Dr. Jonathan Siegel

The applicant sought a catastrophic impairment determination under Criterion 8 (mental and behavioural disorders) following a 2018 motor vehicle accident, along with attendant care benefits and funding for assessments.

The Tribunal found the applicant did not sustain a marked impairment in activities of daily living or social functioning, preferring the respondent's expert evidence over the applicant's due to a more robust, in-person assessment.

As the applicant was not catastrophically impaired, the claims for attendant care benefits and assessments submitted beyond the 260-week limit were denied.

The application was dismissed.

The applicant was injured in a severe motor vehicle accident and sought a determination that she sustained a catastrophic impairment under criterion 7 of the Statutory Accident Benefits Schedule.

The applicant claimed a combined whole person impairment (WPI) of 55%, relying on various physical and psychological assessments.

The respondent argued the WPI was 35%.

The Tribunal evaluated the competing expert medical evidence regarding the applicant's spinal impairments, scarring, headaches, vertigo, and psychological functioning.

Ultimately, the Tribunal preferred the respondent's experts on several key issues, concluding that the applicant's combined WPI was 50%.

As this fell short of the 55% threshold, the application was dismissed.

The applicant sought a determination of catastrophic impairment and entitlement to attendant care benefits and income replacement benefits following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant did not meet the criteria for catastrophic impairment under either Criterion 7 (55% whole person impairment) or Criterion 8 (mental and behavioural disorders).

The Tribunal preferred the evidence of the respondent's experts, noting significant validity concerns and sub-maximal effort during the applicant's assessments.

Consequently, the applicant was not entitled to enhanced attendant care benefits, having exhausted her non-catastrophic limits.

The Tribunal also dismissed the claim for income replacement benefits, finding the applicant failed to prove a substantial inability to perform the essential tasks of her pre-accident employment as a personal support worker.

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

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

The applicant argued she should be removed from the MIG due to chronic pain with functional impairment and a psychological condition.

The Tribunal found the applicant did not meet the burden of proving chronic pain with functional impairment or a psychological condition, relying on the respondent's insurer examinations.

The Tribunal also reviewed the respondent's denial letters for compliance with s. 38(8) of the Schedule.

It found one denial letter non-compliant and ordered the respondent to pay for the associated physiotherapy treatment plan once incurred.

The remaining treatment plans and the claim for an award under s. 10 of Reg. 664 were dismissed.

The applicant sought entitlement to statutory accident benefits for physical rehabilitation, an orthopaedic assessment, and a social work assessment following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide sufficient medical evidence to prove the treatment plans were reasonable and necessary.

The Tribunal relied on the respondent's insurer examination reports, which concluded the applicant had sustained minor injuries, had benefited from prior treatment, and had successfully returned to his pre-accident employment and daily activities.

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

The Licence Appeal Tribunal considered whether the applicant was entitled to psychological and physiotherapy services, interest, and an award under s. 10 of Reg. 664.

The Tribunal denied the claim for psychological services, finding the proposed treatment was not reasonable and necessary given the lack of lasting improvement.

However, the Tribunal granted the claim for physiotherapy services, noting corroborating evidence of chronic pain from treating specialists.

The claim for an award under s. 10 was dismissed as the insurer's conduct was not unreasonable.

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 also claimed entitlement to an income replacement benefit (IRB) and two treatment plans.

The Licence Appeal Tribunal found that the applicant's physical injuries were minor and that he failed to establish a pre-existing psychological condition that would preclude recovery within the MIG.

The Tribunal also dismissed the IRB claim, noting the applicant failed to provide evidence of his pre-accident employment tasks and was found functionally capable of working by the insurer's assessors.

The claims for treatment plans and interest were similarly dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including attendant care and various medical and rehabilitation benefits.

The respondent denied the benefits, and the applicant applied to the Licence Appeal Tribunal.

The Tribunal found that the applicant was not entitled to ongoing attendant care benefits, as the medical evidence demonstrated he was mostly independent in his activities of daily living and failed to prove the expenses were incurred.

The Tribunal granted one physiotherapy treatment plan for $4,022.42, finding it reasonable and necessary for pain reduction, despite the respondent's argument that the injuries fell within the Minor Injury Guideline.

The remaining claims for further treatment, assessments, and treatment provider mileage were dismissed as they were either duplicative, not reasonable and necessary, or not payable under the Schedule.

The applicant sought statutory accident benefits for various treatment plans and assessments following a motor vehicle accident.

The respondent denied the benefits.

The Tribunal dismissed the application, finding that the applicant failed to meet her burden of proving the treatment plans were reasonable and necessary.

Crucially, the applicant failed to submit the actual treatment plans (OCF-18s) into evidence, making it impossible for the Tribunal to assess them.

Furthermore, the Tribunal preferred the respondent's medical evidence, including multiple insurer examinations, which concluded the applicant had reached maximum medical improvement and did not require the disputed treatments.

The applicant sought statutory accident benefits following a motor vehicle accident, including chiropractic treatment, a psychological assessment, a chronic pain assessment, a special award, and interest.

