Dr. Hosseini

The applicant sought statutory accident benefits following a 2014 motor vehicle accident, including funding for physiatry, chronic pain, and neurological assessments, as well as assistive devices.

The respondent denied the treatment plans on the basis of a lack of contemporaneous medical evidence and the application of the Minor Injury Guideline.

The Tribunal found that the applicant failed to establish on a balance of probabilities that the disputed treatment plans were reasonable and necessary, noting the absence of contemporaneous medical records corroborating the applicant's self-reported chronic pain.

The Tribunal also found that the respondent complied with the notice requirements under s. 38(8) of the Schedule.

The application was dismissed in its entirety.

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

The applicant claimed entitlement to an income replacement benefit, outstanding physiotherapy costs, interest, and an award for unreasonable delay.

The Licence Appeal Tribunal found that the applicant failed to provide compelling medical evidence to prove his injuries, including alleged chronic pain and psychological impairments, warranted removal from the MIG.

The Tribunal also found the applicant did not establish a substantial inability to perform the essential tasks of his employment as an Uber driver.

All claims were dismissed.

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

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

The Tribunal found that the applicant's injuries fell outside the MIG due to significant accident-related psychological impairments, relying on the evidence of her treating psychiatrist.

The Tribunal approved one treatment plan for physiotherapy services but denied the remaining plans for physical treatment, devices, and various assessments, finding them not reasonable and necessary.

The applicant's claim for a non-earner benefit was dismissed as she failed to prove a complete inability to carry on a normal life.

The claim for a special award was also dismissed.

The applicant sought statutory accident benefits following a 2014 motor vehicle accident.

The respondent insurer denied treatment plans for physiotherapy and assistive devices/occupational therapy.

The Licence Appeal Tribunal found that the proposed physiotherapy was reasonable and necessary given the applicant's chronic pain and fibromyalgia, preferring the recommendations of the applicant's treating practitioners over the insurer's assessors.

The Tribunal also approved the assistive devices based on a thorough in-home occupational therapy assessment.

The applicant was awarded the claimed benefits with interest, but the claim for a special award under s. 10 of Regulation 664 was dismissed as the insurer's conduct did not rise to the level of being unreasonable.

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

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

The Licence Appeal Tribunal found that the applicant's pre-existing injuries, which were exacerbated by the accident, warranted removal from the MIG.

The Tribunal approved five treatment plans for physiotherapy, finding them reasonable and necessary to address the applicant's ongoing pain and functional limitations.

However, a treatment plan for a social work assessment was denied, as the applicant had largely returned to pre-accident activities and the proposed hourly rate exceeded the professional services guideline.

Interest was awarded on the overdue physiotherapy benefits.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming the outstanding balance for a TENS unit and a treatment plan for physiotherapy (electro-acupuncture).

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the specific, higher-cost TENS unit was reasonable and necessary compared to standard retail models.

The Tribunal also denied the physiotherapy treatment plan, noting a lack of evidence regarding treatment progression or medical recommendation, and relying on the respondent's insurer's examination which concluded maximum medical recovery had been reached.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits, medical benefits, and assessments.

The adjudicator dismissed the claim for non-earner benefits, finding the applicant's reduced capacity did not amount to a complete inability to carry on a normal life.

However, the adjudicator granted the disputed treatment and assessment plans, finding them reasonable and necessary given the applicant's pre-existing conditions that were exacerbated by the accident.

The adjudicator also ordered a special award under s. 10 of O. Reg. 664, finding the insurer unreasonably delayed removing the applicant from the Minor Injury Guideline despite its own assessor's opinion supporting the exacerbation of pre-existing impairments.

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

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

The Tribunal found that the applicant failed to prove she suffered from a pre-existing condition, a concussion, or chronic pain that would warrant removal from the MIG.

Consequently, the applicant was not entitled to the disputed treatment plans as they exceeded the $3,500 funding limit, and no interest was payable.

The application was dismissed.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident.

The Tribunal found that while the applicant established a substantial inability to perform the essential tasks of her employment for the pre-104 week period, the respondent was not liable to pay the IRBs because the applicant failed to provide reasonably required financial documentation to calculate the quantum.

The applicant's claim for post-104 week IRBs was barred due to her failure to attend a reasonably necessary vocational assessment without a reasonable explanation.

Claims for an award and interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits and medical benefits for psychological services.

The respondent denied the benefits, arguing that the applicant's injuries fell within the Minor Injury Guideline (MIG) and that a prior Tribunal decision had already determined this issue.

The Tribunal found that the MIG issue was res judicata, as it had been fully adjudicated in a previous hearing between the same parties.

Regarding the non-earner benefits, the Tribunal concluded that the applicant failed to prove a complete inability to carry on a normal life, preferring the respondent's medical evidence over the applicant's self-reporting and expert opinions.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits and various medical and rehabilitation benefits.

The respondent denied the benefits, arguing that the applicant's injuries fell within the Minor Injury Guideline (MIG) and that the MIG issue was res judicata due to a prior Tribunal decision.

