Dr. Grigory Karmy

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to treatment plans for chiropractic services and a functional abilities evaluation (FAE).

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the proposed treatments were reasonable and necessary.

The adjudicator gave little weight to the applicant's chronic pain diagnosis, noting it did not meet the AMA Guides criteria and was contradicted by surveillance evidence showing the applicant engaging in full-time studies and physical activities without visible pain.

The Tribunal also dismissed the applicant's procedural motions to exclude the respondent's surveillance and insurer's examination reports.

The applicant, who was 14 years old at the time of the motor vehicle accident, sought statutory accident benefits including non-earner benefits (NEBs) and various treatment plans.

The adjudicator found that the applicant demonstrated a complete inability to carry on a normal life due to chronic pain and psychological impairments, entitling her to NEBs of $185 per week for the disputed period.

A treatment plan for psychological services was also approved as reasonable and necessary.

However, the adjudicator denied plans for an attendant care assessment and driving reintegration services, finding insufficient evidence to support them.

The claim for an award for unreasonable delay was dismissed, but interest was awarded on the payable benefits.

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

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

The applicant argued for removal from the MIG based on chronic pain and psychological impairments.

The Tribunal found the applicant's injuries were predominantly minor, preferring the insurer's medical and psychological assessments which indicated no functional impairment and no accident-related psychological diagnosis.

As the applicant remained within the MIG, the disputed treatment plans were not payable.

Claims for an award and interest were also dismissed.

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

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

The Tribunal found that the applicant was barred from disputing one treatment plan because he missed the two-year limitation period and the respondent's denial notice was valid.

On the substantive issues, the Tribunal held that the applicant's physical and psychological injuries were predominantly minor, keeping him within the MIG.

The Tribunal also dismissed the claim for a non-earner benefit, finding the applicant returned to work and failed to establish a complete inability to carry on a normal life.

Claims for an award and interest were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits, physical modalities, and a catastrophic impairment assessment.

The Licence Appeal Tribunal denied the attendant care benefits because the applicant failed to prove the expenses were incurred.

The physical modalities plan was denied as the applicant, who had returned to full-time construction work, failed to establish it was reasonable and necessary.

The Tribunal partially approved the catastrophic assessment plan, granting the WPI component but denying the interview and file review components as duplicative.

The claim for an award was dismissed, but interest was granted on any overdue benefits.

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

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

The applicant argued for removal from the MIG based on a diagnosis of chronic pain syndrome.

The Tribunal found the applicant's medical evidence, specifically a chronic pain assessment, unpersuasive due to a gap in the medical records reviewed and a lack of corroborating evidence for functional impairment.

The Tribunal concluded the applicant's injuries were predominantly minor and subject to the MIG limits.

The application for treatment plans, an award, and interest was dismissed.

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

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

The applicant argued he should be removed from the MIG due to a pre-existing back condition and chronic pain.

The Tribunal found insufficient medical evidence to support that the pre-existing condition prevented maximal medical recovery within the MIG.

The Tribunal also rejected the chronic pain diagnosis, noting inconsistencies in the expert report and the applicant's continued ability to work in a physically demanding job.

The application for treatment plans, interest, and an award was dismissed.

The applicant sought a non-earner benefit and attendant care benefits following a motor vehicle accident.

The Tribunal found the applicant was not entitled to a non-earner benefit, as the evidence did not establish a complete inability to carry on a normal life compared to his pre-accident baseline, which already included functional limitations.

The Tribunal also denied the claim for attendant care benefits, finding the applicant failed to prove the expenses were incurred or that the requested quantum was reasonable and necessary given his demonstrated abilities.

The application was dismissed.

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

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

The Tribunal found the applicant suffered from chronic pain and a T1-T2 herniated disc, warranting removal from the MIG.

The Tribunal also found the respondent failed to provide compliant denial notices under s. 38(8) of the Schedule for two treatment plans, triggering mandatory payment under s. 38(11).

The treatment plan for a chronic pain assessment was deemed reasonable and necessary.

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

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 chronic pain, a pre-existing condition, and psychological impairments.

The Tribunal found that the applicant failed to prove on a balance of probabilities that she suffered from chronic pain with functional impairment, that her pre-existing condition precluded recovery within the MIG, or that she had a psychological condition warranting removal.

As the MIG limit was exhausted, the disputed treatment plans were not payable.

Claims for an award and interest were also dismissed.

The applicant sought statutory accident benefits following a 2020 motor vehicle accident, including income replacement benefits (IRBs), various treatment plans, and an award for unreasonable delay.

