23 total
Application for accident benefits dismissed as proposed chiropractic and psychological treatment plans were not reasonable.
The applicant sought entitlement to statutory accident benefits for chiropractic and psychological services following a motor vehicle accident.
The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the treatment plans were reasonable and necessary.
The Tribunal relied on an insurer's orthopaedic assessment to deny the chiropractic plan and found the applicant did not justify paying a psychotherapist at a psychologist's hourly rate for the psychological services.
Claims for interest and a special award were also dismissed.
Accident benefits denied; applicant's injuries found to be predominantly minor and subject to MIG limit.
The applicant sought accident benefits following a motor vehicle accident, claiming entitlement to several chiropractic and psychological treatment plans outside the Minor Injury Guideline (MIG).
The respondent denied the benefits, arguing the injuries were predominantly minor.
The Tribunal found that the applicant did not sustain a concussion, chronic pain with functional impairment, or a psychological impairment warranting removal from the MIG.
Relying on the insurer's multidisciplinary assessments, the Tribunal concluded the injuries were predominantly minor.
As the applicant was subject to the MIG limit, the disputed treatment plans and interest were denied.
Application for accident benefits dismissed; applicant failed to prove injuries warranted removal from Minor Injury Guideline.
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 chronic pain, psychological impairment, and pre-existing conditions (degenerative disc disease, scoliosis, and kyphosis).
The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain or a psychological impairment caused by the accident.
The Tribunal also found no compelling evidence that his pre-existing conditions prevented his recovery within the MIG limits.
The application for disputed treatment plans and interest was dismissed.
Psychological assessment approved but chiropractic treatment denied in accident benefits dispute.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic services and a psychological assessment.
The respondent insurer denied the treatment plans.
The adjudicator found that the applicant failed to meet her burden of proving the chiropractic treatment plan was reasonable and necessary, as the submitted evidence was not contemporaneous and lacked specific goals.
However, the adjudicator approved the psychological assessment, preferring the evidence of the applicant's assessors over the insurer's examiner, finding it necessary to evaluate the exacerbation of the applicant's pre-existing psychological conditions.
The applicant was also awarded interest on the overdue payment for the psychological assessment.
Application for accident benefits dismissed; applicant's injuries remained within the Minor Injury Guideline limits.
The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline (MIG).
The applicant argued she should be removed from the MIG due to pre-existing conditions, chronic pain, and psychological impairments.
The Licence Appeal Tribunal found that the applicant failed to provide compelling medical evidence that her pre-existing ankylosing spondylitis and arthritis prevented her recovery within the MIG.
The Tribunal preferred the respondent's section 44 assessments, concluding the injuries were predominantly minor soft tissue sprains and strains.
The claims for a non-earner benefit and disputed treatment plans were dismissed, as the applicant did not demonstrate a complete inability to carry on a normal life and remained subject to the MIG limits.
Applicant removed from Minor Injury Guideline based on psychological injuries; psychological treatment plans approved.
The Applicant sought statutory accident benefits following a motor vehicle accident.
The insurer denied benefits, arguing the Applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that while the Applicant's physical injuries did not warrant removal from the MIG, his psychological injuries, specifically an adjustment disorder, did justify removal.
The Tribunal approved two treatment plans for psychological services as reasonable and necessary, but denied a treatment plan for chiropractic services.
Interest was awarded on the overdue psychological benefits.
Application for accident benefits dismissed; injuries found to be predominantly minor and subject to MIG.
The insurer denied several 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 impairment.
The Tribunal found the applicant's evidence of chronic pain and psychological impairment unpersuasive, as it was unsupported by contemporaneous medical records and contradicted by the insurer's examinations.
The Tribunal concluded the injuries were predominantly minor, the applicant remained subject to the MIG limit, and dismissed the application for the disputed treatment plans and interest.
The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline (MIG).
The applicant claimed entitlement to medical and rehabilitation benefits, an income replacement benefit (IRB), and interest.
The Tribunal found that the applicant failed to prove his physical or psychological injuries warranted removal from the MIG, noting a lack of corroborating medical evidence for his psychological claims and finding his physical injuries consistent with soft-tissue minor injuries.
The applicant also failed to provide evidence or submissions to support his IRB claim.
The application was dismissed.
Applicant held to Minor Injury Guideline limit after failing to prove psychological impairment or pre-existing condition.
The applicant sought accident benefits following a motor vehicle accident.
The respondent insurer determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied three treatment plans.
The applicant argued she should be removed from the MIG due to a psychological impairment and a pre-existing condition of pregnancy.
The Tribunal found the applicant failed to prove a psychological impairment, giving significant weight to the respondent's psychological assessment and noting the applicant's failure to attend numerous insurer examinations.
The Tribunal also found no evidence that her pregnancy precluded recovery within the MIG.
The applicant was awarded the $305.75 remaining under her MIG limit for one treatment plan, but the other plans and interest were denied.
Applicant removed from Minor Injury Guideline due to psychological impairment; partial treatment benefits awarded.
The respondent denied funding for psychological and chiropractic treatment, arguing the applicant sustained predominantly minor injuries subject to the $3,500 limit under the Minor Injury Guideline.
The Tribunal found the applicant sustained a psychological impairment, removing him from the Minor Injury Guideline.
The Tribunal awarded the cost of a psychological assessment and partially awarded the costs for psychological and chiropractic treatment, finding that the applicant had recovered substantially over time.
