Dr. Jamie Rusen

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

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

The applicant argued she should be removed from the MIG due to chronic pain, a pre-existing condition, and psychological impairments.

The Tribunal found that the applicant failed to prove on a balance of probabilities that she suffered from chronic pain with functional impairment, that her pre-existing condition precluded recovery within the MIG, or that she had a psychological condition warranting removal.

As the MIG limit was exhausted, the disputed treatment plans were not payable.

Claims for an award and interest were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit, an attendant care assessment, and chiropractic services.

The Licence Appeal Tribunal dismissed the claims for the non-earner benefit and the attendant care assessment, finding the applicant failed to provide sufficient medical evidence or a detailed comparison of pre- and post-accident activities to establish a complete inability to carry on a normal life.

However, the Tribunal granted the treatment plans for chiropractic services, concluding that the medical evidence supported the necessity of physical therapy for the applicant's accident-exacerbated bilateral shoulder and knee impairments.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for psychological services and an attendant care assessment.

The respondent partially denied the psychological services and fully denied the attendant care assessment.

The Licence Appeal Tribunal found the applicant was entitled to 90-minute psychological sessions but not the higher hourly rate requested for a psychotherapist.

The Tribunal also granted the attendant care assessment based on the applicant's ongoing vertigo symptoms.

The applicant's request for a section 10 award for unreasonable delay was dismissed.

The applicant sought entitlement to statutory accident benefits for chiropractic services and an orthopaedic assessment following a 2018 motor vehicle accident.

The respondent denied the treatment plans, arguing the applicant's shoulder impairment was not caused by the accident.

The Tribunal found that the applicant's shoulder instability emerged three years post-accident and was caused by an intervening event at home.

Relying on the insurer's examination and clinical notes, the Tribunal concluded the treatment plans were not reasonable and necessary.

The application was dismissed.

The applicant requested a reconsideration of a Tribunal decision that denied her entitlement to a physiotherapy treatment plan and dismissed her motion to exclude the respondent's section 44 insurer examination reports.

The applicant argued the Tribunal breached procedural fairness and made errors of law and fact by admitting late documents, misapprehending medical evidence, and failing to find that pain relief is a reasonable goal of treatment.

The Tribunal dismissed the reconsideration request, finding no jurisdictional error, breach of procedural fairness, or errors of fact or law, noting that the reconsideration process is not an opportunity to re-litigate disagreements with the original decision or the weight assigned to evidence.

The applicant sought entitlement to six treatment plans for chiropractic services, massage therapy, and physical therapy following a 2019 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to provide sufficient corroborating medical evidence to prove the disputed treatments were reasonable and necessary, noting a lack of objective improvement in range of motion.

The Tribunal accepted the respondent's orthopaedic independent medical examinations, which concluded that only active therapies were reasonable and that the applicant had reached maximal medical recovery from facility-based treatment.

The Tribunal also found the respondent's denial letters complied with section 38(8) of the Schedule.

The application was dismissed.

The applicant sought accident benefits following a 2019 motor vehicle accident.

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

The Tribunal found that the applicant sustained a full-thickness rotator cuff tear requiring surgery as a result of the accident, which warranted removal from the MIG.

The Tribunal approved treatment plans for a chronic pain assessment and an orthopaedic assessment due to the applicant's ongoing pain and functional impairment.

However, a treatment plan for physiotherapy was denied for lack of supporting medical evidence.

The Tribunal also declined to order a special award under s. 10 of Reg. 664, finding that the insurer's incorrect MIG determination did not amount to unreasonable conduct.

The applicant sought entitlement to a $1,020 physiotherapy treatment plan, interest, and an award under s. 10 of Reg. 664 following a 2013 motor vehicle accident.

The applicant also brought a preliminary motion to exclude the respondent's insurer examination reports due to late production of the assessors' CVs.

The Tribunal denied the preliminary motion, finding no prejudice to the applicant.

On the substantive issues, the Tribunal found the applicant failed to prove the physiotherapy was reasonable and necessary, noting a lack of compelling contemporaneous medical evidence and relying on the respondent's s. 44 orthopedic assessment which concluded the applicant had reached maximum medical recovery.

