Dr. Grigory Karmy

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to treatment plans for physiotherapy, psychological services, and chronic pain assessments outside the Minor Injury Guideline (MIG).

The respondent insurer denied the benefits, arguing the injuries were predominantly minor.

The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain or a psychological impairment warranting removal from the MIG.

The Tribunal preferred the evidence of the respondent's section 44 assessors, noting the lack of objective medical evidence, the absence of complaints to family doctors, and Facebook posts showing the applicant performing physical activities without apparent discomfort.

The application was dismissed, and the applicant was limited to the remaining MIG funding.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and several treatment plans.

The Tribunal found the applicant was not entitled to the non-earner benefit, as he continued to work full-time and did not suffer a complete inability to carry on a normal life.

The Tribunal allowed some of the disputed treatment plans, including physiotherapy, an in-home assessment, and a chronic pain assessment, finding them reasonable and necessary.

Other treatment plans were denied, and the Tribunal rejected the applicant's arguments that they were payable due to defective denial notices under s. 38(11).

The Tribunal awarded the applicant $500 in costs due to the respondent's unreasonable failure to comply with production orders.

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

The Tribunal denied the non-earner benefit, finding the applicant failed to prove a complete inability to carry on a normal life.

The Tribunal approved two physiotherapy treatment plans and a psychotherapy treatment plan, finding them reasonable and necessary based on the medical evidence.

A chronic pain treatment plan was denied as the applicant did not meet the criteria for chronic pain with functional limitations.

The Tribunal also ordered a 15% award under s. 10 of Regulation 664, finding the insurer unreasonably withheld benefits by ignoring its own assessor's diagnosis and inflexibly dismissing a treatment plan over a signature issue.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing her injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain, a pre-existing condition, and psychological impairment.

The Licence Appeal Tribunal found that the applicant's injuries fell within the MIG, as the medical evidence did not establish chronic pain with functional impairment, a significant aggravation of her pre-existing back pain, or a psychological impairment.

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

The respondent's request for costs based on the applicant's prior withdrawal of a similar application was denied, as both parties had engaged in similar procedural behaviour and no bad faith was established.

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

The Tribunal found that the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG), rejecting expert evidence of psychological impairment and chronic pain syndrome.

However, the Tribunal ordered the respondent to pay for five disputed physiotherapy and psychological treatment plans because the respondent's denial letters contained boilerplate language that failed to provide sufficient medical reasons as required by s. 38(8) of the Schedule.

A claim for a chronic pain assessment was dismissed as the denial notice for that plan was compliant.

The Tribunal declined to order an award under s. 10 of Reg. 664.

The applicant sought various statutory accident benefits following a motor vehicle accident, including attendant care benefits, assistive devices, chiropractic services, and multiple assessments.

The Tribunal denied the claim for attendant care benefits, finding that the applicant's significant functional limitations were attributable to an intervening stroke rather than the accident.

The Tribunal partially approved the claim for assistive devices and fully approved the claims for chiropractic services, finding them reasonable and necessary for the applicant's accident-related neck and back injuries.

The claims for neurological, orthopaedic, attendant care, and SIE/FAE assessments were denied for lack of supporting medical evidence.

Interest was awarded on overdue payments for incurred assistive devices and chiropractic services.

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

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

The Tribunal found that the applicant's injuries were predominantly minor, preferring the respondent's medical evidence which aligned with the clinical notes of the treating family physician and ER records.

The Tribunal gave less weight to the applicant's assessors due to inconsistent self-reporting by the applicant.

As the applicant remained within the MIG, the disputed treatment plans and interest were denied.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident, claiming catastrophic impairment under Criteria 7 (55% whole person impairment) and Criteria 8 (marked impairment in three of four domains).

The Licence Appeal Tribunal found the applicant's whole person impairment was 47%, falling short of the 55% threshold, and that he did not suffer marked impairment in social functioning.

The Tribunal denied most of the disputed treatment and assessment plans, finding them not reasonable and necessary, but approved a $2,665.50 chronic pain assessment.

Claims for attendant care benefits, an award for unreasonable delay, and costs were 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 claimed removal from the MIG based on psychological impairment and chronic pain.

The Tribunal found the applicant failed to prove on a balance of probabilities that he suffered from a psychological impairment or chronic pain with functional impairment caused by the accident.

The medical evidence indicated soft tissue injuries and the applicant maintained an active lifestyle.

The application was dismissed, and the applicant was not entitled to the disputed treatment plans, an award, or interest.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a non-earner benefit and various treatment plans for chiropractic and psychological services.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the applicant suffered a complete inability to carry on a normal life due to chronic pain and psychological impairments, entitling her to the non-earner benefit for the maximum 104-week period.

The Tribunal also partially approved several treatment plans for physical rehabilitation, acupuncture, and a psychological assessment, finding them reasonable and necessary.

