Dr. Mandel

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) and the limits were exhausted.

The Tribunal found that the applicant failed to prove his injuries fell outside the MIG, as he did not provide compelling medical evidence of a pre-existing condition or a psychological impairment.

However, the Tribunal found that the respondent failed to provide compliant notices under s. 38(8) of the Schedule for several of the denied treatment plans.

As a result, the respondent was ordered to pay for the treatment plans incurred after the 11th business day following their submission, up until compliant notices were issued, along with applicable interest.

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) and the $3,500 limit had been exhausted.

The Tribunal found that the applicant failed to prove her physical or psychological injuries warranted removal from the MIG.

The Tribunal preferred the respondent's expert evidence, noting the applicant's quick return to work and the lack of objective psychometric testing by her psychological expert.

The Tribunal also found the respondent's denial letters complied with s. 38(8) of the Schedule.

The application was dismissed.

The applicant sought income replacement benefits (IRB) and medical benefits for chiropractic treatment following a motor vehicle accident.

The respondent denied the benefits based on multiple insurer's examinations (IEs) which concluded the applicant did not suffer a substantial inability to perform the essential tasks of his employment.

The Tribunal found that the applicant failed to meet his burden of proof, as his family doctor's clinical notes did not directly attribute his ongoing pain to the accident and did not address his inability to work.

The Tribunal accepted the consistent findings of the respondent's IE assessors and dismissed the claims for IRB, medical benefits, interest, and an award.

The applicant, who sustained a catastrophic impairment in a 2017 motor vehicle accident, sought attendant care benefits (ACBs) and various medical and rehabilitation benefits.

The Tribunal found the applicant entitled to ACBs for specific periods based on his psychological impairments, but held the benefits were not payable because the applicant failed to prove they were incurred.

The Tribunal partially approved treatment plans for social work, aquatherapy, concussion treatment, and a home renovation assessment, while denying others that were reasonably available through OHIP.

The Tribunal ordered Aviva to pay a special award of $9,041.12 under s. 10 of Regulation 664, finding that the insurer acted unreasonably and in bad faith by pre-emptively denying treatment plans and failing to comply with procedural timelines.

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 that while the applicant's physical and psychological injuries did not warrant removal from the MIG, her chronic pain syndrome with functional impairment did justify removal.

The Tribunal approved the treatment plans for chiropractic services and a chronic pain assessment, finding them reasonable and necessary.

The claims for psychological and cognitive assessments were dismissed.

Interest was awarded on the approved, overdue benefits.

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 she should be removed from the MIG due to a pre-existing anxiety condition, a new psychological impairment, and chronic pain.

The Tribunal found insufficient evidence that the pre-existing condition prevented recovery or that the accident caused a psychological impairment or chronic pain, preferring the respondent's medical assessments.

The Tribunal also found the respondent's denial notices compliant with the Schedule.

The application was dismissed.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident.

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

The applicant argued for removal from the MIG based on chronic pain and psychological impairments.

The Tribunal found insufficient evidence of chronic pain, noting the lack of a diagnosis or evidence meeting the AMA Guides criteria.

The Tribunal also gave no weight to the applicant's psychological assessment, as it was conducted by a social worker rather than the signing psychologist.

Relying on the respondent's section 44 assessments, the Tribunal concluded the applicant did not suffer a clinically significant psychological impairment.

The application was dismissed, and claims for treatment plans, an award, and interest were denied.

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

The adjudicator found that the applicant failed to meet her burden of proof, as her chronic pain claims lacked objective medical corroboration and her psychological claims were inconsistent with her self-reported functionality to other assessors.

The adjudicator concluded that the applicant's injuries were predominantly minor and subject to the MIG limits.

Because the MIG limits were already exhausted, the disputed treatment plans were not considered, and claims for an award and interest were dismissed.

The applicant was injured in a motor vehicle accident and sought $1,866.95 for a psychological treatment plan (OCF-18) under the Statutory Accident Benefits Schedule.

The insurer denied the claim based on section 44 assessment reports.

The Tribunal found the treatment plan reasonable and necessary, preferring the evidence of the applicant's treating psychologist over the insurer's assessors, whose reports were either outdated or lacked necessary psychological testing.

The Tribunal ordered the insurer to pay the treatment plan with interest, but dismissed the applicant's claim for a section 10 award, finding the insurer's reliance on its assessors was not unreasonable.

The applicant requested a reconsideration of a previous decision finding that her accident-related impairments fell within the Minor Injury Guideline (MIG).

