Dr. Kelly McCutcheon

The applicant sought entitlement to three multidisciplinary treatment plans and interest following a motor vehicle accident.

The respondent denied the plans, arguing the applicant had not established chronic pain syndrome and had already received extensive treatment.

The Tribunal found the treatment plans were reasonable and necessary, noting the applicant had been diagnosed with chronic myofascial pain and psychological conditions linked to his ongoing pain.

The Tribunal also found the applicant had not received extensive treatment due to financial constraints and pandemic-related gaps in care, and that the limited treatment received was beneficial.

The applicant was awarded the treatment plans and interest.

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 for removal from the MIG based on chronic pain and psychological injuries.

The Tribunal found that the applicant failed to provide sufficient medical evidence to establish chronic pain with functional impairment or a psychological injury.

The Tribunal also rejected the applicant's procedural arguments regarding the insurer's compliance with notice requirements under sections 38 and 44 of the Schedule.

As the applicant remained within the MIG, the disputed treatment plans for physiotherapy and a psychological assessment were not payable.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming for psychological services and catastrophic impairment assessments.

The Tribunal found the applicant was entitled to a reduced amount for psychological services, adjusting the hourly rate to that of an unregulated provider.

The claim for catastrophic impairment assessments was denied as the applicant failed to establish grounds suggesting such an impairment existed.

The Tribunal also awarded interest on overdue benefits but declined to order a special award against the insurer.

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 requested a reconsideration of a Licence Appeal Tribunal decision that denied several treatment plans and a claim for an award under the Statutory Accident Benefits Schedule.

The Tribunal dismissed the reconsideration request regarding the award, the psychological assessment, and a chiropractic treatment plan, finding no errors of law or fact that would have changed the outcome.

However, the Tribunal granted the reconsideration in part, finding it had erred by failing to explicitly address a physiotherapy treatment plan dated August 14, 2023.

The Tribunal varied its original decision to approve the physiotherapy plan, noting it was supported by a contemporaneous chronic pain assessment.

The applicant sought a non-earner benefit and attendant care benefits following a motor vehicle accident.

The Tribunal found the applicant was not entitled to a non-earner benefit, as the evidence did not establish a complete inability to carry on a normal life compared to his pre-accident baseline, which already included functional limitations.

The Tribunal also denied the claim for attendant care benefits, finding the applicant failed to prove the expenses were incurred or that the requested quantum was reasonable and necessary given his demonstrated abilities.

The application was dismissed.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident.

The Tribunal found that the applicant suffered an accident-related psychological impairment, specifically an adjustment disorder with mixed anxiety and depressed mood, which caused a substantial inability to perform the essential tasks of her pre-accident employment in customer service.

The Tribunal awarded IRBs in the amount of $287.88 per week for the disputed period, along with interest.

The applicant's claim for an award for unreasonable delay was dismissed, as the insurer's conduct was not found to be excessive or indicative of bad faith.

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

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

The Tribunal found the applicant was removed from the MIG due to pre-existing lupus and chronic pain that prevented maximal recovery.

The Tribunal approved treatment plans for a chronic pain assessment and a multidisciplinary chronic pain program, finding them reasonable and necessary given the applicant's clinical deterioration and diagnosis of chronic pain syndrome.

Claims for chiropractic services, a psychological assessment, prescription medications, and a non-earner benefit were dismissed due to lack of evidence.

The Tribunal declined to order an award against the insurer or costs against the applicant.

The applicant sought entitlement to post-104-week income replacement benefits (IRBs), various medical and rehabilitation benefits, and a chronic pain assessment following a motor vehicle accident.

The respondent insurer denied the benefits and sought repayment of $14,381.91 in previously paid IRBs, alleging wilful misrepresentation.

The Licence Appeal Tribunal dismissed the claim for post-104-week IRBs, finding the applicant failed to establish a complete inability to engage in any employment.

The Tribunal also dismissed the respondent's claim for repayment, ruling that the repayment notice was defective because it failed to specify the period for which repayment was sought.

The applicant was granted entitlement to a chronic pain assessment, as evidence showed it was warranted and not reasonably available through OHIP, but the remaining treatment plans were denied.

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 a non-earner benefit (NEB) and an award following a 2014 motor vehicle accident.

On a rehearing ordered by a reconsideration decision, the Tribunal found the applicant established entitlement to the NEB.

The Tribunal applied the Heath test and concluded that the applicant's accident-related physical and psychological impairments continuously prevented her from engaging in substantially all of her pre-accident activities, which included daily exercise, chores, and socializing.