Claims for an award under s. 10 of Reg. 664 were dismissed, but interest on overdue benefits was granted.

The applicant sought entitlement to a $9,024.34 treatment plan for a chronic pain program following a motor vehicle accident, along with interest and an award for unreasonable delay.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to meet her evidentiary burden to prove the treatment was reasonable and necessary.

The adjudicator noted the applicant's case was hampered by a lack of contemporaneous evidence and a failure to properly pinpoint evidence within the submitted medical reports as required by the case conference report and order.

Consequently, the claims for interest and an award were also dismissed.

The applicant sought $9,024.34 for a chronic pain treatment plan following a 2017 motor vehicle accident.

The respondent denied the benefits, arguing the applicant had recovered and returned to work full-time.

The Tribunal found the treatment plan was not reasonable or necessary, noting a three-year gap between the chronic pain assessment and the treatment plan, a lack of corroborating medical evidence, and the applicant's successful return to a physically demanding job.

The claims for an award under s. 10 of Reg. 664 and interest were also dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found her injuries were predominantly minor and subject to the Minor Injury Guideline (MIG) limit.

The applicant argued the Tribunal acted outside its jurisdiction, breached procedural fairness, and made errors of law and fact by rejecting a diagnosis of chronic pain and preferring the respondent's medical evidence.

The adjudicator dismissed the request, finding that the Tribunal acted within its jurisdiction to weigh the evidence and determine the severity of the injuries.

The adjudicator concluded that the applicant was attempting to relitigate the original findings and failed to meet the high threshold for reconsideration under Rule 18.2.

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

The respondent denied a treatment plan on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued she should be removed from the MIG due to chronic pain and psychological injuries.

The Tribunal found that the applicant's injuries were predominantly minor, preferring the in-person assessments of the respondent's experts and the clinical notes of the applicant's family physician over the virtual assessment of the applicant's expert.

The Tribunal concluded the applicant failed to demonstrate chronic pain with functional impairment or a psychological injury, and dismissed the application.

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

The respondent insurer held that the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied several treatment plans.

The applicant applied to the Licence Appeal Tribunal, arguing her injuries warranted removal from the MIG due to chronic pain and psychological impairment.

The Tribunal found that the applicant failed to demonstrate injuries outside the MIG, preferring the respondent's insurer examination reports over the applicant's medical evidence, which lacked objective support and was inconsistent with clinical records.

The application was dismissed, and the applicant remained subject to the $3,500 MIG limit.

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

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

The Tribunal found that the applicant was statute-barred from claiming a psychological assessment due to her failure to attend scheduled insurer's examinations.

The Tribunal further held that the applicant failed to establish that her physical injuries, pre-existing conditions, alleged psychological impairment, or chronic pain warranted removal from the MIG.

However, the applicant was awarded $225.62 for a physiotherapy plan because the respondent failed to provide a compliant denial notice under s. 38(8) of the Schedule.

The claims for other treatment plans and an award under s. 10 of O. Reg. 664 were dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found his injuries fell within the Minor Injury Guideline (MIG) and denied his claim for ongoing Income Replacement Benefits (IRB).

The applicant argued the Tribunal breached procedural fairness, ignored new medical evidence, and erred in fact regarding the MIG and the IRB dispute period.

The adjudicator found no breach of procedural fairness and held that the new evidence could have been obtained prior to the hearing.

While the adjudicator agreed the Tribunal made a factual error regarding the dates in dispute for the IRB claim, upon reviewing the evidence for the corrected period (February 26, 2020 to April 23, 2023), the adjudicator concluded the applicant failed to prove a substantial inability to perform the essential tasks of his employment.

The reconsideration was allowed in part to correct the dates, but the claim for ongoing IRB was dismissed.

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

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

The Tribunal found that the applicant sustained chronic pain and psychological impairments (including PTSD and driving phobia) that removed her from the MIG.

The Tribunal preferred the evidence of the applicant's treating practitioners and in-person assessors over the insurer's paper reviews and examinations.

The applicant was awarded all disputed medical and rehabilitation benefits, totaling over $10,000, plus interest on overdue payments.

The applicant sought entitlement to statutory accident benefits for various treatment and assessment plans following a motor vehicle accident.

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

The Tribunal preferred the evidence of the respondent's independent medical examiners, who found no substantial impairment and concluded the applicant had reached maximum medical improvement, over the applicant's medical evidence which lacked contemporaneous support.

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

The respondent denied treatment plans for physiotherapy and a chronic pain assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and its $3,500 limit, which was exhausted.

The applicant argued she suffered from chronic pain and psychological impairments warranting removal from the MIG.

The adjudicator found the applicant sustained predominantly minor soft tissue injuries and failed to prove chronic pain with functional impairment or psychological impairment.

The adjudicator preferred the respondent's physiatry assessment over the applicant's medical evidence.

As the applicant remained within the MIG, the disputed treatment plans were denied, and no interest was payable.

The application was dismissed.