The applicant argued the adjudicator erred in law and fact by misapplying s. 18(2) of the Schedule regarding her pre-existing psychological condition and disregarding evidence of driving anxiety.

The adjudicator dismissed the request, finding that the applicant was attempting to relitigate issues and reweigh evidence already considered, which does not meet the criteria for reconsideration under Rule 18.2.

The applicant sought statutory 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 suffered from chronic pain syndrome, meeting the criteria under the AMA Guides, and was therefore removed from the MIG.

The Tribunal ordered the respondent to pay for multiple treatment plans for chiropractic and massage therapy, a psychological assessment, and a chronic pain assessment, finding them reasonable and necessary.

The respondent's request for costs was denied.

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

The respondent insurer denied the benefits 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 pre-existing conditions, a meniscal tear, chronic pain, and psychological impairments.

The Tribunal found that the applicant failed to prove on a balance of probabilities that his injuries warranted removal from the MIG.

As the $3,500 MIG limit was already exhausted, the claims for additional physiotherapy, psychological services, and a social work assessment were dismissed.

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

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

The applicant argued she should be removed from the MIG due to chronic pain and a pre-existing psychological impairment stemming from a prior workplace robbery.

The Tribunal found insufficient evidence of chronic pain or that the pre-existing psychological condition would prevent maximum medical recovery within the MIG.

The application for benefits, interest, and an award was 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 sought statutory accident benefits following a motor vehicle accident.

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

The Tribunal found that the applicant was not subject to the MIG due to a pre-existing medical condition involving a loose screw in a surgically implanted plate in his arm, which was exacerbated by the accident and prevented recovery within the MIG limits.

The Tribunal awarded the outstanding $200 for a partially approved physiotherapy plan but denied the remaining treatment plans for physical rehabilitation and psychological services, finding insufficient evidence that they were reasonable and necessary.

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

The respondent denied the claims, determining the injuries were predominantly minor and subject to the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG due to an accident-related psychological impairment.

The Tribunal found insufficient evidence to support a psychological impairment, noting the lack of psychological treatment and the respondent's expert evidence indicating symptom magnification.

The Tribunal concluded the injuries were within the MIG and the disputed treatment plan was not reasonable and necessary.

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

The respondent placed the applicant in the Minor Injury Guideline (MIG) and denied treatment plans beyond the $3,500 limit.

The Tribunal found the applicant was not subject to the MIG because a pre-existing gunshot wound to his shoulder would prevent maximal recovery from his soft tissue injuries.

The Tribunal ordered the respondent to pay for two physical therapy treatment plans.

A psychological assessment was also deemed payable because the respondent failed to provide notice of its refusal within the required 10 business days under s. 38(8) of the Schedule.

Claims for a special award and costs were dismissed.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision.

The applicant claimed entitlement to expenses for vision therapy and eyeglasses, physiotherapy services, and the unapproved balance of a psychological assessment.

The Tribunal dismissed the application in its entirety.

The Tribunal found that the applicant failed to establish on a balance of probabilities that the visual impairments were caused by the accident, relying on the respondent's optometry assessment.

The Tribunal also preferred the respondent's physiatry assessments, which concluded that maximum therapeutic benefit had been reached, over the applicant's lack of responding reports regarding physical injuries.

Finally, the Tribunal found the applicant failed to justify the additional cost claimed for the psychological assessment beyond what the respondent had already approved.

The applicant sought statutory accident benefits following a motor vehicle accident where he was allegedly struck as a pedestrian.

The insurer determined his injuries fell within the Minor Injury Guideline (MIG) and denied further treatment plans and Income Replacement Benefits (IRBs).

The Tribunal found that the applicant failed to prove his injuries fell outside the MIG, rejecting his claims of chronic pain and psychological injuries due to inconsistent medical evidence and uncompelling expert reports.

The Tribunal also dismissed the claim for IRBs, finding no credible link between the accident and the applicant's inability to work, as the medical evidence showed functional range of motion and no substantial impairment.

All claims were dismissed.

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

The applicant argued for removal from the MIG based on pre-existing conditions, chronic pain, and a psychological impairment.

The Tribunal found insufficient medical evidence to support removal, noting the applicant's injuries were primarily sprains and strains, and relied on s. 44 assessments that found no objective impairments or psychological diagnoses warranting treatment beyond the MIG.

The application for a psychological treatment plan and interest was dismissed.