Dr. Mark Goldstein

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits, psychological treatment, and a chronic pain assessment.

The Tribunal denied the income replacement benefits as the applicant failed to meet her evidentiary burden.

The psychological treatment claims were also denied because the incurred services did not align with the approved plans.

However, the Tribunal approved the chronic pain assessment, finding sufficient medical evidence to warrant an investigation into the applicant's ongoing pain symptoms.

Claims for a special award and costs were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit (NEB), medical benefits, and travel expenses.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that his pre-existing conditions were the primary cause of his impairments.

The Tribunal found the applicant was entitled to the NEB, relying on medical evidence that his physical and psychological impairments continuously prevented him from engaging in his pre-accident activities.

The Tribunal also approved the physiotherapy treatment plan and partial travel expenses, but denied the psychotherapy treatment plan, an award for unreasonable delay, and costs.

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) and raised a preliminary issue that the application should be barred due to the applicant's failure to attend insurer examinations.

The Tribunal found the notice of examination was non-compliant, so the application was not barred.

However, the Tribunal concluded the applicant failed to prove on a balance of probabilities that he suffered from a psychological impairment or chronic pain with functional impairment.

Consequently, the applicant's injuries were deemed predominantly minor, keeping him subject to the $3,500 MIG limit, and the application for additional treatment plans and an award was dismissed.

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

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

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

The Tribunal found that the applicant's psychological and chronic pain evidence was outweighed by the respondent's expert assessments and the lack of contemporaneous complaints in the family doctor's clinical notes.

The Tribunal concluded the applicant's impairments were predominantly minor and subject to the MIG limit.

Consequently, the disputed treatment plans, interest, and an award for unreasonable delay were denied.

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 applicant argued she should be removed from the MIG due to psychological impairment and chronic pain with functional impairment.

The Tribunal found that the applicant failed to establish a psychological impairment, preferring the respondent's expert who conducted a more thorough review of the medical records.

The Tribunal also found that while the applicant experienced chronic pain, she failed to demonstrate an accompanying functional impairment, as she had returned to full-time work and remained independent in her daily activities.

As the applicant remained within the MIG and the funding limit was exhausted, the claims for treatment plans, interest, and an award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to a chronic pain assessment and a chronic pain management program.

The Tribunal found the chronic pain assessment was not reasonable and necessary as it duplicated a previous assessment.

However, the Tribunal found the chronic pain management program was reasonable and necessary, awarding a portion of the outstanding balance, as the evidence showed the accident exacerbated the applicant's pre-existing chronic pain.

The claim for a special award under s. 10 of Regulation 664 was dismissed.

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

The insurer denied treatment plans for a Functional Abilities Evaluation, an Attendant Care Assessment, and a Psychological Assessment.

The Tribunal found that the applicant's pre-existing injuries, including PTSD, were exacerbated by the accident, removing him from the Minor Injury Guideline.

The Tribunal approved the Psychological Assessment as reasonable and necessary based on the family physician's evidence of reactivated PTSD.

However, relying on the insurer's examination report, the Tribunal dismissed the claims for the Functional Abilities Evaluation and Attendant Care Assessment, finding them not reasonable and necessary.

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

The Licence Appeal Tribunal considered claims for a non-earner benefit, an attendant care assessment, psychotherapy treatment, and a chronic pain assessment.

Applying the Heath test, the Tribunal found the applicant failed to establish a complete inability to carry on a normal life, noting inconsistencies in her evidence and symptom magnification identified by the respondent's psychological expert.

The Tribunal denied the non-earner benefit, attendant care assessment, and psychotherapy treatment, preferring the respondent's expert evidence.

However, the Tribunal granted the chronic pain assessment, finding it reasonable and necessary given the respondent's own medical expert's diagnosis of chronic neck and back pain.

Claims for an award under Regulation 664 were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB) and a treatment plan for chiropractic services.

The Tribunal found the IRB claim was statute-barred under s. 56 of the Schedule, as the application was filed more than two years after the insurer's clear and unequivocal denial.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act, noting the lack of a bona fide intention to appeal, an unexplained five-month delay, and prejudice to the respondent.

The claim for chiropractic services was also dismissed, as the applicant failed to provide expert evidence to rebut the respondent's insurer's examination report, which concluded the treatment was not reasonable and necessary.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, which the respondent insurer denied.

The Tribunal found that the applicant's injuries fell outside the Minor Injury Guideline (MIG) due to a pre-existing low back condition that impacted his recovery.

The Tribunal partially allowed the claim for physiotherapy services, finding two treatment plans reasonable and necessary based on medical evidence that the applicant had not yet reached maximum medical improvement.

However, the Tribunal dismissed the claims for further physiotherapy, functional and medical assessments, transportation costs, and the cost of an OCF-3, as the applicant failed to prove they were reasonable and necessary.

