Dr. Kopyto

The applicant sought attendant care benefits of $2,058.90 per month following a 2018 motor vehicle accident.

In a partial rehearing, the Licence Appeal Tribunal considered competing occupational therapy assessments regarding the applicant's need for assistance with personal care, meal preparation, and hygiene.

The Tribunal rejected the respondent's position that no attendant care was required, finding that the applicant's pain, fatigue, and lack of motivation necessitated assistance.

However, the Tribunal reduced the applicant's claimed hours, finding some requests duplicative or mitigated by approved assistive devices.

The Tribunal awarded attendant care benefits of $522.30 per month from January 30, 2026, ongoing.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including attendant care benefits and various treatment plans.

The respondent denied the claims.

The Tribunal found that the applicant failed to prove the attendant care benefits were incurred or reasonable and necessary, preferring the respondent's section 44 assessments.

The Tribunal also dismissed the claims for the outstanding balances of several partially approved treatment plans, finding the applicant did not meet her burden to establish their reasonableness and necessity.

The application was dismissed in its entirety.

The applicant, a minor, sought various statutory accident benefits following a motor vehicle accident, including chiropractic services, physiotherapy, and several assessments.

The respondent insurer denied the treatment plans based on independent medical examinations.

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

The Tribunal accepted the respondent's medical assessments, which concluded the applicant sustained uncomplicated strains and had no functional impairments.

The Tribunal also found the respondent's denial notices complied with the requirements of section 38 of the Schedule.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits (NEBs) and various treatment plans for physiotherapy, a psychological assessment, and a chronic pain assessment.

The Tribunal found that the applicant failed to establish a complete inability to carry on a normal life, noting that the applicant's evidence only showed some activities were more difficult, not that he was prevented from engaging in them.

The Tribunal also dismissed the claims for the treatment plans, finding the applicant failed to provide sufficient evidence or submissions to establish that the proposed treatments were reasonable and necessary.

The claim for incurred physiotherapy expenses was dismissed as the expenses were incurred prior to the submission of a treatment plan.

The application was dismissed in its entirety.

The applicant sought accident benefits following a motor vehicle accident.

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

The Tribunal found the applicant sustained a concussion, removing her from the MIG, based on the contemporaneous diagnoses of her treating physicians.

However, the Tribunal denied the applicant's claim for a $2,845.64 physiotherapy treatment plan, finding insufficient evidence that it was reasonable and necessary.

The Tribunal also dismissed the respondent's claim for repayment of an income replacement benefit overpayment, as the respondent failed to provide evidence to quantify the amount owed.

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

The Tribunal found that the applicant's ongoing complaints were consistent with pre-existing issues from a prior accident and that he did not meet the criteria for chronic pain under the AMA Guides.

The Tribunal concluded the applicant suffered predominantly minor injuries, and having exhausted the MIG limits, he was not entitled to the disputed treatment plan or interest.

The applicant sought accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and occupational therapy services.

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

The Licence Appeal Tribunal found that the applicant's soft tissue injuries were predominantly minor and subject to the MIG limit, which had been exhausted.

The Tribunal also dismissed the claim for IRBs, finding the applicant failed to prove a substantial inability to perform the essential tasks of her pre-accident employment as a general labourer.

The application was dismissed in its entirety.

The applicant sought income replacement benefits and a physiotherapy treatment plan following a motor vehicle accident.

The adjudicator dismissed the application, finding that the applicant failed to meet her burden of proof.

The applicant provided no objective medical evidence, such as clinical notes or an OCF-18, to support her claims.

She relied solely on a psychological report that did not address her ability to work or need for physiotherapy.

Conversely, the respondent's medical examiners opined that the applicant did not suffer a substantial inability to perform her employment tasks and that the treatment was not reasonable and necessary.

The applicant sought various statutory accident benefits following a motor vehicle accident, which were denied by the respondent insurer.

The Tribunal found that the applicant had been removed from the Minor Injury Guideline (MIG) and that the insurer's reliance on assessments limited to the MIG was flawed.

The Tribunal approved treatment plans for chiropractic services, a neurological assessment, a driving evaluation, a chronic pain assessment, and a biopsychosocial assessment as reasonable and necessary.

Claims for cognitive devices, ergonomic devices, and an MRI screening were dismissed for lack of supporting evidence or failure to demonstrate necessity over OHIP-covered services.

Interest was awarded on overdue payments.

The applicant sought statutory accident benefits following a motor vehicle accident, including removal from the Minor Injury Guideline (MIG), a Non-Earner Benefit (NEB), and funding for a psychological assessment.

The Tribunal found that the applicant's chronic pain warranted removal from the MIG and approved the psychological assessment as reasonable and necessary to investigate the pain symptomology.

However, the claim for an NEB was dismissed because the medical evidence and the applicant's post-accident activities, including returning to part-time work, did not demonstrate a complete inability to carry on a normal life.