The application was dismissed in its entirety.

The applicant sought entitlement to statutory accident benefits for chiropractic, massage, psychotherapy, and catastrophic determination assessments following a 2017 motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to meet her evidentiary burden to prove the treatment and assessment plans were reasonable and necessary.

The Tribunal preferred the respondent's more current section 44 assessment reports over the applicant's outdated section 25 reports and noted the lack of consistent recommendations from treating physicians.

The applicant was injured in a 2018 motor vehicle accident and sought ongoing income replacement benefits (IRBs) beyond the 104-week mark, along with medical benefits, an award, and costs.

The respondent denied the IRBs, arguing the applicant could work part-time in alternative roles.

The Tribunal found that the applicant met the post-104 week test for IRBs because the alternative employment proposed by the respondent offered significantly less income and status than her pre-accident work, and her psychological impairments limited her to working only 6 to 10 hours per week.

However, the Tribunal dismissed the claims for metabolic testing, neuromonitoring, and physiotherapy due to insufficient evidence regarding their necessity and reasonable costs.

The claims for a special award and costs were also dismissed.

The applicant was injured in a motor vehicle accident and sought post-104 week income replacement benefits (IRBs) and a physiotherapy treatment plan.

The respondent terminated IRBs based on insurer examinations concluding her physical injuries had resolved.

The Tribunal found that the accident was a necessary cause of the applicant's chronic pain syndrome, which rendered her completely unable to engage in suitable employment.

The Tribunal awarded ongoing IRBs and interest.

The physiotherapy treatment plan was denied as the applicant had reached maximum medical recovery.

The Tribunal also ordered a $2,800 award against the respondent under Regulation 664 for unreasonably failing to provide the applicant's chronic pain assessment report to its own medical examiners, which prejudiced the assessment process.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) for 104 weeks.

The insurer terminated the benefits at the 104-week mark, arguing the applicant did not suffer a complete inability to engage in any employment for which she was reasonably suited by education, training, or experience.

The Tribunal reviewed the medical evidence, including reports from orthopedic surgeons, a psychologist, and a vocational assessor, and found that the applicant's physical and psychological impairments did not meet the post-104-week IRB test.

The application was dismissed, and no interest was payable.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing her injuries should be excluded from the Minor Injury Guideline (MIG) due to chronic pain.

The Tribunal found that the applicant failed to provide a formal diagnosis of chronic pain or demonstrate that her impairments met the criteria outlined in the AMA Guides.

Relying on the respondent's orthopaedic assessment, the Tribunal concluded the applicant's injuries were predominantly minor.

Consequently, the claims for additional medical benefits and assessments were dismissed, and no interest was awarded.

The applicant sought statutory accident benefits following a motor vehicle accident, including physiotherapy, assistive devices, and costs of examinations for driving anxiety, functional abilities, and chronic pain.

The respondent denied the benefits, relying on an orthopedic assessment that placed the applicant in the Minor Injury Guideline.

The Tribunal found that the preponderance of medical evidence, including the applicant's OHIP claims history and clinical notes, supported the reasonableness and necessity of the disputed treatment plans and assessments.

The Tribunal ordered the respondent to pay the claimed benefits and interest, but denied the applicant's claim for a special award, finding no evidence of unreasonable delay or withholding.

The worker, a 59-year-old teacher, suffered a compensable left shoulder rotator cuff tear after slipping on ice in 2009.

He underwent surgery and was deemed fully recovered by September 2010.

In 2014, he sought ongoing entitlement for his left shoulder, claiming a newly discovered bone spur was caused by the surgery, and initial entitlement for his right shoulder, claiming it was also injured in the 2009 fall but masked by the left shoulder pain.

The Appeals Resolution Officer denied both appeals.

The left shoulder claim lacked continuity and clinical compatibility, and the bone spur was deemed degenerative based on the WSIB Medical Consultant's opinion.

The right shoulder claim was denied due to a five-year delay in reporting and lack of contemporaneous medical evidence establishing proof of accident.