Dr. Kopyto

The applicant sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent insurer denied the treatment plans for physiotherapy, assistive devices, psychological treatment, and chiropractic treatment based on its insurer's examinations.

The Licence Appeal Tribunal found the respondent's expert opinions unpersuasive and insufficiently explained, preferring the evidence of the applicant and her treating practitioners.

The Tribunal ordered the respondent to pay all disputed treatment plans and overdue interest.

Furthermore, the Tribunal granted a maximum special award of 50% under Regulation 664, finding that the respondent unreasonably delayed or withheld payments by providing reasons for denial inconsistent with its actual reasons and failing to consider medical records on file.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including medical benefits and Income Replacement Benefits (IRBs).

The insurer denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG), and stopped IRBs based on insurer examinations.

The Licence Appeal Tribunal found that the applicant's median nerve neuropathy removed him from the MIG.

The Tribunal approved one treatment plan for physiotherapy and braces but denied others for lack of supporting evidence.

The Tribunal also ordered the reinstatement of IRBs up to the two-year anniversary of the accident, finding the applicant was substantially unable to perform his pre-accident employment as a warehouse worker and driver, and awarded interest on overdue payments.

The respondent insurer requested a reconsideration of a Tribunal decision awarding the applicant the costs of a chronic pain assessment and a chiropractic functional impairment assessment following a motor vehicle accident.

The insurer argued the Tribunal erred in its causation analysis, its determination of what constitutes a valid medical reason for denying a treatment plan, and its finding that an assessment was for accident benefits rather than a tort claim.

The Adjudicator found that while the Tribunal erred in determining that 'insufficient documentation' was not a valid medical reason for denial, this error would not have changed the ultimate outcome.

The Adjudicator found no other significant errors of law or fact and dismissed the request for reconsideration.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a psychological assessment, chiropractic services, and an occupational therapy in-home assessment.

The insurer denied the benefits, arguing the physical injuries were pre-existing and the psychological assessment costs were unreasonable.

The Licence Appeal Tribunal dismissed the appeal, finding the applicant failed to prove the claimed psychological assessment costs were reasonable compared to the insurer's examination.

The Tribunal also found the applicant failed to establish causation for the physical injuries, noting extensive pre-existing conditions and a lack of evidence connecting the requested chiropractic and occupational therapy treatments to the accident.

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

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

The Tribunal found that the applicant's psychological symptoms, including post-traumatic stress disorder, removed her from the MIG.

The Tribunal ordered the respondent to pay for the disputed chiropractic and psychological treatment plans, as well as the cost of a psychological assessment, finding them reasonable and necessary.

The applicant's claim for an award for unreasonably delayed payments was dismissed for lack of evidence.

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

The Insurer argued that a prior settlement was binding, but the Arbitrator found the Applicant's rescission letter valid despite lacking a fax cover page.

The Arbitrator declined to recuse himself after viewing the settlement documents.

The Applicant was precluded from arbitrating her claim for non-earner benefits because she failed to attend a mandatory section 44 medical examination.

The Arbitrator also found that the Applicant's injuries fell within the Minor Injury Guideline (MIG), as there was no compelling evidence linking her seizures to the accident, and multiple medical assessors concluded her injuries were minor.

Claims for a special award and interest were dismissed, and the Applicant was ordered to pay the Insurer's reasonable expenses.