Dr. Esmail

The applicant sought statutory accident benefits following a 2016 motor vehicle accident, including funding for chiropractic treatment, a social work assessment, and a neurological assessment.

The Licence Appeal Tribunal found the chiropractic treatment plan to be reasonable and necessary, relying on the respondent's own assessors who acknowledged the applicant's chronic pain and potential benefit from facility-based treatment.

However, the Tribunal denied the social work and neurological assessments, finding them duplicative and unsupported by the medical evidence.

Claims for an award for unreasonably withheld benefits and costs were also dismissed.

The applicant sought non-earner benefits, medical and rehabilitation benefits, and a special award following a 2012 motor vehicle accident.

The arbitrator dismissed all claims, finding the applicant lacked credibility due to numerous inconsistencies, misrepresentations, and evidence of symptom exaggeration.

The arbitrator placed little weight on the applicant's treating practitioners, preferring the evidence of the insurer's assessors who conducted more thorough document reviews and found the applicant did not suffer a complete inability to carry on a normal life and that the proposed treatments were not reasonable and necessary.

The applicant was struck by a streetcar as a pedestrian and sought a catastrophic impairment designation under the Statutory Accident Benefits Schedule due to psychological, emotional, and behavioural impairments.

The respondent denied the designation.

The Tribunal found that the applicant sustained a traumatic brain injury resulting in a Class 4 (Marked) impairment in the Adaptation domain under Chapter 14 of the AMA Guides.

The Tribunal preferred the evidence of the applicant's experts, noting the applicant's inability to cope with stressors, recurring need to escape uncontrolled situations, and suicidal ideations.

The Tribunal concluded the applicant sustained a catastrophic impairment and is entitled to extended medical and rehabilitative treatment limits.

The applicant requested a reconsideration of a decision finding he did not suffer a catastrophic impairment under the Glasgow Coma Scale following a motor vehicle accident.

The applicant argued the Tribunal erred by excluding video footage of a paramedic at the scene and by allowing the respondent's expert neurologist to give opinion evidence outside his report without permitting the applicant to recall his own expert.

The adjudicator dismissed the request, finding the video footage had limited probative value and would not have changed the result given the conflicting medical reports.

The adjudicator also found no error in allowing the respondent's expert to comment on inconsistencies in the reports, noting the applicant failed to demonstrate the evidence was false or misleading.

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

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

The Tribunal found that the applicant's psychological injuries, including post-traumatic stress disorder and major depressive disorder, took him outside the MIG.

The Tribunal ordered the respondent to pay for the disputed psychological and physical treatment plans, as well as the cost of a psychological assessment, finding them reasonable and necessary.

The applicant's claim for a special award for unreasonably delayed payments was dismissed due to lack of evidence.

The defendant insurer brought a motion for summary judgment to dismiss the plaintiff's claims for general damages, a catastrophic impairment designation, and income replacement benefits arising from a motor vehicle accident.

The court granted summary judgment dismissing the claims for general damages and catastrophic impairment, finding no evidence to support the bad faith claim and no expert evidence establishing that the plaintiff met the statutory definition of catastrophic impairment.

However, the court dismissed the motion regarding income replacement benefits, finding that conflicting medical evidence about whether the plaintiff's seizure disorder and cognitive decline were caused by the accident or a pre-existing condition created a genuine issue requiring a trial.