Dr. Greg Jaroszynski

The applicant was involved in a motor vehicle accident and sustained a severe traumatic brain injury.

He applied to the Licence Appeal Tribunal after the respondent insurer denied his claims for catastrophic impairment, post-104 week income replacement benefits, and various treatment plans.

The Tribunal found that the applicant sustained a catastrophic impairment under Criterion 4, as his GOS-E assessment demonstrated a Lower Moderate Disability due to his inability to work and constant disruption to relationships.

The Tribunal also awarded post-104 week income replacement benefits, finding the applicant completely unable to engage in suitable employment due to cognitive and emotional impairments.

The claims for treatment plans were dismissed as the applicant failed to make submissions on their reasonableness and necessity.

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

The applicant argued for removal from the MIG based on a pre-existing back injury, chronic pain, and psychological impairments, and also claimed entitlement to Non-Earner Benefits (NEBs).

The Tribunal found that the applicant failed to provide compelling medical evidence to support removal from the MIG, preferring the respondent's insurer's examinations which found no chronic pain or psychological condition requiring treatment beyond the MIG.

The Tribunal also dismissed the claim for NEBs, finding the applicant did not suffer a complete inability to carry on a normal life.

The application was dismissed.

The applicant was injured in a head-on motor vehicle collision, sustaining a severe ankle fracture that developed into progressive post-traumatic arthritis.

He sought post-104 income replacement benefits, funding for three treatment plans, and a special award for unreasonable delay.

The Tribunal found that the applicant was not entitled to post-104 income replacement benefits because he had successfully retrained and was working as a real estate agent, failing to meet the "complete inability" test.

However, the Tribunal approved the disputed treatment plans, finding them reasonable and necessary to manage the applicant's chronic pain and progressive arthritis.

Finally, the Tribunal ordered the respondent to pay a special award of $1,211.40 under s. 10 of O. Reg. 664, finding that the respondent's repeated delays in responding to treatment plans and incorrect demands for repayment constituted excessive and imprudent behavior.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of treatment plans for a neurological assessment, psychotherapy services, transportation costs for an orthopaedic assessment, and physiotherapy services.

The Licence Appeal Tribunal found that the neurological assessment and physiotherapy services were not reasonable and necessary, relying on insurer examination reports and the lack of objective improvement from past treatments.

The Tribunal also held that the applicant failed to justify a higher hourly rate for a psychotherapist and did not provide evidence of incurred transportation expenses.

The application was dismissed in its entirety.

The applicant sought accident benefits following a rear-end motor vehicle collision.

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

The applicant argued she should be removed from the MIG due to a T7 vertebral fracture.

The Tribunal preferred the evidence of the respondent's orthopaedic surgeon, finding the fracture was not accident-related.

As the applicant's injuries were predominantly minor, she was subject to the $3,500 MIG limit, and the disputed treatment plans exceeding that limit were not payable.

The applicant sought a determination that she sustained a catastrophic impairment under the ambulatory mobility criterion following a motor vehicle accident.

While the Tribunal accepted that the accident caused a severe and permanent alteration to the structure and function of her right leg, it rejected the SCIM scoring methodologies presented by both parties' experts.

The applicant's experts improperly scored her using a wheeled walker without a swing gait, and the respondent's expert improperly substituted his hand for a cane.

Without valid SCIM scoring evidence, the applicant failed to meet her burden of proof.

Claims for a walker and a CAT assessment were also dismissed as the applicant made no submissions to establish they were reasonable and necessary.

The applicant sought statutory accident benefits following a 2015 motor vehicle accident, claiming catastrophic impairment under Criterion 7.

The respondent denied a treatment plan for a catastrophic impairment assessment, arguing the issue was res judicata based on a prior Tribunal decision.

The Tribunal found res judicata did not apply as the current treatment plan was new.

On the merits, the Tribunal preferred the respondent's medical evidence that the applicant's spinal stenosis and resulting physical impairments were caused by pre-existing degenerative changes rather than the accident.

As the physical impairments were not accident-related, the applicant could not meet the 55% whole person impairment threshold.

The application for a catastrophic impairment assessment and interest was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit and removal from the Minor Injury Guideline (MIG) due to physical and psychological impairments.

The Tribunal dismissed the application, finding the applicant failed to prove a complete inability to carry on a normal life, noting his continuous employment in construction post-accident.

The Tribunal also held the applicant's injuries were predominantly minor soft tissue injuries and afforded little weight to his psychological evidence, concluding he did not warrant removal from the MIG.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including a determination of catastrophic impairment due to a mental or behavioural disorder.

The respondent denied the benefits, arguing the applicant's psychological impairments pre-dated the accident.

