Dr. E.P. Urovitz

The applicant sought entitlement to various treatment plans for home devices, a sleep system, workplace modifications, and kitchen devices following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove on a balance of probabilities that the proposed treatment plans were reasonable and necessary.

The Tribunal assigned little weight to the applicant's occupational therapist's recommendations due to a lack of contemporaneous assessment and failure to account for a subsequent accident.

Conversely, the Tribunal accepted the contemporaneous insurer's examination reports which concluded the treatments were not required.

Claims for interest and a special award were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing he should be removed from the Minor Injury Guideline (MIG) due to chronic pain and psychological injuries.

The Licence Appeal Tribunal found the applicant failed to establish chronic pain with functional impairment, noting his expert's report lacked corroborating medical records and did not clearly align with the AMA Guides criteria.

The Tribunal also rejected the applicant's psychological claims, preferring the respondent's expert who found a lack of objective information supporting a psychological impairment.

The application was dismissed, and the applicant remained subject to the MIG.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits (IRBs), psychological treatment, and assessment costs.

The adjudicator found that the applicant suffered soft tissue injuries, fractured ribs, and psychological injuries, but failed to prove a substantial inability to perform the essential tasks of his pre-accident employment after January 21, 2020.

The claims for psychological treatment were dismissed because the treatment plans did not comply with the Schedule, as they listed a psychological associate as the provider while the services were actually provided by an unsupervised psychotherapist.

The adjudicator also found the requested 1.5-hour sessions were not reasonable or necessary compared to the 1-hour sessions recommended by the respondent's assessor.

The applicant was awarded $50.39 for the cost of preparing one treatment plan due to an improper denial, with interest.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the denial of attendant care benefits and several treatment plans for physiotherapy and a gym membership.

The Licence Appeal Tribunal found the applicant was not entitled to attendant care benefits because the expenses were not incurred and the required Form 1 was not submitted prior to the claim period.

The Tribunal granted three of the disputed physiotherapy treatment plans, finding one payable due to the insurer's failure to provide medical reasons for denial under s. 38(8) of the Schedule, and two others reasonable and necessary based on medical evidence of ongoing shoulder limitations.

The remaining treatment plans were dismissed as the applicant failed to meet the evidentiary burden to prove they were reasonable and necessary.

The applicant sought entitlement to a non-earner benefit, attendant care benefits, and medical benefits for dental services and a TMJ assessment following a motor vehicle accident.

The Licence Appeal Tribunal dismissed all claims.

The adjudicator found the applicant failed to provide a pre-accident baseline to establish a complete inability to carry on a normal life for the non-earner benefit.

The attendant care claim was denied because the applicant failed to prove the expenses were incurred, relying on non-contemporaneous expense sheets.

The medical benefits were denied due to insufficient evidence establishing a causal link between the accident and the dental/TMJ issues.

The applicant was injured in a motor vehicle accident and sought funding for physiotherapy and a chronic pain treatment program under the Statutory Accident Benefits Schedule.

The insurer denied the treatment plans on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal reviewed the medical evidence, including reports from psychologists and orthopaedic surgeons, and found that the applicant had made significant progress in his recovery.

The Tribunal concluded that the proposed treatment plans were not reasonable or medically necessary and dismissed the application.

The applicant was injured in a motor vehicle accident and received caregiver benefits from her insurer.

The insurer terminated the benefits after 104 weeks, arguing she no longer met the test of suffering a complete inability to carry on a normal life.

The arbitrator found that the applicant's physical injuries, combined with chronic pain and a diagnosed Somatoform Pain Disorder, continuously prevented her from engaging in substantially all of her pre-accident activities.

The arbitrator ordered the insurer to pay ongoing caregiver benefits but declined to order a special award, finding the insurer's denial was not unreasonable given the complex medical evidence.

The applicant, a taxi driver, was injured in a motor vehicle accident and applied for statutory accident benefits, including income replacement, medical, and housekeeping benefits.

The insurer denied the benefits and the matter proceeded to arbitration.

The applicant failed to attend the pre-hearing and the hearing proceeded in writing.

The arbitrator found that while the applicant was substantially disabled for a period, he was not entitled to income replacement benefits because he failed to provide the insurer with reasonable information to calculate the quantum, such as tax returns and taxi run sheets.

The claims for medical and housekeeping benefits were also dismissed for lack of evidence.

The applicant was ordered to pay the insurer's arbitration expenses.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits and supplementary medical expenses.

