Dr. Maria Nesterenko

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

The respondent denied two treatment plans for chiropractic and massage therapy services on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to prove his injuries warranted removal from the MIG.

However, the Tribunal held that the respondent's denial notices for both treatment plans were defective and failed to comply with s. 38(8) of the Schedule because they were confusing and not clear and unequivocal.

Consequently, pursuant to s. 38(11), the treatment plans are payable once incurred and properly invoiced.

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

The Tribunal found the applicant was barred from disputing the denials of an assistive devices plan and a chiropractic plan because she failed to commence the application within the two-year limitation period under section 56 of the Schedule, and declined to extend the time under section 7 of the LAT Act.

On the substantive issues, the Tribunal denied the psychological services plan for lack of medical evidence but approved the orthopedic assessment plan, finding the applicant's complex and persistent musculoskeletal complaints warranted further investigation.

Claims for a special award were dismissed.

The applicant sought statutory accident benefits, claiming catastrophic impairment under Criteria 7 and 8 following a 2006 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove catastrophic impairment, noting pre-existing depression and degenerative disc disease, as well as multiple subsequent accidents.

The Tribunal excluded several of the applicant's expert reports because the experts were not called to testify, denying the respondent the right to cross-examine.

As the applicant was not catastrophically impaired, all claims for treatment plans, assessments, and attendant care incurred more than 10 years post-accident were dismissed.

Claims for a section 10 award and interest were also dismissed, and no costs were awarded to the respondent.

The applicant sought entitlement to statutory accident benefits for chiropractic services and a neurological assessment following a 2018 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, noting a lack of corroborating clinical notes from her family physician and accepting the respondent's independent medical examination reports.

The application was dismissed, and no award for unreasonable delay was granted.

The applicant sought entitlement to statutory accident benefits for physiotherapy and psychological treatment plans following a 2019 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to meet his onus to prove the psychological treatment plan was reasonable and necessary, as no evidence or submissions were provided for it.

Regarding the physiotherapy plan, the Tribunal preferred the objective findings of the insurer's medical examination over the applicant's subjective complaints, concluding the treatment was not reasonable and necessary.

The Tribunal also found that while the insurer's denial was late, the applicant was not entitled to relief under s. 38(11) because no expenses were incurred during the delay period.

Claims for interest and a s. 10 award were dismissed.

The applicant sought statutory accident benefits for chiropractic treatment following a 2018 motor vehicle accident.

The respondent denied the treatment plan, arguing it was not reasonable and necessary and was related to a subsequent 2021 accident.

The Tribunal found that the applicant failed to prove the treatment was reasonable and necessary, noting a lack of contemporaneous medical evidence of ongoing impairment from the 2018 accident and relying on an insurer's examination which concluded the injuries had healed.

The application for benefits and interest was dismissed.

The applicant sought entitlement to various treatment plans and a SPECT scan following a 2017 motor vehicle accident.

The applicant argued the treatment plans were payable because the insurer failed to provide compliant denials within 10 days under s. 38 of the Schedule.

The Tribunal found the insurer's denials were timely and compliant.

On the merits, the Tribunal held the treatment plans were not reasonable and necessary, relying on insurer examinations that found the applicant had adequate functional abilities and no ongoing cognitive impairments.

The SPECT scan was denied as it was submitted beyond the 260-week limitation period.

The application was dismissed.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, claiming entitlement to a chronic pain treatment program, a neurological examination, and a psychological examination.

The respondent denied the treatment plans, arguing the applicant had reached maximum medical recovery and had no ongoing impairments.

The Tribunal found that the applicant's functional abilities, normal gait, and lack of reliance on pain medication undermined the need for the chronic pain program.

Furthermore, previous assessments had already concluded the applicant suffered no neurological or psychological impairments.

The application was dismissed in its entirety.

The applicant sought retroactive attendant care benefits (ACBs), housekeeping and home maintenance benefits (HKHM), chiropractic services, and occupational therapy services following a 1997 motor vehicle accident that resulted in a catastrophic impairment.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove that the delay in submitting a retroactive Form 1 was due to urgency, impossibility, or impracticability, as required by the Morrissey decision.

