Dr. Leon Steiner

The applicant, a self-employed bicycle delivery person, was injured in a motor vehicle accident and sought a determination of catastrophic impairment under criterion 8 of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal assessed the applicant's mental and behavioural impairments across four spheres of function.

Preferring the evidence of the applicant's experts, the Tribunal found the applicant sustained marked impairments in activities of daily living, social functioning, concentration, persistence and pace, and adaptation.

The Tribunal concluded the applicant suffered a catastrophic impairment.

The applicant sought payment for several treatment plans for physiotherapy, chiropractic services, and a catastrophic impairment assessment following a motor vehicle accident.

The Tribunal found that the applicant failed to prove the physical therapy treatment plans were reasonable and necessary, noting a lack of compelling evidence of improvement.

However, because the insurer provided a late denial notice for one treatment plan, the applicant was entitled to payment for the single treatment session incurred during the late period.

The Tribunal also awarded $2,000 for a psychological assessment under criterion 8, finding it was not a duplication of services, but denied the remaining disputed assessment costs and the claim for a special award.

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

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

The Tribunal found that the applicant sustained a psychological impairment and chronic pain that exceeded the MIG definition, relying on evidence from the applicant's treating practitioners and admissions from the respondent's own assessors.

The Tribunal ordered the respondent to pay for the disputed physiotherapy, psychological assessments, psychological services, and chronic pain assessment, along with interest.

However, the Tribunal declined to order a special award under s. 10 of Regulation 664, finding insufficient evidence that the insurer unreasonably withheld or delayed payments.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a non-earner benefit and various treatment plans for chiropractic and psychological services.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the applicant suffered a complete inability to carry on a normal life due to chronic pain and psychological impairments, entitling her to the non-earner benefit for the maximum 104-week period.

The Tribunal also partially approved several treatment plans for physical rehabilitation, acupuncture, and a psychological assessment, finding them reasonable and necessary.

Claims for an award under s. 10 of Reg. 664 were dismissed, but interest on overdue benefits was granted.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB) and various treatment plans outside the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal dismissed the application.

The Tribunal found the applicant was not entitled to an IRB because his post-accident short-term disability income fully negated the benefit quantum under s. 7(3)(a) of the Schedule.

Furthermore, the Tribunal held the applicant's injuries remained within the MIG, rejecting claims of psychological impairment and chronic pain due to evidence of malingering, lack of contemporaneous clinical reporting, and treating physician records indicating full functional capacity.

As the MIG limits were exhausted, the disputed treatment plans were denied.

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

The respondent denied the benefits, relying on medical assessments indicating the injuries were minor sprains and strains.

The Licence Appeal Tribunal found that the applicant failed to provide compelling medical evidence to substantiate his claims of chronic pain or a psychological condition.

The Tribunal preferred the respondent's expert evidence, which found the applicant's physical and psychological symptoms did not meet the threshold for MIG removal.

Consequently, the applicant remained subject to the $3,500 MIG limit, and his claims for additional treatment plans, interest, and a special award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to treatment plans for physiotherapy, chiropractic services, and psychological and chronic pain assessments outside the Minor Injury Guideline (MIG).

The Tribunal found the applicant failed to prove his injuries warranted removal from the MIG, noting his functional abilities and return to work were inconsistent with chronic pain or psychological impairment.

As the MIG limits were exhausted, the treatment plans were not payable.

The Tribunal also found the respondent's denial notices complied with s. 38(8) of the Schedule and dismissed claims for interest and a punitive award.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his psychological impairments and chronic pain warranted removal from the Minor Injury Guideline (MIG).

The Tribunal found the applicant failed to establish impairments outside the MIG, as his self-reports were not corroborated by his family physician's clinical notes and records.

However, the Tribunal ordered the respondent to pay the outstanding balance of one treatment plan due to its failure to provide a compliant notice under s. 38(8) of the Schedule.

The claims for other treatment plans and an award were dismissed.

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

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

The Tribunal found the applicant suffered from a psychological impairment, removing him from the MIG.

The Tribunal ordered the respondent to pay for several treatment plans, including one where the respondent failed to provide a compliant denial notice under s. 38(8) of the Schedule.

Claims for an award for unreasonable delay were dismissed, but interest on overdue benefits was granted.

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

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

The Tribunal found that the applicant sustained a psychological injury, removing her from the MIG, and approved treatment plans for a psychological assessment and psychological treatments.

However, the Tribunal denied the treatment plans for chiropractic treatments and a chronic pain assessment, finding insufficient medical evidence to prove they were reasonable and necessary.

The applicant was awarded interest on overdue payments but denied an award under O. Reg. 664, as the respondent's reliance on its assessors was not unreasonable.

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

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

The Tribunal found that the applicant suffered from psychological impairments, including Major Depressive Disorder, which warranted her removal from the MIG.