The claim for an award under s. 10 of Regulation 664 was dismissed, as the respondent's conduct was not unreasonable.
Application for accident benefits dismissed due to lack of medical evidence supporting the treatment plans.
The applicant sought statutory accident benefits following a motor vehicle accident, including several chiropractic treatment plans, a cognitive assessment, and a chronic pain assessment.
The Tribunal found that the applicant was removed from the Minor Injury Guideline during a prior case conference.
However, the applicant failed to provide sufficient medical evidence to prove that the disputed treatment plans were reasonable and necessary.
Application for accident benefits dismissed; injuries found to be predominantly minor and subject to MIG limits.
The respondent denied certain treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant's physical injuries, diagnosed as whiplash and sprains, were predominantly minor.
The Tribunal also rejected the applicant's claim of psychological impairment, preferring the respondent's psychological assessment over the applicant's, as the latter failed to review the clinical notes and records which were void of psychological complaints.
The application was dismissed, and the disputed treatment plans were found not payable.
Applicant's psychological impairment removed her from the MIG, but most treatment plans were denied for lack of evidence.
The respondent denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant suffered an accident-related psychological impairment, specifically an exacerbation of pre-existing depression and anxiety, which removed her from the MIG.
However, of the numerous treatment and assessment plans claimed, the Tribunal found only one psychological assessment to be reasonable and necessary, as the applicant failed to provide submissions or evidence supporting the other claims.
Offender designated a dangerous offender but receives determinate sentence and 10-year long-term supervision order.
The Crown brought a dangerous offender application against the offender following his convictions for aggravated assault, assault with a weapon, and breaches of probation.
The offender had a lengthy, violent criminal record spanning two decades and was diagnosed with severe antisocial personality disorder and substance use disorder.
The court found the offender met the criteria for a dangerous offender designation, noting his pattern of persistent aggressive behaviour and high likelihood of harmful recidivism.
However, at the penalty stage, the court found a reasonable expectation that the offender's risk could be managed in the community given his recent commitment to treatment and the availability of intensive cognitive behavioural therapy.
The court imposed a determinate sentence of 8 years (with 18 months remaining after pre-sentence custody credit) followed by a 10-year long-term supervision order.
Most accident benefits denied under Minor Injury Guideline; psychological treatment partially approved at reduced rate.
The applicant sought various medical and rehabilitation benefits following a motor vehicle accident, including chiropractic treatments, psychological services, a social work assessment, and a chronic pain assessment.
The Tribunal found that the applicant's physical injuries fell within the Minor Injury Guideline and denied the chiropractic treatments.
The Tribunal also denied the social work and chronic pain assessments, finding the applicant did not meet the criteria for chronic pain syndrome.
However, the Tribunal partially approved one psychological treatment plan, reducing the hourly rate as the services were provided by a social worker rather than a psychologist.
The respondent insurer denied various medical and rehabilitation benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Licence Appeal Tribunal found that the applicant sustained a psychological impairment (moderate depressive episode and adjustment disorder with anxiety) that warranted removal from the MIG.
The Tribunal preferred the evidence of the applicant's psychologist over the insurer's expert.
The Tribunal awarded funding for a psychological assessment, initial chiropractic treatment, and psychological treatment at a reduced hourly rate for unregulated providers.
Subsequent chiropractic treatment plans were denied as the applicant had plateaued in recovery.
Applicant removed from Minor Injury Guideline due to psychological impairment; psychological treatment plans approved.
The Tribunal found that while the applicant's physical injuries were predominantly minor, he had sustained a psychological impairment (adjustment disorder with depressed mood) that removed him from the MIG.
Consequently, the Tribunal approved the treatment plans for a psychological assessment and psychological treatment, along with interest.
The claims for physical therapy were dismissed as not reasonable and necessary.
Accident benefits denied; physical impairments attributed to subsequent slip and fall and second accident.
He subsequently had a slip and fall and a second motor vehicle accident.
The Tribunal found that the applicant's psychological impairments were caused by the first accident, but he failed to prove that his physical impairments were caused by the first accident, as they were likely caused by the subsequent slip and fall or second accident.
The Tribunal dismissed the claims for physical treatment plans due to lack of causation.
The claims for psychological treatment and assessments were also dismissed because the applicant failed to prove they were reasonable and necessary, or failed to comply with the signature requirements under s. 38(3) of the Schedule.
Applicant removed from Minor Injury Guideline for psychological impairment; only psychological assessment deemed payable.
The applicant sought medical benefits following a motor vehicle accident.
The Tribunal found that the applicant suffered from an accident-related psychological impairment, removing him from the MIG.
However, while the Tribunal ordered payment for a psychological assessment, it denied the claims for physical therapy and psychological services, finding the physical therapy had plateaued and the psychological services were reasonably available through OHIP.
Insurer ordered to pay for chiropractic services as applicant's pain and psychological impairments were credible.
The applicant sought medical benefits for chiropractic services following a motor vehicle accident.
The respondent insurer denied the treatment plans, arguing the applicant's pain presentation was inconsistent and his physical injuries no longer required facility-based therapy.
The Tribunal found the applicant's self-reported pain and improvements credible, supported by psychological assessments indicating he was not feigning symptoms.
The Tribunal ordered the respondent to pay for the disputed medical benefits, excluding services incurred prior to the submission of the treatment plan, along with interest.