and assessments were reasonable and necessary.

The evidence showed physiotherapy had not been helpful, there was no indication of a jaw injury from the accident, and the orthopedic assessment would be duplicative of previous assessments.

The application was dismissed.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision.

The insurer denied funding for various assessments and psychological treatment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 limit.

The Tribunal found that the applicant suffered from chronic pain causing functional impairment, removing her from the MIG.

The Tribunal ordered the insurer to fund the proposed chronic pain assessment, psychological assessment, and psychological services, finding them reasonable and necessary.

However, the request for MRIs was denied as they were reasonably available under OHIP.

The applicant sought non-earner benefits and attendant care benefits following a motor vehicle accident.

The Tribunal found the applicant failed to meet the test for a non-earner benefit, as she did not provide compelling evidence comparing her pre- and post-accident activities to establish a complete inability to carry on a normal life.

The Tribunal also denied the claim for attendant care benefits because the applicant failed to prove that any such expenses were incurred.

Claims for an award and interest were dismissed, and the respondent's request for costs was denied.

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 applicant argued that a pre-existing back condition and chronic pain removed him from the MIG.

The Tribunal found that the applicant failed to provide compelling evidence that his pre-existing condition prevented maximal recovery or that he suffered from accident-related chronic pain.

The Tribunal placed significant weight on the respondent's expert reports.

Consequently, the applicant's injuries were deemed predominantly minor.

One treatment plan was partially approved to exhaust the remaining $3,500 MIG limit, while the rest were denied.

The claim for a special award was dismissed.

The applicant sought entitlement to statutory accident benefits for treatment expenses and a chronic pain assessment following a 2015 motor vehicle accident.

The Tribunal dismissed the claim for $763.40 in treatment expenses because they were incurred prior to the submission of an OCF-18, contrary to s. 38(2) of the Schedule.

The Tribunal also dismissed the claim for a $2,400 chronic pain assessment, finding it was not reasonable and necessary as it duplicated services the applicant was already receiving in the United States.

Although the insurer issued a defective denial notice, the Tribunal applied the Divisional Court's ruling in Catic, holding that the insurer was not obligated to fund the assessment because it was not incurred during the period of non-compliance.

The applicant sought statutory accident benefits, including an income replacement benefit and medical/rehabilitation benefits, following a 2015 motor vehicle accident.

The Licence Appeal Tribunal found the applicant failed to prove a substantial inability to perform the essential tasks of his employment, noting he returned to work for over a year post-accident and his work stoppage coincided with the sale of his employer's business.

The Tribunal also denied the claimed medical benefits, finding the applicant's shoulder and knee issues were degenerative or unrelated to the accident, and the psychological assessment lacked evidentiary weight.

The application was dismissed in its entirety.

The applicant sought a Non-Earner Benefit (NEB) and various medical benefits following a motor vehicle accident.

The Tribunal found that while the applicant's life was affected by the accident, she did not suffer a 'complete inability to carry on a normal life' as she continued to engage in substantially all of her pre-accident caregiving activities, albeit with some restrictions and assistance.

The Tribunal approved two physiotherapy treatment plans and an orthopaedic assessment as reasonable and necessary, but denied a third physiotherapy plan, a psychotherapy plan, and a claim for a special award.

Interest was awarded on the approved incurred expenses.

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

She claimed entitlement to ongoing income replacement benefits (IRBs) and a $23,581.00 medical benefit for assessments.

The Licence Appeal Tribunal found that the applicant's injuries were confined to the MIG, noting that her family doctor's records, surveillance evidence, and insurer's examinations contradicted her claims of chronic pain and functional limitation.

The Tribunal dismissed the claim for IRBs, finding the applicant did not suffer a substantial inability to perform the essential tasks of her employment, and denied the medical benefit as the proposed assessments were not reasonable and necessary.

The application was dismissed in its entirety.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) from the respondent.

The respondent terminated the IRBs on September 2, 2016, following insurer examinations.

The applicant applied to the Licence Appeal Tribunal on May 1, 2019, nearly eight months after the two-year limitation period expired.

The Tribunal found the termination letter was a clear and unequivocal denial.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act, finding no bona fide intention to appeal within the time limit, an unreasonable length of delay, and significant prejudice to the respondent, despite acknowledging some merit to the appeal.

The application was dismissed as statute-barred.

The applicant was struck by a vehicle while pushing her infant in a grocery cart and sought a determination of catastrophic impairment due to psychological injuries, along with ongoing Income Replacement Benefits (IRBs) and medical benefits.

The Tribunal found that while the applicant suffered a mental or behavioural disorder caused by the accident, her impairments were moderate rather than marked, and thus she did not meet the catastrophic impairment threshold.

However, the Tribunal granted the applicant's claim for post-104 week IRBs, finding she suffered a complete inability to engage in suitable employment based on vocational and psychological assessments.

Claims for specific physiotherapy and chiropractic treatment plans were dismissed for lack of evidence, though the insurer was ordered to pay HST on an approved psychological treatment plan.

A claim for a special award was dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and the cost of a multi-disciplinary assessment from her insurer.

The insurer terminated IRBs after 104 weeks and denied the assessment costs.

The Licence Appeal Tribunal found that the applicant suffered a substantial inability to perform the essential tasks of her pre-accident employment as a restaurant crew member due to unresolved left shoulder tendonitis, entitling her to IRBs up to the 104-week mark.

However, the Tribunal concluded she did not meet the post-104 week test of a complete inability to engage in any suitable employment, relying on surveillance evidence and vocational assessments showing she could perform alternative jobs.

The Tribunal also awarded partial costs for the multi-disciplinary assessment, finding the occupational therapy, orthopedic, and vocational components reasonable and necessary, while denying the psychological and neurological components.

The applicant sought a medical benefit of $3,483.14 for chiropractic services following a motor vehicle accident.

The respondent denied the treatment plan, relying on an insurer's examination which concluded the applicant's soft tissue injuries were treatable within the Minor Injury Guideline and that maximum medical recovery had been reached.

The Tribunal found the applicant's expert reports did not specifically address the disputed treatment plan or were outside the assessor's area of expertise.

The Tribunal concluded the treatment plan was not reasonable and necessary, and dismissed the claims for the medical benefit, an award for unreasonable delay, and interest.

The applicant, a tow truck driver, was injured in a rear-end motor vehicle accident and sought income replacement benefits (IRBs).

The insurer terminated the IRBs after eight months, arguing that the applicant's ongoing pain was due to pre-existing degenerative disc disease rather than the accident.

The Tribunal found the applicant credible and preferred the evidence of his treating specialists over the insurer's expert, concluding that the accident aggravated his underlying condition and caused chronic pain and radiculopathy.

The Tribunal held that the applicant was substantially unable to perform the heavy physical duties of his pre-accident employment and was therefore entitled to ongoing IRBs.