Dr. Judith Pilowsky

The applicant sought statutory accident benefits for a psychological assessment and a chronic pain assessment following a motor vehicle accident.

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 psychological impairment or chronic pain that would remove her from the MIG, preferring the respondent's medical assessments which aligned with the family physician's clinical notes.

The Tribunal also found insufficient evidence that a pre-existing shoulder condition prevented maximal recovery.

The application was dismissed.

The applicant sought statutory accident benefits for chiropractic and physiotherapy services following a motor vehicle accident.

The insurer denied the treatment plans based on its examination reports.

The Tribunal found that the applicant's contemporaneous medical records, including psychological assessments and family physician notes, demonstrated that the physical therapies were reasonable and necessary to address her accident-related impairments.

The Tribunal ordered the insurer to pay for the disputed treatment plans and interest on overdue payments, but denied the applicant's request for a special award under O. Reg. 664, finding no evidence of unreasonable conduct by the insurer.

The applicant was injured in a motor vehicle accident and sought medical benefits for psychological impairments, which the respondent insurer denied on the basis that the injuries fell within the Minor Injury Guidelines (MIG).

The applicant argued that diagnoses of PTSD and Adjustment Disorder took him outside the MIG.

The Tribunal weighed competing psychological assessments and preferred the respondent's expert, who conducted a response validity test and found no discernible accident-related psychological impairments.

The Tribunal attached minimal weight to the applicant's experts due to methodological flaws and inconsistencies.

The Tribunal concluded the applicant's injuries were predominantly minor, dismissing the claims for psychological assessment and treatment, as well as the claim for an award for unreasonably withheld benefits.

The applicant sought non-earner benefits, attendant care benefits, and the cost of a chronic pain assessment following a motor vehicle accident.

The adjudicator found the applicant was barred from pursuing the chronic pain assessment due to her failure to attend section 44 insurer examinations without a valid reason.

The claims for non-earner and attendant care benefits were dismissed because the applicant failed to establish a complete inability to carry on a normal life or that the attendant care expenses were incurred, with the adjudicator preferring the respondent's medical evidence and noting inconsistencies in the applicant's self-reporting and treating physician's records.

The applicant was injured in a rear-end motor vehicle accident and sought accident benefits.

The respondent insurer deemed the injuries to fall within the Minor Injury Guideline (MIG) and denied a $2,200 psychological assessment.

The applicant applied to the Licence Appeal Tribunal.

The Tribunal found that the applicant's psychological impairments, including adjustment disorder and somatic symptom disorder, fell outside the definition of a minor injury.

The Tribunal preferred the evidence of the applicant's psychologist over the insurer's assessor, noting the insurer's assessor discounted moderate impairment test results without reasonable explanation.

The Tribunal ordered the respondent to pay for the psychological assessment with interest, but declined to order an award for unreasonably withheld payments.

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

The insurer denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

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

The adjudicator preferred the insurer's psychological assessment, which included validity testing indicating symptom magnification, over the applicant's psychological evidence.

The adjudicator concluded the applicant's injuries were predominantly minor, dismissing the claims for additional medical benefits, an award for unreasonable delay, and interest.

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

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

The applicant argued that psychological impairments and chronic pain removed him from the MIG.

The Tribunal preferred the respondent's psychological assessment, which utilized validity indices, over the applicant's assessment, which relied primarily on self-reporting.

The Tribunal found the applicant failed to prove his injuries were not predominantly minor, and therefore the disputed medical benefits, interest, and award were not payable.

The applicant, an elderly woman, was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy, chiropractic services, psychological services, and an orthopaedic assessment.

The respondent insurer denied most of the treatment plans, arguing the injuries were minor soft-tissue injuries and the applicant had received sufficient treatment.

The Licence Appeal Tribunal found the treatment plans for physical and psychological therapy, as well as the orthopaedic assessment, to be reasonable and necessary, accepting the applicant's diagnosis of chronic pain syndrome and severe psychological impairments.

The Tribunal ordered the respondent to pay the disputed medical benefits and assessment costs, along with interest, but denied the request for a special award and the cost of a redundant disability certificate.

The applicant sought statutory accident benefits, including non-earner benefits and payment for two treatment plans, following a motor vehicle accident.

The respondent denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 cap had been reached.

The Tribunal found that the applicant's physical injuries were predominantly soft tissue injuries and that he failed to prove his pre-existing conditions or alleged psychological impairments took him out of the MIG.

The Tribunal rejected the applicant's psychological expert evidence as unreliable and preferred the respondent's expert evidence.

