Dr. Michael West

The applicant was struck by a vehicle while riding her bicycle and sought statutory accident benefits for an orthopaedic assessment and physiotherapy services.

The respondent denied the claims, initially arguing the injuries fell within the Minor Injury Guideline, but later conceding they did not while maintaining the denials.

The Tribunal found that the respondent failed to provide proper medical reasons for denying the orthopaedic assessment, but ultimately dismissed the claim as the assessment was a duplication of services already provided by the applicant's treating orthopaedic surgeon.

However, the Tribunal granted the claim for physiotherapy services, finding them reasonable and necessary to provide short-term pain relief for the applicant's accident-related chronic pain syndrome.

Claims for interest and costs were dismissed.

The applicant sought reconsideration of a decision denying three chiropractic treatment plans and a chronic pain assessment.

The applicant argued the Tribunal made a significant error of law by preferring the respondent's medical expert, who found no objective basis for chronic pain syndrome, over the applicant's expert.

The applicant also sought to introduce a 1995 academic paper as new evidence.

The Tribunal dismissed the reconsideration request, finding that the weighing of expert evidence is within the adjudicator's prerogative and did not constitute an error of law.

The Tribunal also refused to admit the academic paper, as it could have been obtained earlier and actually supported the respondent's expert's characterization of chronic pain syndrome.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued the Tribunal made errors of fact and law by giving little weight to her orthopaedic surgeon's report, failing to consider her family physician's records, and failing to conclude she suffered from chronic pain syndrome due to a partial shoulder tear.

The adjudicator dismissed the request, finding no error in affording the orthopaedic report little weight as it lacked diagnostic criteria and credentials regarding chronic pain.

Furthermore, the family physician's records did not establish the AMA criteria for chronic pain syndrome, and the applicant failed to prove the Tribunal would have reached a different decision based on the shoulder tear.

The applicant sought medical benefits for physiotherapy, chiropractic, and massage therapy services following a motor vehicle accident.

The respondent denied the treatment plan based on an insurer's examination.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the treatment was reasonable and necessary.

The Tribunal preferred the evidence of the respondent's orthopedic surgeon, who concluded the applicant had reached maximum medical recovery and would not benefit from further facility-based treatment, over the applicant's medical records which showed limited improvement.

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

The insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained predominantly minor injuries and failed to prove that pre-existing conditions, psychological injuries, or chronic pain warranted removal from the MIG.

However, because the insurer failed to comply with the strict notice requirements under sections 38(8) and 38(9) of the Schedule when denying a treatment plan for an orthopaedic assessment, the Tribunal ordered the insurer to pay for the assessment along with applicable interest.

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

The insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued her injuries, including a partial rotator cuff tear and chronic pain syndrome, warranted removal from the MIG.

The Tribunal found that the partial rotator cuff tear met the definition of a strain and thus a minor injury under the Schedule.

The Tribunal also rejected the diagnosis of chronic pain syndrome due to a lack of supporting evidence and methodology in the expert report.

As the injuries fell within the MIG and the $3,500 limit was exhausted, the claims for further medical benefits, examination costs, interest, and an award were dismissed.

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

The respondent denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline and that he had recovered through a home-based exercise program.

The Licence Appeal Tribunal dismissed the application, finding that the chiropractic treatments were not reasonable and necessary as they provided minimal improvement compared to the home exercise program.

The Tribunal also denied the chronic pain assessment, preferring the respondent's expert evidence that the applicant lacked objective markers of chronic pain syndrome over the applicant's expert, whose opinion relied on subjective reports contradicted by contemporaneous medical records.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) for a six-month period during which the respondent insurer had terminated them.

The adjudicator found that the applicant, who worked as a personal support worker at two locations prior to the accident, suffered physical impairments that rendered her substantially unable to perform the essential tasks of her employment.

Relying on the applicant's medical evidence, including reports from her family doctor and specialists, the adjudicator ordered the respondent to pay the IRBs with interest.

However, the applicant's request for an award under Ontario Regulation 664 for unreasonable delay was denied, as the respondent had actively assessed the file and relied on its own medical assessors.

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

The insurer terminated IRBs after 104 weeks, arguing the applicant did not meet the test for complete inability to work.

The Tribunal found that while the applicant failed to prove physical impairment, he successfully established that his psychological impairments, caused by the accident, rendered him completely unable to engage in any employment for which he was reasonably suited.

The Tribunal awarded IRBs from November 15, 2015, ongoing, with interest.

The respondent's request for costs was denied.

The applicant was injured in a motor vehicle accident and subsequently suffered two workplace accidents.

He sought medical benefits for orthopaedic, chronic pain, and neurological assessments, as well as psychological treatment, arguing his injuries fell outside the Minor Injury Guideline.

The Tribunal found that the injuries from the motor vehicle accident were predominantly minor soft tissue injuries.

