Farhana Jessa

The applicant sought statutory accident benefits following a motor vehicle accident, including post-104 income replacement benefits (IRB), medical benefits, and a special award.

The Tribunal found the applicant did not meet the test for post-104 IRB, as she failed to prove a complete inability to engage in any employment for which she was reasonably suited.

The Tribunal preferred the evidence of the respondent's assessors, noting inconsistencies in the applicant's reporting and her failure to complete several assessments.

The claims for medical benefits, assessments, and a special award were also dismissed.

The applicant sought a post-104-week income replacement benefit (IRB) following a motor vehicle accident, which the respondent insurer denied.

The Tribunal found that the applicant suffers a complete inability to engage in any employment for which she is reasonably suited by education, training, or experience, primarily due to chronic pain syndrome and psychological impairments.

The Tribunal preferred the evidence of the applicant's expert assessors over the respondent's assessors, noting that the alternate employment roles proposed by the respondent were not comparable in status or wages.

The applicant was awarded the IRB and interest on overdue payments, but her claim for a special award under section 10 of Regulation 664 was dismissed as the insurer's conduct was not found to be unreasonable or vexatious.

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

In a supplementary decision following a reconsideration order, the adjudicator redetermined whether the applicant's injuries fell within the Minor Injury Guideline (MIG) and whether she was entitled to income replacement benefits (IRBs).

The adjudicator found that the applicant's chronic pain did not affect her functionality, relying on surveillance evidence, Ontario Works applications indicating no work restrictions, and the respondent's medical assessments.

The evidence of the applicant's occupational therapist was rejected as unreliable.

Consequently, the adjudicator concluded the injuries fell within the MIG and dismissed the claims for IRBs, medical benefits, and interest.

The applicant sought ongoing Income Replacement Benefits (IRBs) and a psychological assessment following a motor vehicle accident.

The insurer terminated IRBs after 104 weeks, arguing the applicant no longer met the test for entitlement.

The Tribunal found that while the applicant suffered from accident-related physical and psychological impairments, he failed to prove a substantial or complete inability to work as a real estate agent.

The applicant's credibility was significantly undermined by a forensic accounting report revealing he misrepresented his pre- and post-accident income to all assessors, and that he actually earned more in the year following the accident.

Consequently, the claim for ongoing IRBs was dismissed.

However, the Tribunal granted the $2,000 psychological assessment, finding it reasonable and necessary to address the applicant's ongoing psychological impairment.

The applicant sought reconsideration of a Licence Appeal Tribunal decision that dismissed her claims for income replacement and medical benefits, finding her injuries fell within the Minor Injury Guideline.

The Vice-Chair granted the reconsideration, finding that the original adjudicator misapprehended key evidence from the applicant's family physician and occupational therapist, and provided inadequate reasons that failed to meet the standards of justification, transparency, and intelligibility set out in Vavilov.

The matter was referred back to the original adjudicator for a redetermination on the existing record.

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.