The Tribunal agreed that the MIG issue was res judicata, as it had been fully determined in a previous hearing between the same parties.

Consequently, the claims for medical benefits and examinations were dismissed because the MIG limits were exhausted.

The Tribunal also dismissed the claim for non-earner benefits, finding that the applicant failed to establish a complete inability to carry on a normal life, as medical evidence indicated she could perform many pre-accident activities.

Claims for interest and a special award were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming income replacement benefits (IRBs) and a medical benefit for physiotherapy.

The respondent denied the benefits and sought repayment of IRBs previously paid.

The Tribunal found the applicant was entitled to IRBs for the period of June 5, 2018, to November 30, 2018, as she demonstrated a substantial inability to perform the essential tasks of her employment.

However, she did not meet the post-104-week test for IRBs thereafter.

The Tribunal also approved the physiotherapy treatment plan as reasonable and necessary.

Finally, the Tribunal ordered the applicant to repay $1,975.64 in IRBs that were paid in error after she had returned to work, as the respondent provided timely notice of the overpayment.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including non-earner benefits, medical/rehabilitation treatments, and various assessments.

The insurer denied many of the benefits based on reports from its assessors.

The Licence Appeal Tribunal found that the applicant met the test for a complete inability to carry on a normal life and awarded non-earner benefits for the 104-week post-accident period.

The Tribunal also approved the disputed treatment plans and assessments, subject to the $2,000 statutory cap per assessment.

Furthermore, the Tribunal ordered the insurer to pay interest on overdue benefits and a special award of 33% under O. Reg. 664, finding that the insurer unreasonably delayed approving treatments that its own experts had recommended.

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

The respondent insurer denied the benefits on the basis that the applicant's injuries were predominantly minor and subject to the $3,500 limit under the Minor Injury Guideline (MIG).

The applicant argued that her physical injuries, pre-existing conditions, and psychological impairments warranted removal from the MIG.

The Tribunal found that the applicant's physical injuries were soft-tissue in nature and fell within the MIG.

The Tribunal also found insufficient evidence that any pre-existing conditions prevented maximal recovery or that the applicant suffered from a psychological impairment caused by the accident.

As the MIG limits were exhausted, the claims for treatment plans and assessments were dismissed.

The applicant sought payment for statutory accident benefits following a motor vehicle accident, specifically four treatment plans for chiropractic services and a functional abilities assessment, which the insurer denied.

The Licence Appeal Tribunal found that two of the treatment plans for passive, facility-based chiropractic services were reasonable and necessary because they relieved the applicant's physical pain, which in turn prevented his psychological injuries from worsening.

However, the Tribunal denied a third treatment plan involving active home-based exercise as it would aggravate his pain, and denied a second functional abilities assessment as duplicative.

The applicant was awarded interest on the approved plans but denied an award for unreasonable delay, as the insurer did not have the critical evidence linking the physical treatment to the psychological injuries until the hearing.

The applicant sought income replacement benefits (IRBs) and medical benefits following a motor vehicle accident.

The adjudicator found the applicant's testimony credible regarding the heavy physical demands of his pre-accident employment as a drywaller and steel framer.

Relying on the applicant's evidence and his treating chronic pain specialist, the adjudicator concluded the applicant suffered a substantial inability to perform the essential tasks of his employment due to pain, and awarded IRBs.

However, the claims for medical benefits and the cost of an examination were dismissed because the applicant failed to submit the disputed treatment plans into evidence.

The claim for a special award was also dismissed as the insurer reasonably relied on its own medical experts.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and medical benefits from his insurer.

The insurer denied the benefits based on its assessors' reports.

The Licence Appeal Tribunal found the applicant's testimony regarding his heavy physical labour as a drywaller and his debilitating pain to be credible, supported by his treating chronic pain specialist and the insurer's own kinesiologist.

The Tribunal awarded IRBs of $400 per week.

However, the claims for medical benefits and examination costs were dismissed because the applicant failed to enter the disputed treatment plans into evidence.

The Tribunal declined to award costs or a special award, finding the insurer did not act in bad faith.

The applicant sought statutory accident benefits for a driver anxiety assessment and a hydrotherapy program following a motor vehicle accident.

The Tribunal found that while the insurer's initial denial of the driver anxiety assessment was defective for failing to provide medical reasons, the defect was cured by a subsequent letter.

Because the applicant had not incurred the expense during the defective notice period, the insurer was not obligated to pay.

The Tribunal further held that neither the driver anxiety assessment nor the hydrotherapy program were reasonable and necessary, as the medical evidence did not support their effectiveness.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming chronic pain and psychological impairments removed him from the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found the applicant's injuries were predominantly minor, noting inconsistencies in the applicant's expert reports and preferring the thoroughness of the insurer's examinations.

As the injuries fell within the MIG, the applicant was not entitled to attendant care benefits or the disputed medical and examination expenses.

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