Dr. Marino

The applicant sought payment for a psychological treatment plan following a motor vehicle accident.

The respondent partially approved the plan but denied the balance of $4,918.00.

The Tribunal found that the applicant established the reasonableness and necessity of a sound machine and relaxation CD/DVD, awarding $188.00 plus interest.

However, the applicant failed to prove that the remaining balance, which included additional therapy session time, a CES medical device, and virtual reality sessions, was reasonable and necessary.

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

The applicant claimed ongoing physical and psychological impairments warranted removal from the MIG and sought funding for various treatment plans and assessments.

The Tribunal found that the applicant's injuries were predominantly minor, relying on the unanimous conclusions of several independent medical examiners and the lack of compelling medical evidence of chronic pain or psychological conditions.

As the $3,500 MIG funding limit had already been exhausted, the applicant was not entitled to the disputed treatment plans or interest.

The application was dismissed.

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

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

The Tribunal found that the applicant failed to provide compelling evidence of chronic pain or psychological impairment to justify removal from the MIG.

As the MIG limits were exhausted, the disputed treatment plans were not reasonable and necessary.

The claims for a non-earner benefit and an award for unreasonable delay were also dismissed.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident.

The respondent denied several treatment plans for physiotherapy, a psychological assessment, and a chronic pain assessment.

The Tribunal first considered whether the applicant was statute-barred from disputing two physiotherapy denials from 2017.

Applying the four-part test under section 7 of the Licence Appeal Tribunal Act, the Tribunal declined to extend the limitation period, finding no bona fide intention to appeal and an unexplained delay.

On the substantive issues, the Tribunal found the psychological assessment was reasonable and necessary given conflicting section 44 assessments regarding causation of the applicant's psychological condition.

However, the Tribunal denied the chronic pain assessment and further physical therapy, finding insufficient evidence that the applicant's current physical complaints were causally related to the accident.

Claims for an award under section 10 of O. Reg. 664 were also dismissed.

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

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

The applicant claimed removal from the MIG was warranted due to psychological injuries, chronic pain, and a pre-existing right knee condition.

The Tribunal found the applicant failed to meet his burden of demonstrating his injuries fell outside the MIG.

The Tribunal preferred the respondent's psychological assessment over the applicant's, found no objective evidence of chronic pain, and concluded the pre-existing knee condition did not preclude recovery from the accident-related injuries.

The application 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 Tribunal found that the applicant's physical injuries were predominantly minor and did not warrant removal from the MIG, dismissing claims for physiotherapy, chiropractic services, and orthopaedic/neurological assessments.

However, the Tribunal preferred the applicant's psychological evidence over the respondent's section 44 assessor, finding that the applicant suffered from severe depression and anxiety directly resulting from the accident.

Consequently, the applicant was removed from the MIG on psychological grounds, and the treatment plans for a psychological assessment and psychological treatment were deemed reasonable and necessary, with interest payable.

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

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

The Tribunal found that the applicant failed to demonstrate that her physical or psychological impairments warranted removal from the MIG, noting a lack of objective evidence and preferring the respondent's medical assessments.

Consequently, the disputed treatment plan was deemed not reasonable and necessary, and the application was dismissed.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident, including funding for chiropractic treatment, a social work assessment, and a neurological assessment.

The Licence Appeal Tribunal found the chiropractic treatment plan to be reasonable and necessary, relying on the respondent's own assessors who acknowledged the applicant's chronic pain and potential benefit from facility-based treatment.

However, the Tribunal denied the social work and neurological assessments, finding them duplicative and unsupported by the medical evidence.

Claims for an award for unreasonably withheld benefits and costs were also dismissed.

The applicant sought accident benefits for physiotherapy and removal from the Minor Injury Guideline (MIG) following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to provide sufficient medical evidence to demonstrate that her soft-tissue injuries, lingering pain, or alleged psychological distress warranted removal from the MIG.