The Tribunal placed limited weight on the respondent's expert reports, finding they either lacked a comprehensive analysis of the applicant's activities or contradicted their own findings.

The applicant's request for an award under s. 10 of O. Reg. 664 was dismissed, as she failed to establish that the respondent unreasonably withheld or delayed payment of the NEB.

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 sought removal from the MIG based on psychological impairments, relying on a virtual assessment.

The Tribunal preferred the in-person assessment of the respondent's expert, which found subclinical psychological symptoms consistent with the objective medical records.

The Tribunal concluded the applicant failed to prove a psychological impairment warranting removal from the MIG.

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

The applicant sought non-earner benefits and attendant care benefits following a motor vehicle accident.

The respondent denied the benefits based on section 44 assessments.

The Tribunal found that the respondent's denial letter complied with the requirement to provide medical reasons under section 37(6) of the Schedule.

On the substantive issues, the Tribunal placed little weight on the applicant's expert reports due to inaccuracies and a failure to account for the applicant's significant pre-existing health conditions and prior accidents.

The Tribunal accepted the respondent's section 44 assessors' opinions that the applicant did not suffer a complete inability to carry on a normal life and did not require attendant care.

The application was dismissed in its entirety.

The applicant sought a non-earner benefit, interest, and an award under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Tribunal applied the Heath framework and found that the applicant failed to prove a complete inability to carry on a normal life.

The applicant did not provide sufficient evidence of the frequency and time commitments of his pre-accident activities to allow for a proper comparison with his post-accident abilities.

The Tribunal preferred the respondent's insurer examination reports, which concluded the applicant did not suffer a complete inability to carry on a normal life from either a musculoskeletal or psychological perspective.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought various treatment plans under the Statutory Accident Benefits Schedule.

The respondent denied the plans.

The Tribunal found that the applicant was not entitled to the treatment plans for chiropractic services, an orthopedic assessment, and chronic pain treatment, as he failed to demonstrate they were reasonable and necessary.

However, the Tribunal found the applicant was entitled to a chronic pain assessment to investigate his ongoing pain complaints, along with interest on overdue benefits.

The self-represented applicant sought a non-earner benefit following a motor vehicle accident.

At the hearing, the Tribunal denied the applicant's oral request for an adjournment, finding she had not taken reasonable steps to secure new counsel.

The Tribunal also denied the respondent's motion to dismiss the application as abandoned.

On the merits, the Tribunal found the applicant failed to prove she suffered a complete inability to carry on a normal life, preferring the respondent's multidisciplinary assessments over the applicant's oral testimony and unsupported claims.

The application was dismissed, and the applicant was ordered to pay $100 in costs for her unreasonable conduct and failure to comply with Tribunal orders.

The applicant sought statutory accident benefits for a multidisciplinary chronic pain treatment program and chiropractic services following a motor vehicle accident.

The insurer denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain syndrome or that the proposed treatment plans were reasonable and necessary.

The Tribunal noted a lack of objective medical evidence and found that the applicant did not meet the criteria for chronic pain under the AMA Guides.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her psychological impairments and pre-existing conditions warranted removal from the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant failed to provide compelling evidence of a psychological impairment caused by the accident or a documented pre-existing condition that would prevent maximal recovery within the MIG.

The Tribunal preferred the respondent's psychological and musculoskeletal assessments, which concluded the applicant suffered only minor soft tissue injuries and no diagnosable psychological condition.

As the MIG limit was already exhausted, the disputed treatment plans for chiropractic services and the claim for interest were dismissed.

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

The respondent denied the benefits on the basis that the applicant's injuries were minor and he had reached maximum medical improvement.

The Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, preferring the respondent's independent medical examination reports which concluded the soft tissue injuries had healed.

The application was dismissed in its entirety.

The applicant sought various statutory accident benefits following a motor vehicle accident, including psychological assessments, chronic pain assessments, chiropractic services, and a gym membership.

The respondent insurer denied the benefits and argued the applicant was barred from proceeding because she failed to attend a neurology insurer's examination.

The adjudicator found the neurology examination was not reasonably necessary, allowing the application to proceed.

However, the adjudicator dismissed all claims for benefits, finding the applicant failed to meet her onus to prove the treatment plans were reasonable and necessary, as she did not provide sufficient medical evidence linking her complaints to the accident or showing the goals of the treatment plans could reasonably be met.