Dr. Loritz

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's pre-existing lower back pain and sciatica prevented her from achieving maximal recovery within the MIG, warranting removal.

The Tribunal granted entitlement to physiotherapy treatment plans, a chronic pain assessment, and a neurological assessment, finding them reasonable and necessary.

However, claims for chronic pain treatment, psychological services, and certain medical devices were dismissed for lack of supporting medical evidence.

Interest was awarded on the approved plans.

The applicant sought statutory accident benefits for a chronic pain assessment and a psychological assessment following a motor vehicle accident.

The respondent denied the treatment plans.

The Tribunal found that the applicant failed to prove on a balance of probabilities that either assessment was reasonable and necessary.

The Tribunal preferred the respondent's medical evidence, which included in-person assessments and psychometric testing, over the applicant's evidence, which relied on phone screens and lacked corroborating medical records.

The application was dismissed, and claims for a special award and interest were denied.

The applicant sought various medical and rehabilitation benefits following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant was entitled to funding for physiotherapy, Botox injections, a mental health driving assessment, a virtual social work assessment, a sleep study, an oculo-visual assessment, and prescription medication, as these were reasonable and necessary to treat his accident-related impairments, including a mild traumatic brain injury.

However, claims for a functional cognitive assessment, an attendant care assessment, and occupational therapy were denied because the applicant demonstrated an ability to engage in pre-accident activities and perform necessary tasks independently.

The Tribunal also denied the applicant's request for a special award, finding that the insurer reasonably relied on its assessors' opinions.

The applicant sought statutory accident benefits for chiropractic services and a social work assessment following a motor vehicle accident.

The Tribunal found the chiropractic treatment plans reasonable and necessary, preferring the evidence of the applicant's specialists over the respondent's general physicians.

The claim for a social work assessment was dismissed due to a lack of supporting evidence.

The Tribunal also granted an award of 5% under s. 10 of Regulation 664, finding that the respondent unreasonably delayed the approval and payment of benefits despite receiving corroborative medical evidence.

The applicant sought statutory accident benefits following a 2014 motor vehicle accident, specifically claiming $2,486.00 for a physiatry assessment and an award for unreasonably withheld payments.

The adjudicator found that the applicant failed to prove the assessment was reasonable and necessary, preferring the insurer's medical examination report which found normal neurological findings and functional range of motion.

The applicant's expert evidence on chronic pain was rejected due to reliance on subjective reporting without objective validity testing.

The claim for an award under s. 10 of O. Reg. 664 was also dismissed, as the insurer reasonably relied on its assessors' reports in denying the benefit.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs), medical benefits, and cost of examinations.

The respondent denied the benefits, arguing the applicant had returned to work and suffered only minor injuries.

The Tribunal found the applicant was entitled to IRBs up to June 2018, but made no order for payment as the applicant failed to provide post-accident income information.

The Tribunal also found the applicant was entitled to various medical benefits, including physiotherapy, psychological services, shockwave therapy, and a chronic pain program, as the evidence demonstrated she suffered from chronic pain caused by the accident.

The claims for cost of examinations and a Regulation 664 award were dismissed.

The applicant sought a determination that her injuries from a motor vehicle accident fell outside the Minor Injury Guideline (MIG) and claimed entitlement to several treatment plans.

She argued that a pre-existing foot injury, concussion, psychological issues, chronic pain, and radiculopathy warranted removal from the MIG.

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

Furthermore, the Tribunal concluded that the applicant did not meet the criteria for chronic pain or establish that her other conditions took her outside the MIG.

As the applicant's injuries were predominantly minor, she was not entitled to the disputed treatment plans or interest.

The applicant sought entitlement to statutory accident benefits for a chronic pain assessment and a neurological assessment following a 2015 motor vehicle accident.

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

The Tribunal preferred the evidence of the respondent's medical examiners, which indicated the applicant's injuries were manageable with soft tissue interventions and that his neurological symptoms were likely unrelated to the accident.

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

The applicant sought medical and rehabilitation benefits following a motor vehicle accident.

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

The Licence Appeal Tribunal found that the applicant sustained a concussion, which falls outside the Schedule's definition of a minor injury, thereby removing him from the MIG.

The Tribunal further held that the disputed $3,297.08 physiotherapy treatment plan was reasonable and necessary to treat the applicant's accident-related injuries, which had been exacerbated by a subsequent accident.

The treatment plan was ordered payable with interest.

The applicant sought a medical and rehabilitation benefit for a psychological assessment following a motor vehicle accident.

The respondent denied the benefit, asserting the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit was exhausted.

The Tribunal found that the applicant's physical injuries were sprains and strains falling within the MIG.

The Tribunal rejected the applicant's claims of psychological impairment and chronic pain, finding insufficient medical evidence to support either diagnosis.

As the applicant's injuries were predominantly minor and the MIG limit was exhausted, the application was dismissed.

The applicant was injured in a motorcycle accident and sought statutory accident benefits, including a non-earner benefit, medical benefits for physiotherapy and a stationary bike, and the cost of an orthopaedic assessment.

The Licence Appeal Tribunal found that the applicant was not entitled to the non-earner benefit because he had not sustained a complete inability to carry on a normal life, having returned to work full-time and resumed most pre-accident activities.

However, the Tribunal found the disputed medical benefits and the cost of examination were reasonable and necessary to treat ongoing shoulder and knee injuries caused by the accident.

The Tribunal ordered payment of the medical benefits and assessment costs with interest, but declined to make an award for unreasonable delay.

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).

The applicant argued he should be removed from the MIG due to chronic pain.

The Tribunal found the applicant's evidence of chronic pain unreliable and inconsistent with his own reporting and medical records.

The Tribunal concluded the applicant's injuries fell within the MIG, and since the $3,500 limit was exhausted, the claims for further chiropractic treatment were dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits for exercise equipment, assistive devices, a chronic pain assessment, and chiropractic services under the Statutory Accident Benefits Schedule.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding that the applicant relied solely on self-reporting of pain without corroborating medical documentation.

The Tribunal preferred the evidence of the respondent's insurer examination assessors, who concluded that the requested treatments and assessments were not reasonable and necessary.

As no benefits were payable, the claims for interest and an award were also dismissed.