Furthermore, the Tribunal determined that the applicant's chronic pain and psychological impairments were caused by the subsequent workplace accidents, not the motor vehicle accident.

The application for benefits was dismissed.

The insurer requested a reconsideration of a Licence Appeal Tribunal decision that awarded the insured physiotherapy services, orthopaedic and psychiatric assessments, and a special award under s. 10 of Regulation 664.

The Executive Chair found no significant error of law in the adjudicator's determination that the treatment plans and assessments were reasonable and necessary for managing the insured's chronic pain.

However, the Executive Chair allowed the reconsideration regarding the s. 10 award, finding that the adjudicator erred by conflating the reasonableness of the treatment plans with the unreasonableness of the insurer's conduct.

The award was overturned as there was no evidence the insurer unreasonably withheld or delayed payments.

The applicant was injured in a motor vehicle accident and sought payment for two orthopaedic assessments under the Statutory Accident Benefits Schedule.

The insurer denied the treatment plans.

The Licence Appeal Tribunal found that the applicant failed to prove the assessments were reasonable and necessary, noting the absence of the actual treatment plans in evidence and preferring the insurer's medical evidence that the applicant suffered only soft tissue injuries.

The appeal was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a physiotherapy treatment plan and an orthopaedic assessment.

The insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit applied.

The applicant argued that her injuries were not predominantly minor and that she had a pre-existing condition that would prevent her from achieving maximal recovery within the MIG limit.

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor soft tissue injuries.

The Tribunal also found no compelling evidence of a pre-existing medical condition that would take the applicant outside the MIG.

As funds remained within the MIG limit, the Tribunal dismissed the claims for the treatment plan, assessment, and interest.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits, an orthopaedic assessment, assistive devices, and occupational therapy services.

The adjudicator dismissed the application, finding that the applicant was independent with his activities of daily living and failed to establish any economic loss for attendant care.

The adjudicator also found that the requested medical benefits and assistive devices were not reasonable and necessary, preferring the respondent's medical evidence over the applicant's contradictory and incomplete reports.

The applicant sought statutory accident benefits for physiotherapy services and orthopaedic and psychiatric assessments following a motor vehicle accident.

The respondent insurer denied the claims based on insurer examinations.

The adjudicator found that the physiotherapy services were reasonable and necessary for managing the applicant's chronic pain, rejecting the insurer's argument that treatment must lead to full recovery.

The adjudicator also approved the assessments, noting the insurer's assessors conducted paper reviews without reviewing key medical reports.

Finding that the insurer unreasonably withheld payments, the adjudicator ordered a special award of 50% of the disputed amounts, plus interest.

The defendants brought a motion seeking an order to compel the plaintiff to attend a further defence orthopedic examination.

The plaintiff opposed the motion.

The court applied the seven-factor test from Bonello v. Taylor, 2010 ONSC 5723, for ordering further examinations.

The court noted that the defendants had previously chosen a physiatrist for examination despite knowing the plaintiff would rely on an orthopedic surgeon's report.

No significant change in the plaintiff's condition was demonstrated, and the defendants' own physiatrist's addendum report confirmed his original opinion remained unaltered, even after new information about a subsequent accident.

The court found that the defendants failed to demonstrate the necessity for a second physical examination and dismissed the motion.

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

The insurer terminated income replacement and housekeeping benefits, arguing that the applicant's ongoing impairments were related to pre-existing conditions rather than the accident.

The arbitrator found that the accident materially contributed to the applicant's development of chronic pain syndrome and depression.

The arbitrator concluded that the applicant suffered a complete inability to engage in any employment for which he was reasonably suited and awarded ongoing income replacement benefits, housekeeping benefits, and various medical and rehabilitation benefits.

The claim for a special award was dismissed as the insurer's reliance on incorrectly completed disability certificates was not unreasonable.

The applicant sought income replacement benefits and the cost of medical examinations following a motor vehicle accident.

The applicant failed to attend the arbitration hearing.

The arbitrator proceeded in his absence and found that the applicant had returned to full-time employment and earned in excess of the claimed benefit amount.

The arbitrator accepted the insurer's independent medical examination and rejected the applicant's medical reports due to factual errors and omissions.

The application was dismissed, and the applicant was ordered to pay the insurer's legal expenses.

The applicant was injured when her car door fell off its hinges.

She received weekly income benefits until the insurer terminated them based on medical reports indicating she could return to work.

The applicant sought arbitration, claiming ongoing chronic pain prevented her from performing her job as an accounts receivable clerk.

The arbitrator dismissed the claim, finding the medical evidence did not support a causal link between the minor trauma and her ongoing complaints.

Furthermore, video surveillance evidence contradicted her claims of physical limitation, leading the arbitrator to conclude she had not established a substantial inability to perform the essential tasks of her employment.