The Tribunal also dismissed the claim for a $2,384.58 physiotherapy treatment plan because the applicant failed to submit the required OCF-21 invoice.

All claims, including the request for a section 10 award, were dismissed.

The applicant sought payment for a psychological treatment plan following a motor vehicle accident.

The insurer denied the plan, arguing it was not reasonable and necessary.

The Tribunal found that the applicant failed to demonstrate the treatment was reasonable and necessary, noting that the most recent psychological assessment revealed no diagnosable condition and that the applicant's current complaints appeared related to a subsequent accident.

The application was dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought various medical and rehabilitation benefits, including psychological, chiropractic, physiotherapy services, and a neurological assessment.

The insurer denied the benefits.

The Licence Appeal Tribunal dismissed the application in its entirety, finding that the applicant had reached maximum medical recovery for his soft tissue injuries and that the proposed psychological services could be provided at a lower hourly rate by a subordinate practitioner.

The Tribunal also found the neurological assessment was not reasonable and necessary as the applicant's headaches were not directly caused by the accident.

The applicant was injured in a 2015 motor vehicle accident and sought statutory accident benefits.

The insurer denied medical benefits, placing her in the Minor Injury Guideline (MIG), and denied a non-earner benefit.

The Tribunal found that the accident exacerbated the applicant's pre-existing conditions and caused chronic pain, removing her from the MIG.

The Tribunal ordered the insurer to pay for a psychological assessment with interest, finding it reasonable and necessary.

However, the claims for an in-home attendant care assessment and a non-earner benefit were dismissed, as the applicant failed to prove a complete inability to carry on a normal life.

The applicant was injured in a motor vehicle accident and subsequently in a bicycle accident.

He sought medical benefits for chiropractic treatment, which the insurer denied on the basis that his injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's physical injuries were predominantly minor and that he failed to prove on a balance of probabilities that he suffered from a psychological injury or a pre-existing condition that would remove him from the MIG.

As the $3,500 MIG limit was exhausted, the Tribunal dismissed the claims for further medical benefits and interest.

The applicant was injured in a 2015 motor vehicle accident and sought accident benefits, which the respondent insurer denied on the basis that her injuries fell within the Minor Injury Guideline (MIG).

The applicant had significant pre-existing injuries from prior accidents.

The Tribunal found that the subject accident exacerbated her pre-existing conditions and caused chronic pain, removing her from the MIG.

The Tribunal ordered the respondent to pay for a psychological assessment, finding it reasonable and necessary, along with interest.

However, the Tribunal dismissed the claims for an In-Home Attendant Care assessment and a non-earner benefit, as the applicant failed to prove a complete inability to carry on a normal life.

The applicant sought medical and rehabilitation 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 that pre-existing shoulder issues, psychological impairments, and chronic pain warranted removal from the MIG.

The Tribunal found insufficient evidence to support the applicant's claims, preferring the respondent's section 44 assessment reports which concluded the injuries were predominantly minor.

As the MIG limits had been exhausted, the application for further benefits, interest, and an award was dismissed.

Following a determination that the applicant was catastrophically impaired as a result of a motor vehicle accident, the applicant sought her expenses for the arbitration hearing.

The arbitrator found the applicant was entirely successful and entitled to her expenses.

After reviewing the claimed fees and disbursements, including expert witness fees and preparation time, the arbitrator awarded the applicant $51,679.28 inclusive of fees, disbursements, and HST.

The applicant sought statutory accident benefits, including income replacement benefits and a medical benefit for chiropractic treatment, following a motor vehicle accident.

The arbitrator dismissed the claims, finding the applicant's evidence and that of his medical experts lacked credibility.

Surveillance evidence contradicted the applicant's claims regarding his inability to drive and work.

The arbitrator concluded the applicant did not suffer a substantial inability to perform the essential tasks of his employment and that the disputed treatment plan was not reasonable or necessary.

The applicant was ordered to pay the insurer's arbitration expenses.