The Tribunal found that the accident exacerbated the applicant's pre-existing condition, resulting in a marked class 4 impairment in her adaption to the workplace.

The Tribunal concluded the applicant was catastrophically impaired and awarded attendant care benefits of $931.57 per month, along with partial entitlement to claimed medical, rehabilitation, and examination expenses.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to chiropractic treatment, physiotherapy, a chronic pain assessment, and a chronic pain treatment program.

The respondent denied the benefits, arguing the impairments were not accident-related but due to pre-existing degenerative changes.

The Tribunal found that while the accident exacerbated the applicant's left shoulder and left knee conditions, the applicant failed to prove the proposed treatment plans were reasonable and necessary.

The medical evidence did not support the need for further physical therapy or the diagnosis of chronic pain syndrome.

The application was dismissed, and no award or interest was payable.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries, including chronic pain and a pre-existing knee condition, warranted removal from the Minor Injury Guideline (MIG).

The applicant passed away before the decision was rendered, but the Tribunal found the proceeding was not moot as a decision could impact deemed incurred expenses.

The Tribunal held that the applicant failed to establish on a balance of probabilities that his injuries fell outside the MIG, noting a significant 14-15 month gap in treatment and compelling medical evidence attributing his worsening pain to degenerative changes.

However, the Tribunal found the respondent failed to deny a February 2017 treatment plan within the required 10 business days under s. 38(8) of the Schedule, precluding it from relying on the MIG to deny that specific plan.

No interest was awarded.

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

The adjudicator held a written hearing to determine entitlement to attendant care benefits, physiotherapy, occupational therapy, and psychological services.

The adjudicator denied the claim for attendant care benefits, finding that the applicant failed to prove the expenses were incurred under s. 3(7)(e) of the Schedule, as there was no evidence of economic loss by the family member providing care.

The adjudicator partially allowed the claims for physiotherapy, finding that provider travel time was reasonable and necessary given the applicant's mobility limitations, but denied funding for planning services and mileage.

The claims for occupational therapy and psychological services were dismissed for lack of evidence demonstrating reasonableness and necessity.

The applicant sought payment for various treatment and assessment plans following a motor vehicle accident.

The insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 coverage limit had been exhausted.

The Tribunal found that the applicant sustained predominantly minor injuries, specifically neck and back strains, and that her ongoing pain was attributable to pre-existing degenerative disc disease and osteoarthritis rather than the accident.

The Tribunal rejected the applicant's claims of chronic pain and psychological impairment, preferring the insurer's expert evidence.

As the applicant did not meet the criteria for a pre-existing condition exception, she remained subject to the MIG limit, and her claims for further benefits, interest, and a special award were dismissed.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule, which the respondent insurer denied.

The adjudicator first determined that the applicant's shoulder and back injuries were caused by the accident, rejecting the insurer's argument that they were pre-existing.

The adjudicator then reviewed six disputed treatment plans.

Five plans for chiropractic, physiotherapy, dental splints, and active release treatment were found to be reasonable and necessary to treat the applicant's ongoing pain and impairments.

However, a treatment plan for extensive psychological services was deemed excessive, with the adjudicator preferring the insurer's psychological assessment that limited sessions were sufficient.

The applicant was awarded the approved treatment plans along with interest on the overdue amounts.

The applicant sought statutory accident benefits following a 2010 motor vehicle accident, claiming catastrophic impairment, attendant care, housekeeping, and non-earner benefits.

The insurer argued the applicant's impairments were solely due to pre-existing rheumatoid arthritis.

The arbitrator found the accident was a material contributing factor to the applicant's catastrophic impairment, relying on expert medical and psychological evidence.

However, the claims for attendant care and housekeeping benefits were dismissed because the applicant failed to provide documentary evidence that her service providers suffered an economic loss.

The claim for non-earner benefits was also dismissed due to insufficient evidence comparing pre- and post-accident activities.

The applicant was awarded $3,100 for the cost of examinations.

The applicant was injured in a rear-end motor vehicle collision and sought statutory accident benefits from his insurer.

The insurer terminated income replacement, attendant care, and housekeeping benefits, arguing the applicant was no longer disabled and had not sustained a catastrophic impairment.

The arbitrator found that while the applicant's physical injuries were largely resolved or pre-existing, the accident triggered a mental disorder (Adjustment Disorder/Major Depressive Disorder) that caused a marked impairment in the sphere of adaptation.

Consequently, the applicant was deemed catastrophically impaired.

The arbitrator ordered the insurer to pay ongoing income replacement benefits, finding the applicant met both the eligibility and disability tests.

The arbitrator also awarded ongoing housekeeping benefits at $90 per week and specific attendant care benefits, but dismissed the claims for assessment costs and a special award.