Dr. James Stewart

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit (NEB), a functional abilities assessment, and a chronic pain assessment.

The Tribunal found the respondent failed to comply with a production order regarding the NEB denial letter and drew an adverse inference, concluding the respondent failed to provide proper notice under s. 36(4) of the Schedule.

Consequently, the NEB was payable under s. 36(6).

The Tribunal denied the functional abilities assessment, finding the applicant's physical condition did not limit his daily tasks or employment.

However, the Tribunal approved the chronic pain assessment based on consistent reports of ongoing pain.

Claims for an award and costs were dismissed.

The applicant sought accident benefits following a motor vehicle accident but was denied by the respondent on the basis that his injuries fell within the Minor Injury Guideline (MIG).

The applicant argued he should be removed from the MIG due to chronic pain.

The Tribunal found that the applicant's clinical notes did not establish ongoing, consistent complaints of accident-related pain, and a section 44 assessment concluded he suffered only minor sprain and strain injuries.

The Tribunal held the applicant to the MIG limit and dismissed the claims for further treatment plans and interest.

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

The Tribunal found the applicant failed to provide compelling medical evidence that her pre-existing depression and anxiety precluded recovery within the MIG.

Furthermore, the Tribunal rejected the applicant's claims of chronic pain with functional impairment and psychological impairment, noting inconsistencies in her reporting and placing little weight on her psychological assessment.

As the MIG limits were already exhausted, the claims for further treatment plans, interest, and an award were dismissed.

The applicant was severely injured when pinned between two vehicles, sustaining massive abdominal trauma including a subtotal colectomy and partial kidney infarction.

He applied for a catastrophic impairment determination under Criterion 7 of the SABS.

The Tribunal conducted a detailed analysis of his Whole Person Impairment (WPI) ratings under the AMA Guides, assigning 15% for musculoskeletal, 9% for scarring, 25% for gastrointestinal (Class 3), 2% for medication, and 20% for mental and behavioural impairments.

The combined WPI of 54.5% rounded to 55%, meeting the catastrophic threshold.

The Tribunal denied attendant care benefits because the applicant failed to prove the expenses were incurred, but approved several medical treatment plans including psychological services and nutrition counselling.

Costs of $250 were awarded against the respondent for late production of adjuster log notes.

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 also claimed income replacement benefits (IRBs) and approval for several treatment plans.

The Tribunal found that the applicant failed to provide sufficient medical evidence to prove her injuries warranted removal from the MIG.

Furthermore, the applicant was not entitled to IRBs because she failed to submit a completed disability certificate (OCF-3) prior to her return to work and did not provide evidence regarding her inability to perform the essential tasks of her employment.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming catastrophic impairment under Criterion 7.

The respondent denied the benefits.

The Tribunal found the applicant was not catastrophically impaired, as her Whole Person Impairment rating was 48%, falling short of the 55% threshold.

The Tribunal rejected the WPI ratings for incontinence and headaches provided by the respondent's own expert, finding the incontinence was pre-existing and did not worsen post-accident.

Claims for psychological services, case management, interest, and a section 10 award were also dismissed.

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 for removal from the MIG based on a pre-existing right-leg fracture and an accident-related psychological impairment.

The Tribunal found that the applicant failed to provide compelling medical evidence that her pre-existing condition prevented maximal recovery within the MIG.

Furthermore, the Tribunal afforded little weight to the applicant's psychological assessment due to a lack of corroborating medical records and reliability issues.

As the applicant remained within the MIG, her claims for disputed treatment plans, interest, and an award were dismissed.

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

The adjudicator found that the applicant was statute-barred from disputing a chronic pain assessment because she failed to file an application within the two-year limitation period after receiving valid denials from the insurer.

The adjudicator also dismissed claims for a psycho-vocational assessment, finding the applicant had returned to her pre-accident employment, and for psychological services, as the applicant failed to justify the need for longer sessions at a higher rate than approved.

A claim for chiropractic services was denied because the expense was incurred before a treatment plan was submitted.

Claims for interest and an award were consequently dismissed.

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

The Tribunal found the applicant did not meet the burden of proving her injuries warranted removal from the MIG, noting her continued ability to work full-time and lack of compelling medical evidence.

As the applicant was subject to the MIG and the funding limit was exhausted, the claim for a chiropractic treatment plan and interest was dismissed.

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

The respondent denied benefits beyond the $3,500 Minor Injury Guideline (MIG) limit and terminated income replacement benefits.

