Dr. Esmat Dessouki

The applicant was struck by a motor vehicle as a pedestrian and sought statutory accident benefits for chiropractic services.

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

The Licence Appeal Tribunal found that the applicant's injuries, which included chronic pain, fell outside the MIG based on the detailed medical evidence of her chronic pain specialist.

The Tribunal ordered the respondent to pay the disputed medical benefits, finding them reasonable and necessary, along with interest on the overdue amounts.

The appellants, minors injured in a motor vehicle accident, appealed an Arbitrator's decision dismissing their claim for a special award and ordering them to pay the insurer's expenses.

The Director's Delegate found that the Arbitrator breached natural justice by failing to provide reasons for the expenses award, rescinding that portion of the order and remitting it for a re-hearing.

However, the Delegate upheld the dismissal of the special award claim, finding the Arbitrator correctly concluded there was insufficient evidence that the insurer unreasonably withheld or delayed payments.

The Delegate also held that while the Arbitrator may have erred in applying witness notice rules to a party, the exclusion of the appellant's testimony had no bearing on the outcome.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit, medical and rehabilitation benefits, and assessment costs outside the Minor Injury Guideline (MIG).

The Tribunal found the applicant's subjective reports of impairment inconsistent with surveillance footage and objective medical evidence.

Preferring the respondent's expert assessments, the Tribunal concluded the applicant did not suffer a complete inability to carry on a normal life and that her injuries were predominantly minor.

Consequently, the claims for a non-earner benefit, treatment plans outside the MIG, interest, and a special award were dismissed.

The applicant was injured in a motor vehicle accident and sought accident benefits from the insurer.

The insurer argued that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant, who had been an active amateur hockey player and weightlifter, claimed he developed chronic back pain as a result of the accident, which prevented him from continuing his athletic pursuits.

The arbitrator reviewed conflicting medical evidence from orthopaedic surgeons and other experts.

The arbitrator accepted the applicant's evidence and the medical opinions supporting a chronic pain diagnosis, finding that the ongoing sharp back pain constituted an injury beyond the scope of the MIG.

The arbitrator concluded that the applicant's injuries do not fall within the Minor Injury Guideline and awarded expenses to the applicant.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the $3,500 Minor Injury Guideline (MIG) limit.

The adjudicator found that while the applicant's physical injuries were predominantly soft-tissue and she did not suffer a diagnosable psychological impairment, she was nevertheless removed from the MIG limit because the insurer's notice failed to explicitly state its belief that the MIG applied, breaching section 38(9) of the Schedule.

Consequently, the applicant was awarded the outstanding balance of an incurred chiropractic plan and reimbursement for prescription expenses.

However, claims for a psychological assessment and a further chiropractic plan were dismissed as not reasonable and necessary.

The applicant sought various statutory accident benefits following a motor vehicle accident, including ongoing income replacement benefits, removal from the Minor Injury Guideline (MIG), and funding for treatment plans.

The adjudicator found significant credibility issues with the applicant's evidence, including inconsistencies regarding his post-accident employment and medical history.

The claim for ongoing income replacement benefits was dismissed as the applicant failed to prove a substantial inability to perform his pre-accident employment.

However, the adjudicator found that the insurer failed to comply with the procedural requirements of section 38 of the Schedule when responding to a chiropractic treatment plan.

As a result, the insurer was prohibited from taking the position that the MIG applied, and the chiropractic treatment plan was approved.

The remaining claims for prescriptions, a psychological assessment, and costs were dismissed.

The applicant sought income replacement benefits (IRBs) and non-earner benefits (NEBs) following two motor vehicle accidents.

The insurer denied the benefits and sought repayment of $42,402.58 in IRBs previously paid, alleging material misrepresentation regarding the applicant's employment and income.

The arbitrator dismissed the applicant's claims, finding that his pain complaints were long-standing and pre-existing, and he failed to prove a substantial inability to perform his employment tasks or a complete inability to carry on a normal life.

The arbitrator also dismissed the insurer's claim for repayment, concluding there was insufficient evidence to prove the applicant wilfully misrepresented his employment or committed fraud.