The respondent denied the benefits, arguing the applicant's impairments were due to pre-existing degenerative disc disease and a prior 2016 accident.

The Tribunal found the applicant failed to prove her impairments were caused by the subject accident, relying on the respondent's s. 44 assessors who concluded her physical and psychological complaints were not accident-related.

All claims for IRBs, treatment plans, assessments, interest, and an award were dismissed.

The respondent's request for costs was also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically a chronic pain assessment.

The respondent denied the benefit, arguing the applicant's fibromyalgia predated the accident and she was not in active treatment.

Procedurally, the adjudicator dismissed the respondent's motion to admit late insurer examination reports, finding it would prejudice the applicant.

The adjudicator also denied the respondent's request to file a sur-reply.

On the merits, the adjudicator found the chronic pain assessment to be reasonable and necessary, preferring the evidence of the applicant's pain management specialist and noting that the respondent's own multidisciplinary assessment corroborated the applicant's symptoms.

The adjudicator awarded the disputed treatment plan with interest, but declined to award costs to either party, finding no unreasonable or bad faith conduct.

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

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

The Tribunal found the applicant was removed from the MIG due to pre-existing lupus and chronic pain that prevented maximal recovery.

The Tribunal approved treatment plans for a chronic pain assessment and a multidisciplinary chronic pain program, finding them reasonable and necessary given the applicant's clinical deterioration and diagnosis of chronic pain syndrome.

Claims for chiropractic services, a psychological assessment, prescription medications, and a non-earner benefit were dismissed due to lack of evidence.

The Tribunal declined to order an award against the insurer or costs against the applicant.

The respondent insurer requested a reconsideration of a Tribunal decision that awarded the applicant entitlement to a psychological services treatment plan and a chronic pain management program.

The insurer argued the Tribunal erred in law and fact by approving a higher hourly rate for a psychotherapist and by misapprehending the credentials and evidence of its medical expert.

The Tribunal dismissed the request, finding that the psychotherapist was supervised and entitled to the higher rate, and that the adjudicator's assessment of the medical evidence did not constitute a significant error of law or fact that would have changed the outcome.

The reconsideration request was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain syndrome and psychological impairments.

The respondent denied the benefits, arguing the injuries were predominantly minor soft tissue sprains and strains.

The Tribunal found the applicant's medical evidence, primarily a section 25 assessment, relied heavily on subjective reports and lacked objective findings compared to the respondent's section 44 assessments.

Applying the AMA Guides as an interpretative tool, the Tribunal concluded the applicant failed to establish chronic pain with functional impairment.

The application was dismissed, and the injuries were deemed subject to the $3,500 MIG limit.

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

The respondent insurer denied a treatment plan for a chronic pain assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant established he suffers from chronic pain with functional impairments, warranting removal from the MIG.

The Tribunal ordered the respondent to pay $2,460.00 for the chronic pain assessment and interest on overdue benefits, but denied the applicant's request for a special award under s. 10 of Regulation 664.

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

The respondent denied various treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that pre-existing conditions, chronic pain, and psychological impairments warranted removal from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence to establish that his pre-existing conditions prevented maximal recovery within the MIG, or that he suffered from chronic pain with functional impairment or a psychological impairment.

As the applicant remained subject to the MIG, the disputed treatment plans were not payable.

The application was dismissed.

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

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued he should be removed from the MIG due to chronic pain, psychological impairments, and pre-existing conditions.

The Tribunal found that the applicant's evidence, including expert reports, was inconsistent with his family doctor's clinical notes and his return to work as an Uber driver.

The Tribunal preferred the respondent's section 44 assessments, concluding the applicant's injuries were predominantly minor.

The application for benefits and interest was dismissed.

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

The Licence Appeal Tribunal considered claims for psychological services, dental services, and a chronic pain management program.

The Tribunal awarded the psychological services, finding the hourly rate for psychotherapy reasonable.

The Tribunal also awarded the chronic pain management program, accepting the applicant's expert evidence that treatment was necessary despite the respondent's argument that the applicant did not meet the criteria for chronic pain syndrome.

The claim for dental services was dismissed due to insufficient evidence linking the injuries to the accident.

Interest was awarded on the overdue payments.

The applicant sought entitlement to statutory accident benefits following a motor vehicle accident, specifically claiming unapproved balances for a psychological assessment and psychological services, as well as a treatment plan for chiropractic and massage therapy.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the claimed costs for the psychological assessment were reasonable.

The Tribunal also held the applicant failed to justify paying a psychotherapist at a psychologist's hourly rate, and lacked sufficient medical evidence to establish that the chiropractic and massage therapy treatments were reasonable and necessary.