Dr. Hannah Rockman

The applicant, a law student who was struck by a vehicle while riding a bicycle, sought a determination of catastrophic impairment under Criterion 8 (mental and behavioural disorders) and entitlement to various treatment plans.

The Tribunal found that the applicant did not meet the threshold for catastrophic impairment, as he did not demonstrate a marked impairment in three of four functional domains.

Despite accident-related challenges, the applicant successfully completed law school, passed the bar, and maintained employment as a lawyer.

The Tribunal also dismissed the claims for the disputed treatment plans, finding that the applicant failed to prove they were reasonable and necessary.

The applicant, who sustained a catastrophic impairment including a traumatic brain injury in a motor vehicle accident, sought various statutory accident benefits.

The Licence Appeal Tribunal found the applicant was entitled to a non-earner benefit for a limited period, as she demonstrated a complete inability to carry on a normal life.

The Tribunal also approved a treatment plan for psychological services, finding it reasonable and necessary given her ongoing psychological impairments.

However, claims for a rehabilitation support worker, occupational therapy, kinesiology, and life skills training were dismissed due to insufficient evidence or because similar previously approved funds remained unutilized.

The claim for a special award was dismissed as the insurer did not act in bad faith.

The applicant, a resident of China injured in a tour bus crash in Ontario, sought various statutory accident benefits including non-earner benefits, attendant care, and multiple treatment plans.

The Licence Appeal Tribunal denied the non-earner benefits due to the applicant's failure to provide an updated disability certificate as reasonably requested by the insurer.

The Tribunal also denied the attendant care benefits and most of the treatment plans, finding the applicant failed to meet her burden of proving they were reasonable and necessary.

However, the Tribunal approved a treatment plan for psychological services, finding the applicant continued to experience significant psychological symptoms that warranted further treatment.

The claim for a bad faith award was dismissed.

The applicant, a Chinese tourist, was involved in a single-vehicle bus accident in Ontario and sought statutory accident benefits, claiming she sustained a catastrophic impairment including a traumatic brain injury and severe psychological impairments.

The respondent denied the benefits, arguing her ongoing impairments were related to pre-existing conditions and post-accident falls in China.

The Licence Appeal Tribunal found that the applicant failed to prove she sustained a traumatic brain injury in the accident, attributing her cognitive and physical decline to a probable cerebrovascular event and subsequent falls.

The Tribunal dismissed the claims for catastrophic impairment, non-earner benefits, and most medical and rehabilitation benefits.

However, the Tribunal awarded CN ¥159,705 yuan for incurred attendant care services and CN ¥612.32 yuan for specific prescription medications, finding the respondent had sufficient information to adjust those claims and the applicant had proven they were incurred.

The applicant, a tourist from China, was injured in a motorcoach accident and sought statutory accident benefits, including attendant care benefits (ACB) and various medical and rehabilitation benefits.

The respondent denied the benefits.

The Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, preferring the respondent's section 44 assessors who found normal range of motion and negative response bias over the applicant's outdated and self-report-based assessments.

The Tribunal also found the applicant was not entitled to ACB due to inconsistent evidence regarding incurred expenses and non-compliance with section 33 of the Schedule.

The application was dismissed.

The applicant sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent insurer denied the treatment plans.

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

The Tribunal preferred the evidence of the respondent's assessors, noting credibility issues and a lack of contemporaneous medical evidence supporting the applicant's assessors.

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

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits and several treatment plans.

The Licence Appeal Tribunal denied the attendant care benefits, finding the applicant failed to prove the expenses were incurred, noting contradictory evidence and a lack of detailed invoices.

The Tribunal also denied treatment plans for physiotherapy, occupational therapy, and life skills training, as the applicant failed to establish they were reasonable and necessary or payable due to insurer non-compliance.

However, the Tribunal granted the treatment plan for psychological services, finding it reasonable and necessary based on the applicant's progress and ongoing symptoms.

The claim for a special award was dismissed.

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

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

The applicant argued she should be removed from the MIG due to pre-existing back and neck pain, chronic pain, and psychological issues.

The Tribunal found insufficient medical evidence to establish a pre-existing condition that would preclude recovery within the MIG.

Furthermore, applying the AMA criteria, the Tribunal concluded the applicant did not suffer from chronic pain or a psychological impairment caused by the accident.

The application was dismissed, and the respondent's request for costs was denied.

The applicant sought a catastrophic impairment designation due to a mental or behavioural disorder following a motor vehicle accident.

The Tribunal found that the applicant did not meet the criteria for a Class 4 (Marked) impairment in three of the four domains under the AMA Guides.

The evidence indicated that many of the applicant's functional limitations, including social withdrawal and learning difficulties, pre-dated the accident.

As the applicant was not catastrophically impaired and the non-catastrophic medical and rehabilitation limits were exhausted, the claims for treatment plans, a section 10 award, and interest were dismissed.

The applicant sought non-earner benefits and funding for various treatment plans following a 2016 motor vehicle accident.

The adjudicator found that the applicant did not submit a completed disability certificate until February 2019, precluding non-earner benefits prior to that date.

For the period after February 2019, the adjudicator dismissed the claim because the applicant provided highly inconsistent evidence regarding his pre-accident employment and activities, making it impossible to apply the Heath test to determine if he suffered a complete inability to carry on a normal life.

The adjudicator also dismissed the claims for the treatment plans, finding one statute-barred and all of them lacking contemporaneous medical evidence to prove they were reasonable and necessary.

The application was dismissed in its entirety.

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

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

The Tribunal found that the applicant's physical and psychological injuries were minor and that she did not have a pre-existing condition that would prevent maximal recovery within the MIG limits.

Consequently, the applicant's claims for medical and rehabilitation benefits were dismissed as the $3,500 limit had been exhausted.

The Tribunal also dismissed the claim for income replacement benefits, finding insufficient evidence that the applicant suffered a substantial inability to perform the essential tasks of her pre-accident employment.

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

The insurer denied income replacement benefits, a medical benefit, and the cost of a psychological assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's injuries were not minor, as he suffered from a psychological impairment and chronic pain syndrome that could not be treated within the $3,500 MIG limit.

The Tribunal awarded income replacement benefits up to the 104-week mark, finding the applicant suffered a substantial inability to perform the essential tasks of his pre-accident employment.

The Tribunal also awarded the cost of a psychological assessment but denied the remaining balance for a physiotherapy treatment plan because the massage therapy rate exceeded the FSCO guideline limit.

The applicant, a 72-year-old retiree, sought non-earner benefits following a motor vehicle accident.

The insurer denied the claim based on insurer's examinations.

The Tribunal applied the Heath test to compare the applicant's pre- and post-accident activities.

The Tribunal found that while the applicant experienced some pain and psychological distress, she failed to prove a complete inability to carry on a normal life, as she continued to participate in her pre-accident activities.

The application for non-earner benefits was 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.