Dr. Michael Gofeld

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

The respondent denied the treatment plans, which were authored by the applicant's husband, who is also her treating chiropractor.

The Tribunal addressed procedural issues regarding the applicant's non-compliance with submission page limits and the late filing of a rebuttal report.

On the merits, the Tribunal found that the applicant failed to comply with s. 38(2) of the Schedule for an OCF-6 submitted without a prior treatment plan.

For the remaining treatment plans, the Tribunal concluded that the applicant did not provide sufficient objective medical evidence or contemporaneous clinical notes to prove the treatment was reasonable and necessary, especially given the competing independent medical examinations concluding no further treatment was warranted.

The application was dismissed.

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

The Licence Appeal Tribunal found that the applicant was statute-barred from disputing a 2019 physiotherapy treatment plan because she failed to apply within the two-year limitation period, and there were no reasonable grounds to extend the time under s. 7 of the LAT Act.

The Tribunal further held that the applicant's injuries fell within the Minor Injury Guideline (MIG), as she failed to establish that her chronic pain or psychological impairments were caused by the subject accident rather than a prior 2016 accident.

Consequently, the disputed treatment plans were not payable, and claims for interest and a special award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including funding for hyperbaric oxygen therapy and two catastrophic impairment assessments.

The respondent denied the treatment plans.

The Tribunal found that the applicant failed to prove the hyperbaric oxygen therapy was reasonable and necessary, noting a lack of medical evidence supporting its effectiveness for her injuries and deeming it experimental.

The Tribunal also denied the catastrophic impairment assessments, finding the applicant failed to justify the need for multiple assessments in single disciplines and the duplication of services across the two treatment plans.

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

The applicant sought payment for two treatment plans for chiropractic services and interest following a motor vehicle accident.

The respondent denied the benefits based on an independent medical examination which concluded the injuries had largely resolved.

The adjudicator found that the applicant failed to meet the burden of proving the treatment plans were reasonable and necessary, noting a lack of formal referrals for chiropractic treatment and an absence of progress reports demonstrating that treatment goals were being met.

The application was dismissed and no interest was awarded.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including income replacement benefits, treatment plans for physiotherapy and psychological services, assessments, and assistive devices.

The Licence Appeal Tribunal found that the applicant failed to prove entitlement to income replacement benefits, psychological services, and most assessments.

However, the Tribunal approved several physiotherapy plans and a portion of the requested assistive devices, finding them reasonable and necessary to manage the applicant's chronic pain.

The applicant's claim for a special award under s. 10 of O. Reg. 664 was dismissed, as the insurer's reliance on its assessors' reports was not unreasonable.

The applicant sought statutory accident benefits for various treatment and assessment plans following a motor vehicle accident, including chiropractic treatment, a chronic pain assessment, a neurological assessment, and a concussion assessment.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to meet her burden of proving the plans were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's insurer's examinations and the applicant's own family doctors' clinical notes, which did not corroborate the need for the proposed assessments or treatments.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to a TMJ assessment and a treatment plan for chiropractic, physiotherapy, and acupuncture services.

The respondent denied the benefits.

The Tribunal found that the applicant failed to prove the TMJ assessment was reasonable and necessary, noting inconsistencies in his self-reporting and preferring the respondent's dental assessor over the applicant's chronic pain specialist.

The Tribunal also found insufficient evidence to support the need for the proposed chiropractic, physiotherapy, and acupuncture services.

The application was dismissed, and no interest was payable.

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

The Tribunal found the applicant failed to prove on a balance of probabilities that his injuries fell outside the MIG.

The Tribunal preferred the respondent's insurer's examinations over the applicant's assessments, noting a lack of contemporaneous medical evidence supporting chronic pain or psychological impairment.

The application for disputed treatment plans, interest, and an award was dismissed.

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

The respondent denied several treatment plans for physiotherapy on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued that the MIG no longer applied because the treatment plans were submitted outside the 12-week timeframe, and alternatively, that he should be removed from the MIG due to chronic pain and psychological impairments.

The Tribunal found that the applicant failed to establish accident-related impairments warranting removal from the MIG.

The Tribunal also rejected the applicant's argument that the respondent's initial non-compliant notices rendered the treatment plans payable, as the respondent subsequently provided a compliant notice and no services were incurred during the period of non-compliance.

The application was dismissed.

The applicant sought a non-earner benefit following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove she suffered a complete inability to carry on a normal life.

The adjudicator noted that the applicant had returned to her pre-accident employment as a practical nurse, increased her hours to full-time, and failed to provide sufficient particulars regarding her pre-accident activities and how her pain practically prevented her from engaging in them.

As no benefits were payable, the claim for interest was also dismissed.

The applicant sought payment for three chiropractic treatment plans following a motor vehicle accident.