The Tribunal ordered the insurer to pay for a psychological assessment, psychological treatment, and a laptop required to access virtual therapy during the COVID-19 pandemic, along with interest on overdue payments.

The applicant's claim for a special award under Regulation 664 was dismissed, as the insurer's denial was not found to be unreasonable.

The applicant requested a reconsideration of a decision finding he did not sustain a catastrophic impairment following a motor vehicle accident.

He argued the adjudicator breached procedural fairness by failing to address his testimony and the four spheres of Criterion 8, and that new evidence in the form of addendum reports should be considered.

The Vice-Chair dismissed the request, finding the adjudicator's reasons adequately explained the preference for the respondent's medical evidence over the applicant's.

The Vice-Chair also found the addendum reports did not constitute new evidence and would not have changed the outcome.

The respondent's request for costs was denied.

The applicant sought statutory accident benefits following a 2014 motor vehicle accident, claiming catastrophic impairment due to psychological issues.

The Licence Appeal Tribunal found the respondent's expert evidence more reliable than the applicant's expert, concluding the applicant did not sustain a catastrophic impairment.

The Tribunal also denied the disputed treatment plans for occupational therapy and a driving rehabilitation assessment, finding them not reasonable and necessary.

Claims for an award and interest were consequently dismissed.

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

The respondent denied benefits beyond the $3,500 Minor Injury Guideline (MIG) limit and terminated income replacement benefits.

The Tribunal found that the applicant's physical injuries fell within the definition of a minor injury and that she failed to establish a pre-existing condition, chronic pain, or psychological impairment warranting removal from the MIG.

The Tribunal accepted the respondent's expert evidence, which raised significant validity concerns regarding the applicant's presentation, over the applicant's evidence.

The Tribunal also dismissed the claim for ongoing income replacement benefits, finding the applicant failed to prove a substantial inability to perform the essential tasks of her employment.

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 applied to the Licence Appeal Tribunal, claiming removal from the MIG due to psychological impairment, chronic pain, and pre-existing conditions.

The Tribunal found insufficient medical evidence to support a psychological injury, chronic pain with functional limitations, or a pre-existing condition that would preclude recovery within the MIG.

The Tribunal held that the applicant remains subject to the $3,500 MIG limit.

The disputed treatment plans were deemed reasonable and necessary up to the remaining MIG limit, provided they are incurred.

The claim for an award for unreasonable delay was dismissed.

The applicant sought statutory accident benefits following a 2019 motor vehicle accident.

The Tribunal found the applicant was precluded from claiming Income Replacement Benefits due to her failure to submit an OCF-3 until four years post-accident.

However, the Tribunal removed the applicant from the Minor Injury Guideline (MIG) based on uncontested psychological impairments diagnosed by her section 25 assessor.

The Tribunal approved treatment plans for psychological services, a psychological assessment, and a social work assessment, but denied physical therapy, a chronic pain assessment, and out-of-pocket expenses due to a lack of evidence linking ongoing physical complaints to the accident.

Claims for a special award and costs were dismissed.

The applicant sought attendant care benefits and several treatment plans for psychological, chiropractic, and occupational therapy services following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the benefits were reasonable and necessary.

The Tribunal preferred the respondent's insurer's examination reports over the applicant's medical evidence, noting significant contradictions between the applicant's own examination under oath testimony—where she reported being largely independent and emotionally well—and the severe impairments documented by her assessors.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that their injuries fell within the Minor Injury Guideline (MIG).

The applicant also claimed entitlement to income replacement benefits (IRBs) and a physiotherapy treatment plan.

The Licence Appeal Tribunal found that the applicant's physical and psychological injuries were predominantly minor, relying on contemporaneous medical records and independent assessments.

The Tribunal also dismissed the claim for IRBs, noting a lack of medical evidence demonstrating an inability to work.

All claims were dismissed.

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

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

The adjudicator found the applicant failed to establish chronic pain or psychological impairments warranting removal from the MIG, preferring the respondent's expert evidence.

However, the adjudicator ordered the respondent to pay for a chronic pain assessment and psychological treatment because the respondent's denial notices failed to comply with s. 38 of the Schedule by not explicitly stating that the MIG applied.

Claims for an award and costs were dismissed.

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

The respondent denied treatment plans for a chronic pain assessment, assistive devices, and psychological services.

The Tribunal found that the chronic pain assessment and assistive devices were not reasonable and necessary, noting significant delays in seeking treatment and a subsequent accident that raised causation issues.

However, the Tribunal granted the psychological services treatment plan, finding it reasonable and necessary based on the medical evidence, and noted that the respondent failed to provide sufficient reasons for its partial denial in contravention of s. 38(8) of the Schedule.

The applicant's claim for a special award was dismissed as the respondent's conduct was not unreasonable.