Lital Grinberg

The applicant sought entitlement to statutory accident benefits following a 2019 motor vehicle accident, disputing the insurer's denial of various treatment and assessment plans.

The Licence Appeal Tribunal found that the applicant failed to prove that psychiatric, psychological, orthopaedic, and functional abilities assessments were reasonable and necessary.

However, the Tribunal partially approved a physiotherapy treatment plan, noting that pain reduction is a legitimate goal, while excluding the cost of orthotic devices unrelated to the accident.

The applicant's request for an award under s. 10 of O. Reg. 664 was denied, as the insurer's conduct was not found to be unreasonable.

The applicant sought entitlement to statutory accident benefits following a motor vehicle accident, specifically claiming costs for psychiatric, orthopaedic, functional abilities, and psychological assessments, as well as a physiotherapy treatment plan.

The Tribunal dismissed the claims for the assessments, finding the applicant failed to demonstrate they were reasonable and necessary, noting she had already been diagnosed and was receiving treatments.

The Tribunal partially granted the physiotherapy treatment plan, approving it for pain reduction but excluding the cost of orthotic devices unrelated to the accident.

The claim for a special award under s. 10 of Reg. 664 was dismissed, as the insurer's conduct was not found to be unreasonable.

Interest was awarded on the overdue physiotherapy benefits.

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

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

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

However, the applicant failed to prove entitlement to a non-earner benefit, as he returned to most pre-accident activities.

Most treatment plans were denied as not reasonable and necessary, or because the respondent cured initially deficient notices before the plans were incurred.

One psychological assessment was deemed payable under s. 38(11) because it was incurred before the respondent provided proper medical reasons for denial.

The claim for an award for unreasonable delay was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits (IRBs) and a neurological assessment.

The Tribunal found that the applicant failed to prove she met the disability test for IRBs, as the medical evidence did not establish a substantial inability to perform the essential tasks of her self-employment.

However, because the respondent insurer issued deficient notices suspending and terminating the IRBs, the Tribunal ordered the respondent to pay IRBs totaling $9,783.83 for the period before a compliant notice was issued.

The claim for a neurological assessment was dismissed as not reasonable and necessary.

The Tribunal denied a special award but granted $500 in costs to the applicant due to the respondent's late service of an accounting report.

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

The Tribunal found that the applicant sustained a psychological impairment, removing him from the Minor Injury Guideline (MIG).

The applicant's claim for an income replacement benefit was dismissed due to a lack of compelling evidence explaining his inability to work.

The Tribunal approved treatment plans for psychological services, a psychological assessment, and a neurological assessment, but denied plans for chiropractic services.

The claim for an award for unreasonable delay was dismissed.

The applicant sought statutory accident benefits 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 funding limit had been exhausted.

The Tribunal found that the applicant failed to prove a pre-existing condition or a psychological injury that would warrant removal from the MIG.

The Tribunal gave limited weight to the applicant's psychological assessment as it relied heavily on self-reporting without corroborating medical records.

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

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

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

The applicant argued for removal from the MIG due to psychological impairments, pre-existing sciatica and scoliosis, and chronic pain.

The Tribunal found insufficient medical evidence to support removal from the MIG, preferring the respondent's assessments which aligned with the family physician's clinical notes.

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

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB) beyond the 104-week mark, and funding for a psychological and neurological assessment.

The Tribunal found the applicant failed to prove a complete inability to engage in any employment for which she was reasonably suited, preferring the respondent's insurer examinations which found only soft-tissue injuries and no psychological inability to work.

The Tribunal also denied the treatment plans, finding the psychological assessment fees exceeded the Guideline and the neurological assessment was not supported by contemporaneous medical records.

The application was dismissed in its entirety.

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), subject to a $3,500 limit.

The applicant argued she should be removed from the MIG due to pre-existing conditions, psychological impairments, and chronic pain.