The insurer terminated her income replacement benefits, arguing she had recovered and could return to her pre-accident employment as a meat packer.

The arbitrator found that the applicant suffered from chronic pain syndrome and a major depressive disorder caused by the accident, rendering her substantially unable to perform the essential tasks of her employment.

The arbitrator preferred the evidence of the applicant's treating practitioners and experts over the insurer's assessors.

The applicant was awarded ongoing income replacement benefits, supplementary medical expenses, and interest on overdue benefits.

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

The insurer denied benefits, initially disputing that the applicant was in the insured vehicle.

The arbitrator found the applicant was a passenger but concluded his injuries were minor soft tissue strains.

Claims for extensive physiotherapy and chiropractic treatments were partially allowed, limited to what was reasonable for an uncomplicated injury.

Claims for income replacement and other disability benefits were dismissed, as the applicant was unemployed prior to the accident and his inability to carry on a normal life was attributable to a pre-existing, chronic psychosis rather than the accident.

The applicant sought income replacement and supplementary medical benefits following a 1994 motor vehicle accident.

The insurer terminated benefits, arguing the applicant could return to his pre-accident employment as a shipper/receiver.

The arbitrator found that the applicant suffered only soft-tissue injuries, not a cervical disc herniation, and that these injuries did not substantially disable him from his essential tasks.

The applicant's credibility was severely undermined by his failure to disclose pre-existing injuries, inconsistent symptom reporting, and surveillance evidence.

The insurer's claim for repayment of benefits due to undisclosed workers' compensation benefits was dismissed because the WCB benefits were permanent, not temporary.

The applicant's claims were dismissed, but he was awarded half his arbitration expenses.

The applicant was injured in a motor vehicle accident and received weekly income benefits until the insurer terminated them, claiming he was no longer substantially disabled from his pre-accident employment as a drywall installer and glazier.

The arbitrator found the applicant's complaints of chronic pain to be genuine and supported by medical evidence, concluding he remained substantially disabled.

The arbitrator also determined the applicant was self-employed rather than an employee, requiring a recalculation of his weekly income benefits by deducting ceasing business expenses.

The insurer was ordered to pay ongoing benefits at a reduced rate, and the applicant was ordered to repay the resulting overpayment from the initial period.

The applicant was injured in a snowmobile accident and received caregiver benefits until the insurer terminated them.

The arbitrator found that the applicant was deemed to have elected caregiver benefits.

While the applicant did not suffer a substantial inability to engage in caregiving activities after the termination date, she did suffer a partial inability to carry on a normal life due to her restricted mobility.

The arbitrator awarded caregiver benefits for the 104-week period following the accident, along with interest and expenses.

The applicant was injured in a motor vehicle accident and received weekly income benefits for three years.

The insurer terminated benefits, and the applicant sought arbitration to reinstate them under section 12(5)(b) of the Statutory Accident Benefits Schedule, claiming he was continuously prevented from engaging in any suitable occupation.

The arbitrator dismissed the application, finding the applicant's evidence regarding his post-accident employment and level of disability to be unreliable and not credible.

This finding was supported by surveillance video showing the applicant at his former workplace and medical evidence suggesting symptom magnification and voluntary simulation.

The applicant's claim for arbitration expenses was also denied due to his lack of credibility.

The applicant, a 70-year-old retiree, was injured in a motor vehicle accident and suffered a compression fracture of the L4 vertebrae.

The insurer paid weekly benefits under section 13 of the Statutory Accident Benefits Schedule but terminated them on April 21, 1993, arguing the applicant was no longer substantially unable to perform his essential pre-accident tasks.

The arbitrator determined the applicant's essential tasks included personal care, limited household chores, and a daily walk.

The arbitrator found that the applicant remained substantially unable to perform these tasks until June 8, 1993, when he was discharged from a physiotherapy program having resumed about 70% of his normal daily regimes.

The applicant was awarded weekly benefits for the closed period from April 21 to June 8, 1993, plus interest and arbitration expenses.

The Applicant sought weekly income benefits following a motor vehicle accident.

The Insurer terminated benefits, arguing the Applicant was no longer substantially unable to perform his employment tasks.

The Arbitrator found the Applicant to be highly unreliable, noting he had worked as a meat cutter for six weeks following the accident while claiming total disability, and had fabricated employment records.

Relying on the objective medical evidence and the Applicant's extensive pre-existing back issues, the Arbitrator concluded the Applicant was not significantly injured in the accident and was never entitled to the benefits received.

The Applicant was ordered to repay $25,660.07 to the Insurer.