The Tribunal found that the applicant's physical injuries fell within the definition of a minor injury and that she failed to establish a pre-existing condition, chronic pain, or psychological impairment warranting removal from the MIG.

The Tribunal accepted the respondent's expert evidence, which raised significant validity concerns regarding the applicant's presentation, over the applicant's evidence.

The Tribunal also dismissed the claim for ongoing income replacement benefits, finding the applicant failed to prove a substantial inability to perform the essential tasks of her employment.

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 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 argued he suffered a psychological impairment and had a pre-existing condition of scoliosis that precluded recovery within the MIG.

The Tribunal found that the physical injuries were predominantly minor and that the applicant failed to establish a psychological injury or a documented pre-existing condition that would warrant removal from the MIG.

As the proposed physiotherapy treatment plan exceeded the $3,500 MIG limit, it was deemed not reasonable and necessary, and the application was dismissed.

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

The applicant argued that accident-related psychological impairments and chronic pain warranted removal from the MIG, and claimed entitlement to a non-earner benefit (NEB) and various treatment plans.

The Tribunal found that the applicant failed to prove she suffered from a psychological impairment or chronic pain, noting that her family physician's records did not support her claims and she had returned to work post-accident.

The Tribunal concluded the applicant's injuries were predominantly minor, dismissed the claim for NEB as she did not suffer a complete inability to carry on a normal life, and denied the disputed treatment plans and interest.

The applicant sought various medical and rehabilitation benefits following a motor vehicle accident, including natural supplements, medical marijuana, Platelet Rich Plasma (PRP) therapy, physiotherapy, psychological services, and a visual assessment.

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal found that medical marijuana was contraindicated due to the applicant's pre-existing conditions, and that PRP therapy was experimental and thus excluded under s. 15(2)(a) of the Schedule.

Relying on independent medical examinations, the Tribunal concluded that the remaining physical and psychological treatment plans were not reasonable and necessary.

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

The adjudicator denied the claims for medical cannabis and an in-home ergonomic assessment, finding them not reasonable and necessary.

However, the adjudicator approved a work site ergonomic assessment and physiotherapy services based on the recommendations of the applicant's treating physician and medical assessors.

The adjudicator also ordered the respondent to pay for a psychological treatment plan because the respondent's denial letter failed to provide sufficient medical and other reasons, breaching section 38(8) of the Schedule.

The claim for a special 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 was involved in a motor vehicle accident and sought statutory accident benefits.

The respondent determined 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 that psychological impairments and chronic pain warranted removal from the MIG.

The Tribunal found that the applicant's medical evidence, which relied heavily on subjective reporting and lacked objective support, failed to establish a psychological impairment or chronic pain condition.

The Tribunal concluded the applicant sustained predominantly minor injuries and remains subject to the $3,500 MIG limit.

Pursuant to s. 40(8) of the Schedule, the disputed treatment plans were deemed reasonable and necessary up to the remaining MIG limit of $168.73.

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

The respondent denied medical and rehabilitation benefits, arguing the injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant sustained a psychological impairment (Adjustment Disorder) that removed him from the MIG.

The Tribunal awarded the costs of a psychological assessment, psychological treatment, and physiotherapy.

The applicant was also awarded income replacement benefits for a limited period, the cost of an accountant's report to calculate self-employment income, and interest.

The claim for a special award under s. 10 of Regulation 664 was dismissed as the insurer's conduct was not unreasonable.

The applicant sought $2,570.00 for a physiotherapy treatment plan and interest under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent denied the plan.

The Tribunal addressed several procedural issues, excluding late medical evidence and striking references to an undisclosed medical report due to prejudice to the respondent.

On the merits, the Tribunal found the applicant failed to demonstrate the treatment plan was reasonable and necessary, preferring the comprehensive insurer's examination reports over the applicant's limited medical evidence.

The application was dismissed.

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

The respondent determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and capped medical and rehabilitation benefits at $3,500.

The applicant applied to the Licence Appeal Tribunal, arguing that pre-existing conditions, chronic pain, and psychological impairments warranted removal from the MIG.

The Tribunal found insufficient evidence to support the applicant's claims, preferring the respondent's independent medical examination reports over the applicant's orthopaedic expert.

The Tribunal concluded the applicant sustained minor injuries, and having exhausted the $3,500 limit, was not entitled to further chiropractic benefits, interest, or an award.