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

Furthermore, the Tribunal gave little weight to the applicant's expert reports regarding psychological impairments and chronic pain, finding them inconsistent with other medical evidence and lacking in establishing causation.

As the $3,500 MIG limit was exhausted, all claims for treatment, assessments, and an award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her injuries fell outside the Minor Injury Guideline (MIG) due to pre-existing physical and psychological conditions.

She also sought a non-earner benefit and funding for various treatment plans.

The Tribunal found that the applicant failed to provide compelling medical evidence that her pre-existing conditions were exacerbated by the accident or prevented her from achieving maximum medical recovery within the MIG.

The Tribunal preferred the evidence of the respondent's assessors, finding the applicant's injuries were predominantly minor.

The claim for a non-earner benefit was dismissed as the applicant did not demonstrate a complete inability to carry on a normal life compared to her pre-accident activities.

Consequently, the proposed treatment plans outside the MIG were deemed not reasonable and necessary, and claims for an award and interest were dismissed.

The applicant sought statutory accident benefits 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 on a balance of probabilities that his physical or psychological injuries warranted removal from the MIG.

The Tribunal preferred the respondent's s. 44 assessors over the applicant's experts, noting contradictions in the applicant's psychological evidence and a lack of objective medical documentation supporting significant impairment.

The application was dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRB) and various treatment plans.

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

The Tribunal found that the applicant's physical injuries, including a claimed pars defect, and psychological impairments did not warrant removal from the MIG.

The Tribunal preferred the respondent's medical evidence, noting the applicant's diagnostic imaging showed no fractures and the psychological assessment relied heavily on self-reporting.

The Tribunal also found that the respondent had already paid the claimed IRB.

The application was dismissed.

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

The respondent insurer denied a treatment plan for a psychological assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on pre-existing back and hip issues and a post-accident psychological injury.

The Tribunal found no compelling medical evidence that the pre-existing conditions would preclude maximal medical recovery under the MIG.

Furthermore, the Tribunal preferred the respondent's psychological assessment, finding the applicant's self-reporting did not support a psychological impairment.

The application was dismissed, and the applicant's injuries were deemed subject to the MIG limit.

The applicant sought various statutory accident benefits and a catastrophic impairment (CAT) designation following a 2016 motor vehicle accident.

The Licence Appeal Tribunal found that while the accident contributed to the applicant's psychological impairment, the applicant's self-reports were not credible due to significant inconsistencies regarding his pre-accident health and functional status.

The Tribunal concluded the applicant did not suffer a marked impairment in three spheres of functioning and therefore did not meet the CAT threshold.

All claims for income replacement benefits, attendant care, and medical benefits were dismissed as the applicant failed to prove they were reasonable, necessary, or incurred.

The applicant was injured in a motor vehicle accident while working as a personal support worker.

The respondent insurer argued the applicant was precluded from claiming statutory accident benefits because she opted out of WSIB benefits solely to claim accident benefits.

The Tribunal found the applicant had a bona fide intent to pursue a tort action and was not precluded under s. 61(2) of the Schedule.

However, the Tribunal concluded the applicant's impairments fell within the Minor Injury Guideline (MIG), rejecting her claims of chronic pain, mild traumatic brain injury, and psychological impairment due to a lack of objective medical evidence.

As the $3,500 MIG limit was exhausted and the insurer's denial notices were compliant with s. 38(8), the applicant was not entitled to the disputed treatment plans or assessments.

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 his injuries, including chronic pain, psychological impairments, and post-concussion syndrome, as well as a pre-existing condition, removed him from the MIG.

The Tribunal found that the applicant failed to provide compelling evidence of a pre-existing condition that would prevent maximal recovery within the MIG.

Furthermore, the Tribunal rejected the applicant's expert reports regarding chronic pain and psychological impairments due to their reliance on incomplete medical histories and self-reporting.

The Tribunal concluded that the applicant sustained predominantly minor injuries subject to the $3,500 limit, and dismissed the application.