The Tribunal also found the applicant did not suffer a complete inability to carry on a normal life, dismissing the claim for non-earner benefits.

The applicant appealed an arbitrator's decision dismissing his claims for income replacement benefits and medical benefits outside the Minor Injury Guideline following a motor vehicle accident.

The arbitrator found the applicant lacked credibility due to inconsistencies between his reports to doctors and his employment records, which showed he continued working after the accident.

The arbitrator also concluded the applicant's injuries were predominantly minor and there was no compelling evidence that pre-existing conditions prevented his recovery within the guideline limits.

The Director's Delegate upheld the arbitrator's decision, finding no error in the assessment of credibility or the weighing of medical evidence.

The applicant sought statutory accident benefits following a motor vehicle accident, including costs for a psychological assessment, psychological treatment, and physiotherapy.

The Licence Appeal Tribunal found the insurer liable to pay for the psychological assessment because its denial notice failed to provide medical reasons as required by s. 38(8) of the Schedule.

However, the claims for psychological treatment and physiotherapy were dismissed, as the applicant failed to prove they were reasonable and necessary, with the Tribunal preferring the insurer's examination reports over the applicant's contradictory self-reporting.

The claim for a special award was also dismissed.

The applicant sought a medical benefit for psychological services following a motor vehicle accident.

The insurer denied the treatment plan based on an insurer examination.

The Tribunal found the applicant's self-reporting to his own psychologist was contradicted by his statements to the insurer's assessor, where he minimized his symptoms.

Given the lack of corroborating evidence and the unexplained discrepancies in self-reporting, the Tribunal concluded the applicant failed to prove the treatment plan was reasonable and necessary.

The claims for the medical benefit, a special award, and interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including ongoing non-earner benefits and two physiotherapy treatment plans.

The insurer had paid non-earner benefits for six months but sought to retroactively terminate them, while also denying the treatment plans.

The Licence Appeal Tribunal found that the applicant did not meet the test for ongoing non-earner benefits after November 2015, given her level of post-accident activity, but refused to retroactively terminate the benefits already paid.

The Tribunal granted the two physiotherapy treatment plans, finding them reasonable and necessary due to the close connection between the applicant's physical pain and her psychological conditions, including post-traumatic stress disorder and depression.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, which the respondent denied on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that his physical injuries, including a partial shoulder tear, and psychological impairments, diagnosed as an adjustment disorder, warranted removal from the MIG.

The Tribunal found that the physical injuries were predominantly minor and that the psychological diagnosis was not supported by the psychometric testing or DSM-5 criteria.

The application was dismissed, and no benefits or awards were granted.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming $677.93 for the outstanding cost of a psychological assessment plan.

The respondent had partially approved the plan but disputed the remaining cost.

The applicant argued the respondent was statute-barred from denying the claim due to late notice under s. 38(8) of the Schedule.

The Tribunal found the applicant incurred the cost after receiving the denial notice, meaning s. 38(11)2 did not apply.

On the merits, the Tribunal preferred the evidence of the respondent's expert and found the applicant failed to prove the additional cost was reasonable and necessary.

The application was dismissed, along with 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 sought ongoing income replacement benefits following a motor vehicle accident.

The respondent had paid benefits until November 2014 but denied further entitlement.

The Tribunal found that the applicant's ongoing back pain was related to pre-existing mild degenerative changes and obesity, not the accident.

Medical evidence also suggested symptom embellishment.

The Tribunal concluded the applicant failed to prove a substantial inability to perform his pre-accident employment or a complete inability to engage in any suitable employment.

The application for ongoing benefits was dismissed.

The respondent's request for repayment of an overpayment was also dismissed as it was not properly raised at the case conference.

The applicant sought payment for a physiotherapy treatment plan following a motor vehicle accident.

The respondent denied the plan, arguing the applicant's physical injuries were minor and subject to the Minor Injury Guideline (MIG), although the applicant was removed from the MIG due to psychological impairment.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plan was reasonable and necessary, preferring the respondent's orthopaedic assessment which concluded the physical injuries had resolved.

The application for the treatment plan, an award, and interest was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, but the insurer denied further payments on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been reached.

The applicant argued that his injuries were not predominantly minor due to psychological impairments, physical injuries including chronic pain, and pre-existing conditions.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from a psychological impairment, a non-minor physical injury, or a pre-existing condition that would prevent maximal recovery under the MIG.

Consequently, the applicant was not entitled to the disputed medical benefits and assessments.