The applicant sought payment for two chiropractic treatment plans following a motor vehicle accident.

The respondent denied the benefits on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment was reasonable and necessary, noting the lack of recommendation from his family physician and his own reports that his soft tissue injuries had resolved.

The Tribunal also dismissed the applicant's claims for a section 10 award and costs, finding that the applicant's failure to provide timely medical documentation impeded the respondent's ability to adjust the claim.

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 non-earner benefits and certain treatment plans.

The Licence Appeal Tribunal found that the applicant's physical injuries were predominantly soft tissue injuries falling within the MIG, and she failed to prove that pre-existing conditions, chronic pain, or psychological injuries warranted removal from the MIG.

The Tribunal also dismissed the claim for non-earner benefits, finding the applicant did not suffer a complete inability to carry on a normal life, as she continued to perform many pre-accident activities.

The disputed chiropractic treatment plans were deemed not reasonable and necessary, and claims for a special award and interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming a full-thickness shoulder tear warranted removal from the Minor Injury Guideline (MIG).

The respondent denied the claim, arguing the injuries were minor and the shoulder tear was not accident-related.

The Tribunal found the applicant failed to prove causation, noting a lack of contemporaneous complaints, a subsequent snow-shoveling injury, and a two-and-a-half-year delay before the ultrasound.

The application was dismissed, and the disputed treatment plan was denied.

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

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

The applicant contended that her pre-existing migraines and back pain were exacerbated by the accident, and that she suffered from chronic pain and a possible concussion, warranting removal from the MIG.

The Tribunal found insufficient medical evidence to support removal from the MIG, noting the applicant's functional abilities remained intact and there was no formal diagnosis of a concussion or chronic pain syndrome.

As the MIG limits were exhausted, the disputed treatment plan was deemed not reasonable and necessary.

The applicant sought payment for a $2,065.00 chiropractic treatment plan following a 2016 motor vehicle accident.

The respondent insurer denied the benefit, arguing the applicant had reached maximum medical recovery.

The Tribunal found that the applicant failed to prove the treatment was reasonable and necessary, noting that her ongoing pain was likely attributable to pre-existing juvenile rheumatoid arthritis rather than the accident.

The application was dismissed.

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

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

The applicant argued that her pre-existing conditions, including back pain, headaches, and congenital deafness, prevented her from achieving maximal recovery within the MIG limits.

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

The Tribunal also found that the applicant's injuries were predominantly minor in nature.

As the applicant had already exhausted the $3,500 limit under the MIG, her application for further medical benefits was dismissed.

The applicant was injured in a 2015 motor vehicle accident and sought statutory accident benefits.

The insurer denied medical benefits, placing her in the Minor Injury Guideline (MIG), and denied a non-earner benefit.

The Tribunal found that the accident exacerbated the applicant's pre-existing conditions and caused chronic pain, removing her from the MIG.

The Tribunal ordered the insurer to pay for a psychological assessment with interest, finding it reasonable and necessary.

However, the claims for an in-home attendant care assessment and a non-earner benefit were dismissed, as the applicant failed to prove a complete inability to carry on a normal life.

The applicant sought statutory accident benefits for physical and psychological injuries allegedly sustained in a motor vehicle accident.

The respondent denied the claims, arguing that the accident was not the cause of the applicant's impairments, pointing to extensive pre-existing medical and psychological issues, including trauma from Syria and family legal troubles.

The Tribunal applied the 'but for' test and found that the applicant failed to prove the accident was a necessary cause of her impairments.

Furthermore, the Tribunal found that the requested medical benefits and catastrophic impairment assessments were not reasonable and necessary, or were duplicative and contrary to the Schedule.

The application was dismissed.

The applicant was injured in a 2015 motor vehicle accident and sought accident benefits, which the respondent insurer denied on the basis that her injuries fell within the Minor Injury Guideline (MIG).

The applicant had significant pre-existing injuries from prior accidents.

The Tribunal found that the subject accident exacerbated her pre-existing conditions and caused chronic pain, removing her from the MIG.

The Tribunal ordered the respondent to pay for a psychological assessment, finding it reasonable and necessary, along with interest.

However, the Tribunal dismissed the claims for an In-Home Attendant Care assessment and a non-earner benefit, as the applicant failed to prove a complete inability to carry on a normal life.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including non-earner benefits, medical/rehabilitation treatments, and various assessments.

The insurer denied many of the benefits based on reports from its assessors.

The Licence Appeal Tribunal found that the applicant met the test for a complete inability to carry on a normal life and awarded non-earner benefits for the 104-week post-accident period.

The Tribunal also approved the disputed treatment plans and assessments, subject to the $2,000 statutory cap per assessment.

Furthermore, the Tribunal ordered the insurer to pay interest on overdue benefits and a special award of 33% under O. Reg. 664, finding that the insurer unreasonably delayed approving treatments that its own experts had recommended.