Dr. Gelman

The applicant sought payment for various treatment and assessment plans following a motor vehicle accident, including a chronic pain assessment, attendant care assessment, neuropsychological assessment, physiotherapy, chiropractic, and massage therapy.

The respondent denied the benefits.

The Tribunal dismissed the application, finding that the applicant failed to meet the burden of proving the plans were reasonable and necessary.

The Tribunal noted a lack of supporting medical evidence, found the chronic pain assessment to be duplicative of existing treatment, and concluded that no interest was payable as no benefits were overdue.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits, physiotherapy, psychological services, and a psychological assessment.

The respondent denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the treatment plans were reasonable and necessary.

The Tribunal also found the applicant did not suffer a complete inability to carry on a normal life, relying on independent medical examinations indicating the applicant continued to work and attend school without significant functional limitations.

Claims for interest and an award for unreasonable delay were also dismissed.

The applicant sought statutory accident benefits for medical cannabis and nutritionist services following a 2015 motor vehicle accident.

The respondent insurer denied the treatment plans.

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

The Tribunal preferred the evidence of the respondent's section 44 examiners, who concluded that medical cannabis was contraindicated and unsupported by guidelines, and that nutritionist services were unnecessary given the applicant's stable weight.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident.

The insurer denied the claims and raised a preliminary issue regarding the two-year limitation period.

The Tribunal found that the claims for income replacement benefits and a psychological assessment were time-barred, but allowed the claims for other medical and rehabilitation benefits to proceed due to the Covid-19 limitation period extension under O. Reg. 73/20.

On the merits, the Tribunal dismissed the claims for medical benefits, finding the applicant failed to prove they were reasonable and necessary given his significant pre-existing chronic pain and active post-accident lifestyle.

Claims for an award, interest, and costs were also dismissed.

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

The insurer denied certain medical benefits and income replacement benefits (IRBs) on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's ongoing chronic pain warranted removal from the MIG, entitling her to funding for physiotherapy, a physiatry assessment, an occupational therapy assessment, and a chronic pain assessment.

The Tribunal also awarded IRBs for the first 104 weeks post-accident, finding the applicant suffered a substantial inability to perform the essential tasks of her pre-accident employment as a cleaner.

However, the Tribunal denied IRBs beyond 104 weeks, as the applicant failed to prove a complete inability to engage in any suitable employment.

Claims for a psychological assessment and a special award for unreasonable delay were also dismissed.

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

The respondent denied treatment plans for chiropractic care and occupational therapy, and the applicant sought an award for unreasonable delay in paying income replacement benefits.

The Tribunal found the treatment plans reasonable and necessary, noting they were supported by the applicant's treating practitioners and consistent with the medical evidence, while rejecting the respondent's independent medical examinations as inconsistent.

The Tribunal awarded the treatment plans and interest but declined to order an award under Regulation 664, finding the respondent's two-month delay in paying the reinstated income replacement benefit was an error promptly corrected and did not constitute unreasonable conduct.

The applicant sought statutory accident benefits following a 2014 motor vehicle accident, specifically claiming a chronic pain assessment and a chronic pain treatment program.

The Licence Appeal Tribunal dismissed the claims.

The Tribunal found the assessment expense was incurred prior to the submission of the treatment plan, contravening section 38(2) of the Schedule.

Furthermore, the Tribunal held the applicant failed to prove she suffered from an accident-related chronic pain condition, preferring the respondent's medical evidence which showed she had reached maximum medical improvement and maintained a normal life.

Claims for a Regulation 664 award and interest were also dismissed.

The applicant was injured in a motor vehicle accident and sought a medical benefit of $8,738.06 for a chronic pain treatment plan, which the respondent insurer denied.

The Tribunal found the treatment plan to be reasonable and necessary, preferring the evidence of the applicant's pain medicine specialist over the respondent's assessors.

The applicant was awarded the claimed medical benefit and interest on overdue payments.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, including psychological testing, psychological services, and physiotherapy.

The insurer partially approved the psychological treatment plans based on independent medical examinations and denied the physiotherapy plans.

The Tribunal found the applicant failed to prove the unapproved portions of the psychological plans were reasonable and necessary.

However, the Tribunal approved one of the two identical physiotherapy treatment plans to determine if further passive modalities could provide tangible benefit.

The claim for an award for unreasonable delay was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including ongoing income replacement benefits (IRBs) and various medical treatment plans.

The Licence Appeal Tribunal found that the applicant's pre-existing knee impairments were not worsened by the accident and that he did not meet the test for a substantial or complete inability to work.

Consequently, the claims for ongoing IRBs and physical treatment plans were dismissed.

However, the Tribunal found that the insurer had unreasonably delayed payment of the initial IRBs and failed to pay interest.

The Tribunal ordered the insurer to pay interest on the delayed payments along with a 20% special award under O. Reg. 664.

Both parties' requests for costs were denied.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident, claiming an inability to perform his pre-accident employment as a factory worker.

The adjudicator dismissed the claim, finding that the applicant failed to prove what his essential pre-accident employment tasks were, which tasks he was unable to perform, and the extent of his inability.

The applicant's claim for costs was also dismissed due to a lack of evidentiary basis.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and medical benefits for physiotherapy and chiropractic treatment.

The insurer denied the claims.

The Tribunal found that the applicant was not entitled to IRBs for the initial period due to her failure to provide requested financial information on time.

However, the Tribunal concluded that the applicant suffered a substantial inability to perform the essential tasks of her pre-accident employment as a kitchen helper due to her physical and deteriorating psychological impairments, entitling her to IRBs for the subsequent periods claimed.

The Tribunal denied the medical benefits, finding that the applicant's physical injuries had largely resolved and the disputed treatment plans were not reasonable and necessary.