Dr. Inese Robertus

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 the applicant suffered from an accident-related psychological impairment, specifically Somatic Symptom Disorder and Adjustment Disorder, warranting removal from the MIG.

The Tribunal approved a treatment plan for a psychological assessment but denied other treatment plans for chronic pain, physiotherapy, guided exercise, and a social work assessment due to lack of supporting evidence.

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

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

The Tribunal found the applicant's pre-existing lower back pain and sciatica prevented her from achieving maximal recovery within the MIG, warranting removal.

The Tribunal granted entitlement to physiotherapy treatment plans, a chronic pain assessment, and a neurological assessment, finding them reasonable and necessary.

However, claims for chronic pain treatment, psychological services, and certain medical devices were dismissed for lack of supporting medical evidence.

Interest was awarded on the approved plans.

The applicant sought payment for a chronic pain program following a motor vehicle accident, which the respondent insurer partially denied.

The Tribunal found the physical rehabilitation sessions were reasonable and necessary based on the applicant's established chronic pain syndrome and the recommendations of her family physician and orthopaedic surgeon.

However, the applicant failed to prove the necessity of the remaining proposed services, including educational procedures and transportation costs.

The Tribunal awarded $5,785.50 for the physical rehabilitation sessions with interest, but declined to order a special award, finding the insurer did not act unreasonably in its handling of the claim.

The applicant sought income replacement benefits and approval for various treatment plans following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove on a balance of probabilities that he suffered a substantial inability to perform the essential tasks of his employment or a complete inability to engage in any employment.

The Tribunal preferred the respondent's medical evidence, noting inconsistencies in the applicant's expert reports and relying on the applicant's successful completion of a three-month accounting work placement.

The claims for treatment plans, an award, and interest were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming costs for a psychological assessment, a chronic pain assessment, and a chronic pain program.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove on a balance of probabilities that the proposed treatment plans were reasonable and necessary.

The Tribunal preferred the evidence of the insurer's experts, noting a lack of corroborative evidence for chronic pain syndrome and failure to demonstrate functional impairment under the AMA Guides.

The applicant requested a reconsideration of a decision finding that her accident-related impairments fell within the Minor Injury Guideline (MIG) and that she was not entitled to further medical benefits as the MIG limits were exhausted.

The applicant argued the adjudicator erred in law and fact by failing to find she suffered from chronic pain and by not properly considering certain medical evidence.

The adjudicator denied the request, finding no error in the weighing of the medical evidence, which did not corroborate the chronic pain diagnosis.

The adjudicator also held that arguments regarding pre-existing conditions were improperly raised for the first time on reconsideration.

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

The insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the requested treatments were not reasonable and necessary.

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

The Tribunal found the applicant's injuries were predominantly minor, noting her active lifestyle including weightlifting and combat sports contradicted claims of chronic pain and functional impairment.

The Tribunal also found the insurer's denial notices complied with section 38(8) of the Schedule, and the applicant failed to prove the disputed assessments were reasonable and necessary.

The application was dismissed.

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 applicant argued she suffered from chronic pain and psychological impairments that removed her from the MIG.

The Tribunal found that the applicant's physical injuries were soft tissue in nature and that her claims of chronic pain and psychological injury were not corroborated by the contemporaneous medical records of her family physician.

As the applicant failed to prove her injuries warranted treatment beyond the MIG, and the $3,500 limit had been exhausted, the disputed treatment plans were not payable.

The claims for interest and an award were also dismissed.

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

The respondent insurer determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied further medical benefits and assessments.

The applicant argued that his pre-existing degenerative disc disease and chronic pain warranted removal from the MIG.

The Tribunal found that the applicant failed to prove his pre-existing condition prevented maximal recovery under the MIG limits.

Furthermore, the Tribunal rejected the applicant's chronic pain assessment, finding it contradicted by the treating physician's clinical notes and records.

As the applicant's injuries were predominantly minor and the $3,500 MIG limit was exhausted, the disputed treatment plans were not payable.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to chiropractic treatment, physiotherapy, a chronic pain assessment, and a chronic pain treatment program.

The respondent denied the benefits, arguing the impairments were not accident-related but due to pre-existing degenerative changes.

The Tribunal found that while the accident exacerbated the applicant's left shoulder and left knee conditions, the applicant failed to prove the proposed treatment plans were reasonable and necessary.

The medical evidence did not support the need for further physical therapy or the diagnosis of chronic pain syndrome.

The application was dismissed, and no award or interest was payable.

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

The respondent denied several treatment and assessment plans, arguing they were not reasonable and necessary.

The Tribunal found that while the applicant's pre-existing degenerative disc disease and chronic pain syndrome removed her from the Minor Injury Guideline, she had reached maximum medical improvement from her accident-related injuries.