The respondent denied the benefits, arguing the treatments were not reasonable and necessary and pointing to the applicant's extensive pre-existing conditions, including fibromyalgia and chronic pain.

The Tribunal found that the applicant failed to meet his burden of proof, noting that the proposed treatment plans overlapped and duplicated services, reducing their reliability.

The Tribunal preferred the respondent's section 44 musculoskeletal assessment, which concluded the applicant had reached maximum medical improvement for soft-tissue injuries.

The application was dismissed, and no interest was awarded.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the denial of treatment plans for physiotherapy, psychotherapy, and multiple assessments.

The Tribunal found that the applicant failed to prove the physiotherapy and assessments were reasonable and necessary, noting a lack of clinical notes and preferring the respondent's medical assessments.

However, the Tribunal granted the outstanding balance for psychotherapy services, finding the proposed 1.5-hour sessions reasonable as recommended by the assessing psychologist.

Interest was awarded on the overdue psychotherapy benefits.

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 applicant sought removal from the MIG based on psychological impairments and chronic pain.

The Tribunal found insufficient evidence of psychological impairment or functional limitations caused by chronic pain to warrant removal from the MIG, preferring the respondent's medical evidence which was corroborated by the applicant's treating physician's records.

As the applicant's injuries were predominantly minor and the MIG limit was exhausted, the disputed treatment plans and assessments were denied.

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

The Licence Appeal Tribunal found the applicant was entitled to funding for psychotherapy, a neuropsychological assessment, and a COGMED assessment/treatment, as these were reasonable and necessary given objective evidence of a traumatic brain injury and ongoing psychological symptoms.

Claims for chiropractic services and a driver evaluation were dismissed.

The Tribunal also held the applicant was barred from pursuing a neurological assessment due to his failure to attend scheduled insurer's examinations without a reasonable explanation.

A claim for a special award under s. 10 of O. Reg. 664 was dismissed, but interest was awarded on the approved treatment plans.

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), subject to a $3,500 limit.

The applicant argued she should be removed from the MIG due to pre-existing conditions, psychological impairments, and chronic pain.

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

Furthermore, the Tribunal gave little weight to the applicant's expert reports regarding psychological impairments and chronic pain, finding them inconsistent with other medical evidence and lacking in establishing causation.

As the $3,500 MIG limit was exhausted, all claims for treatment, assessments, and an award were dismissed.

The applicant was injured in a motor vehicle accident and sought payment for various medical and rehabilitation benefits, including chiropractic, physiotherapy, occupational therapy, a brain SPECT scan, an EMG assessment, and cognitive devices.

The respondent insurer denied the treatment plans on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to meet his burden of proof.

The Tribunal afforded little weight to the applicant's medical experts due to factual inaccuracies in their reports and relied on the respondent's assessors, who concluded the applicant had reached maximum medical improvement and that the proposed treatments were not medically justified.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to treatment plans for chiropractic services, a psychological assessment, and a chronic pain assessment.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the policy limits were exhausted.

The Tribunal found that the applicant failed to prove her chronic pain and psychological impairments were accident-related or severe enough to warrant removal from the MIG.

As the MIG limits were exhausted, the claims for treatment plans, a section 10 award, and interest were dismissed.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including treatment plans for occupational therapy, a chronic pain program, and assessments for neuropsychological, chronic pain, functional cognitive, and catastrophic impairment, as well as a SPECT scan.

The insurer denied the claims.

The Licence Appeal Tribunal dismissed the application in its entirety, finding that the applicant failed to demonstrate on a balance of probabilities that the proposed plans were reasonable and necessary.

The Tribunal relied on insurer examination reports and surveillance evidence showing the applicant engaging in normal activities, which contradicted the applicant's self-reported functional limitations and the opinions of his assessors.

The applicant sought a non-earner benefit, a special award, and interest following a motor vehicle accident.

The Tribunal applied the test for a complete inability to carry on a normal life, comparing the applicant's pre- and post-accident activities.

Despite some reported pain and adjustments to her routine, the Tribunal found the applicant was still capable of performing most of her pre-accident activities, including working, studying, and personal care.

The Tribunal concluded the applicant did not suffer a complete inability to carry on a normal life and dismissed the application for the non-earner benefit, the special award, and interest.

The applicant sought various statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs), attendant care benefits (ACBs), transportation costs, and a chronic pain assessment.

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal found the applicant failed to prove a substantial or complete inability to work to qualify for IRBs, noting she had returned to work and later received CERB due to pandemic-related job loss.

Claims for ACBs, transportation costs, and the chronic pain assessment were also dismissed for lack of supporting evidence and failure to meet the respective legal thresholds.

Consequently, claims for interest and a Regulation 664 award were denied.