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

The insurer determined her injuries fell within the Minor Injury Guideline (MIG) and denied several treatment plans.

The Tribunal found that the applicant's injuries were not predominantly minor due to chronic pain, removing her from the MIG.

Furthermore, the Tribunal held that the insurer failed to provide sufficient medical reasons in its denial notices as required by s. 38(8) of the Schedule.

Consequently, the disputed treatment plans for chiropractic care, massage therapy, and a chronic pain assessment were payable.

The applicant's claim for an award under O. Reg. 664 was dismissed, as the insurer's conduct was not found to be excessive or imprudent.

The applicant sought statutory accident benefits for physiotherapy, acupuncture, and assistive devices following a 2015 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant was not entitled to reimbursement for physiotherapy expenses incurred before submitting a treatment plan.

For two subsequent treatment plans, the Tribunal approved shockwave therapy at a reduced rate but dismissed claims for acupuncture, orthotics, and other assistive devices, finding them not reasonable and necessary given the applicant's ongoing participation in a chronic pain program and lack of evidence supporting their efficacy.

The applicant's claim for costs was dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including non-earner benefits (NEBs) and medical benefits for physiotherapy and a chronic pain assessment.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal found that the applicant suffered a complete inability to carry on a normal life due to severe psychological impairment resulting from the accident, which continuously prevented her from engaging in her pre-accident activities of caring for her children and pursuing her vocational goals.

The Tribunal awarded NEBs of $185.00 per week and interest.

However, the Tribunal dismissed the claims for physiotherapy and a chronic pain assessment, finding insufficient evidence that they were reasonable and necessary, as the applicant's impairment was fundamentally psychological rather than physical.

The applicant was involved in a motor vehicle accident and sought a medical benefit of $1,977.05 for chiropractic services under the Statutory Accident Benefits Schedule.

The insurer denied the treatment plan.

The Adjudicator found that the applicant failed to prove the treatment was reasonable and necessary, noting that her treating physician did not recommend physical treatment for accident-related symptoms and relying on the insurer's assessment that further passive modalities would not be beneficial.

The claims for the medical benefit, interest, and a special award were dismissed.

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

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

The Licence Appeal Tribunal found that the applicant sustained a psychological injury and chronic pain syndrome, removing her from the MIG.

The Tribunal awarded medical benefits for a chronic pain program and one chiropractic/massage treatment plan, as well as the costs of psychological and orthopaedic assessments.

The applicant was also awarded pre-104 week income replacement benefits (IRBs) due to her inability to perform her heavy pre-accident work as a machine operator, but her claim for post-104 week IRBs was dismissed for lack of evidence regarding alternative suitable employment.

A claim for a special award for unreasonable delay was dismissed.

The applicant sought medical benefits for psychological and chiropractic services following a 2013 motor vehicle accident.

The respondent insurer denied the claims.

The Tribunal found that the applicant failed to prove the proposed treatments were reasonable and necessary, noting that many of the applicant's complaints stemmed from previous and subsequent accidents.

The applicant also failed to comply with production orders, prejudicing the respondent.

The claims were dismissed, and no costs were awarded as the applicant's conduct did not meet the high threshold for a costs award.

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

The respondent denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG) and its $3,500 limit.

The Tribunal found that the applicant's pre-existing psychological issues were exacerbated by the accident, resulting in diagnoses of depression and anxiety that removed her from the MIG.

The Tribunal preferred the evidence of the applicant's psychologist over the respondent's insurer examination psychologist.

Consequently, the Tribunal ordered the respondent to pay for the disputed physical treatment, psychological assessment, and psychological treatment, finding them all to be reasonable and necessary, along with interest on overdue payments.

The applicant sought payment for several treatment plans and assessments following a motor vehicle accident, which the respondent insurer denied.

The Licence Appeal Tribunal found that the applicant failed to provide sufficient medical evidence to prove the treatment plans were reasonable and necessary.

The Tribunal preferred the evidence of the insurer's assessors, who concluded the physical injuries were minor and had largely resolved, and that there was no objective evidence linking the applicant's psychological issues to chronic physical pain.

The application was dismissed.

The insurer requested a reconsideration of a Licence Appeal Tribunal decision that awarded the insured $1,160.50 for a Treatment and Assessment Plan.

The insurer argued that the insured filed hearing materials late in breach of Rule 9.2, and that the Tribunal erred in its assessment of the evidence regarding the insured's physical limitations, work capacity, and causation.

The Executive Chair denied the reconsideration request, finding that the insured complied with the disclosure timeline set in a case conference order, rendering the Rule 9.2 argument moot.

Furthermore, the Chair held that the Tribunal's factual findings regarding the insured's limitations and need for the recommended assistive devices were reasonably supported by the evidentiary record, including reports from the insurer's own examiners.

The insured's request for costs was also denied, as the insurer's conduct was not unreasonable, frivolous, or in bad faith.