Relying on the respondent's medical examinations, the Tribunal concluded that further facility-based treatment would not yield substantial improvement.

The application for benefits, interest, and a special award was dismissed.

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

The respondent insurer denied the benefits.

The Licence Appeal Tribunal found that while the applicant's pre-existing chronic pain and degenerative disc disease removed her from the Minor Injury Guideline, she had reached maximum medical improvement from her accident-related injuries.

Relying on the respondent's medical assessments, the Tribunal concluded that further facility-based treatment was not reasonable and necessary.

The application for benefits, interest, and a special award was dismissed.

The applicant sought entitlement to statutory accident benefits for psychological services, massage therapy, and chiropractic treatment following a motor vehicle accident.

The adjudicator found that the applicant failed to prove the treatment plans were reasonable and necessary.

The psychological assessment relied upon by the applicant was given little weight because it was unclear whether the supervising psychologist or the psychometrist conducted the clinical interview and made the diagnosis.

The respondent's psychological assessment, which found no impairment warranting a diagnosis, was preferred.

The claims for massage and chiropractic treatment were also dismissed as there was insufficient evidence they would provide relief comparable to physiotherapy.

The application was dismissed.

The applicant sought statutory accident benefits for physiotherapy, a chronic pain program, and an orthopaedic assessment following a rear-end collision.

The respondent insurer denied the claims, arguing the applicant failed to prove the impairments were caused by the accident.

The Tribunal found that the applicant had an extensive pre-accident medical history, including knee replacements, fibromyalgia, and depression, and failed to provide sufficient clinical notes and records to establish a baseline for comparison.

The Tribunal gave no weight to the applicant's expert reports due to factual inaccuracies and incomplete medical reviews.

The application was dismissed as the applicant failed to prove causation on a balance of probabilities.

The applicant was injured in a motor vehicle accident and sought a medical benefit of $10,600 for a chronic pain treatment program, which the respondent insurer denied.

The Licence Appeal Tribunal found that the applicant proved on a balance of probabilities that the treatment plan was reasonable and necessary, preferring the evidence of the applicant's experts who diagnosed chronic pain over the respondent's assessors who did not specifically evaluate for chronic pain.

The Tribunal ordered the respondent to pay for the treatment plan and interest on overdue amounts, but denied the applicant's request for a special award under Ontario Regulation 664, finding no evidence that the insurer unreasonably withheld or delayed payment.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for a psychological assessment and a chronic pain treatment program.

The respondent insurer denied both claims, initially relying on the Minor Injury Guideline.

The Licence Appeal Tribunal found that the applicant demonstrated psychological symptoms and chronic pain related to the accident that warranted the disputed treatment plans.

The Tribunal preferred the evidence of the applicant's assessor over the respondent's paper-review expert, noting inconsistencies in the latter's reports.

The Tribunal ordered the respondent to pay for both the psychological assessment and the chronic pain treatment program, along with interest on the overdue payments.

The applicant sought a medical and rehabilitation benefit of $12,001.80 for a chronic pain treatment program following a motor vehicle accident.

The insurer denied the claim.

The Tribunal found that the applicant did not meet the AMA criteria for chronic pain, noting that he had returned to full-time work, completed a university degree, and maintained social and self-care activities.

The Tribunal concluded the treatment was not reasonable and necessary, dismissing the appeal and the claims for interest and a special award.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a chronic pain management program and an orthopaedic assessment.

The respondent insurer denied the treatment plans, arguing they were not reasonable or necessary.

The Licence Appeal Tribunal found the applicant's medical evidence, which included diagnoses of chronic pain syndrome and recommendations for multidisciplinary treatment, to be more persuasive than the insurer's assessments.

The Tribunal ordered the respondent to pay for the chronic pain program and the orthopaedic assessment, along with interest on incurred expenses.

However, the Tribunal dismissed the applicant's claim for a special award under Regulation 664, finding no evidence that the insurer acted unreasonably or in bad faith.

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

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove her entitlement to the benefits.

The Tribunal gave substantial weight to the respondent's insurer's examination reports, noting that the applicant's self-reporting to her own experts was inconsistent with her statements to the respondent's assessors, undermining her claims of complete inability to carry on a normal life, psychological impairment, and chronic pain syndrome.

The applicant's requests for interest and a special award were also denied.

The applicant was injured in a motor vehicle accident and sought funding for physiotherapy and a chronic pain treatment program under the Statutory Accident Benefits Schedule.

The insurer denied the treatment plans on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal reviewed the medical evidence, including reports from psychologists and orthopaedic surgeons, and found that the applicant had made significant progress in his recovery.

The Tribunal concluded that the proposed treatment plans were not reasonable or medically necessary and dismissed the application.