The adjudicator found no jurisdiction over the chiropractic treatment plans as they had already been approved by the respondent and the dispute arose from improper invoicing.

The claim for the remaining cost of a psychological assessment was dismissed because the applicant failed to prove that fees exceeding the guideline rate were reasonable.

However, the adjudicator granted the cost of a chronic pain assessment, finding it necessary to explore the applicant's pain complaints and rejecting the respondent's medical examination report.

The claim for a special award for unreasonable delay was dismissed, but interest was awarded on the approved chronic pain assessment.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and a medical benefit for physiotherapy.

The Licence Appeal Tribunal found that the applicant suffered a substantial inability to perform the essential tasks of his pre-accident employment as a janitorial cleaner due to physical and psychological impairments, entitling him to pre-104-week IRBs.

However, the applicant failed to establish a complete inability to engage in any suitable employment, and was therefore denied post-104-week IRBs.

The Tribunal also denied the proposed physiotherapy treatment plan, noting the applicant had an unexhausted, previously approved treatment plan and had provided inconsistent evidence regarding the benefits of physiotherapy.

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 statutory accident benefits following a motor vehicle accident.

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

The applicant argued she sustained psychological injuries that removed her from the MIG.

The Tribunal found the insurer's psychological assessment more persuasive, noting the applicant's own statements contradicted her claimed psychological impairments.

The Tribunal concluded the applicant's injuries were minor and governed by the MIG, dismissing her appeal and denying her claim for an award.

The insurer's request for costs was also denied.

The applicant, who was struck by an automobile while riding a bicycle, sought a medical and rehabilitation benefit of $10,033.92 for a chronic pain program.

The insurer denied the claim based on independent medical examinations suggesting the applicant had reached maximal medical recovery.

The Tribunal found the proposed treatment plan reasonable and necessary, preferring the evidence of the applicant's assessors which demonstrated ongoing pain and functional impairment exceeding physical signs of injury.

The appeal was allowed, and the insurer was ordered to pay the benefit with interest.

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

The Tribunal found the applicant lacked credibility, having concealed her return to work and regular gym attendance from assessors.

Relying on objective medical imaging and the respondent's experts, the Tribunal concluded the applicant did not suffer a substantial inability to perform the essential tasks of her pre-accident employment as a dental assistant.

The claim for ACBs was dismissed because the expenses were not incurred as defined in the Schedule.

The respondent was awarded repayment of $2,984.59 for IRBs paid while the applicant was working.

Both parties' requests for costs were denied.

The applicant was injured in a motor vehicle accident and claimed she sustained a catastrophic impairment due to a mental or behavioural disorder.

The insurer argued the accident was minor and her impairments were pre-existing or caused by unrelated post-accident stressors.

Applying the three-stage process from Pastore, the arbitrator found that the accident materially contributed to the applicant's diagnosed mental and behavioural disorders, including major depressive disorder and pain disorder.

The arbitrator preferred the evidence of the applicant's experts and the insurer's occupational therapist over the insurer's psychiatrist, concluding the applicant suffered a marked impairment in the sphere of deterioration or decompensation in work or worklike settings.

The applicant was deemed catastrophically impaired.

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

The insurer terminated her income replacement benefits, arguing she was capable of returning to work.

The arbitrator found that the applicant made honest and sustained attempts to return to her pre-accident employment as an accountant, but was unable to continue due to her injuries.

The arbitrator rejected the insurer's medical assessments suggesting a lack of motivation, finding the applicant's testimony credible and her attempts to work genuine.

The applicant was found to be substantially disabled from performing the essential tasks of her employment and completely unable to engage in suitable employment, entitling her to ongoing income replacement benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement, medical, housekeeping, and assessment costs.

The insurer terminated benefits based on an assessment by a general practitioner and a Disability DAC report.

The arbitrator found that the applicant suffered a substantial inability to perform her pre-accident employment as a sewing machine operator for the first 104 weeks, relying on the chronic pain diagnosis of her treating physiatrist and psychologist.

However, the applicant failed to meet the stricter "complete inability" test for post-104 week benefits.

The arbitrator awarded the claimed medical, housekeeping, and assessment expenses.

Furthermore, the arbitrator ordered the insurer to pay a $10,000 special award under s. 282(10) of the Insurance Act, finding that the insurer unreasonably withheld benefits by relying on flawed assessments, ignoring substantial medical evidence, and improperly requesting a supplementary report from a neutral DAC assessor.

The applicant was injured in a motor vehicle accident and sought ongoing income replacement benefits and payment for treatment expenses after the insurer terminated them.

The applicant failed to attend the arbitration hearing.

The arbitrator reviewed the insurer's evidence, including medical opinions indicating the applicant was capable of returning to work as a manicurist.

The arbitrator found the applicant failed to meet the burden of proving a substantial inability to perform the essential tasks of his employment or that the disputed treatment was reasonable and necessary.

The claims were dismissed, and the insurer was awarded its expenses for the arbitration.