The Tribunal also found no evidence that the ACB or HKHM expenses were actually incurred.

Furthermore, the requested chiropractic treatment and a one-year golf membership were deemed not reasonable and necessary based on the medical evidence.

Claims for a section 10 award, interest, and costs were also dismissed.

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

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

The Tribunal found that the applicant suffered predominantly minor soft tissue injuries, relying on the respondent's Insurer's Examination report and the clinical notes of the applicant's family physician, which indicated the injuries had largely resolved.

Because the $3,500 MIG limit had already been exhausted, the disputed treatment plans were not payable.

Claims for an award and interest were also dismissed.

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

The respondent insurer denied the claims and sought a preliminary determination on whether an 'accident' occurred and whether the applicant wilfully misrepresented material facts.

The applicant failed to attend the hearing.

Relying on engineering reports and crash data retrieval showing the other vehicle was parked and the applicant's airbags did not deploy, the adjudicator found the collision was a staged accident.

The adjudicator concluded the applicant was not involved in an 'accident' under s. 3(1) of the Schedule, wilfully misrepresented material facts, and ordered the applicant to repay $558.55 in benefits.

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

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

The Tribunal found that the respondent's initial notices denying the treatment plans were defective under s. 38(8) of the Schedule, as they failed to provide adequate medical reasons.

Furthermore, the Tribunal determined that the applicant's injuries fell outside the MIG due to her accident-related psychological impairments, preferring the evidence of the applicant's psychological expert over the insurer's examiner.

The Tribunal concluded that all three disputed treatment plans were reasonable and necessary, and ordered the respondent to pay for them along with interest on overdue payments.

The applicant was injured in a motor vehicle accident and received income replacement benefits until they were terminated by the insurer.

The applicant applied to the Licence Appeal Tribunal for ongoing benefits.

The insurer argued the application was statute-barred, but the Tribunal found it was commenced within the applicable time limits.

On the merits, the Tribunal found the applicant lacked credibility, noting he had returned to work as a superintendent for two different employers without disclosing this to the insurer or his own doctors.

Relying on the insurer's assessors and the applicant's employment records, the Tribunal concluded the applicant did not suffer a substantial inability to perform the essential tasks of his employment and dismissed the application.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident.

The insurer terminated IRBs on April 15, 2014.

The Tribunal first determined that the application was not statute-barred, as the applicant was caught in the transition period between FSCO and the LAT.

On the merits, the Tribunal found the applicant lacked credibility, noting documentary evidence that he had returned to work as a superintendent for two different employers during the period he claimed to be substantially unable to work.

Relying on the insurer's expert assessments and the applicant's employment records, the Tribunal concluded the applicant did not suffer a substantial inability to perform the essential tasks of his employment.

The application was dismissed.

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

The insurer denied several treatment plans and assessments, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) limit of $3,500.

The applicant argued his injuries had developed into chronic pain, taking him outside the MIG.

The arbitrator found the applicant provided compelling evidence of chronic pain, removing him from the MIG.

The arbitrator granted the claims for a functional abilities evaluation, chiropractic treatment, and certain assistive devices, finding them reasonable and necessary.

Claims for a social-emotional assessment and additional assistive devices were denied.

The arbitrator awarded interest on the overdue benefits but denied the applicant's request for a special award, finding the insurer's conduct was not unreasonable.

The applicant was injured in a rear-end motor vehicle accident and sought accident benefits, including an Income Replacement Benefit (IRB), medical benefits, and the cost of examinations.

The arbitrator dismissed the claim for an IRB, finding the applicant failed to prove he was employed at the time of the accident and failed to attend required insurer examinations.

However, the arbitrator found that the applicant's physical and psychological injuries fell outside the Minor Injury Guideline (MIG), preferring the evidence of the applicant's experts over the insurer's experts.

The arbitrator concluded the applicant was not malingering and that the proposed medical treatments and assessments were reasonable and necessary.

The claim for a Special Award was dismissed as the applicant and his counsel contributed to the delays.