Dr. Mitchell Fox

The applicant sought a medical benefit of $3,405.00 for 75 chiropractic sessions following a motor vehicle accident.

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

The Tribunal found the applicant failed to prove the treatment was reasonable and necessary, noting the lack of medical evidence explaining the need for the specific treatment and the applicant's own reports of only temporary relief.

The Tribunal also rejected the applicant's argument that an allegedly deficient denial notice under s. 38(14) of the Schedule triggered a mandatory payment obligation under s. 38(11).

The application for benefits, interest, and an award was dismissed.

The applicant, a self-employed taxi driver, sought income replacement benefits (IRBs) and a medical benefit for physiotherapy following a motor vehicle accident.

The insurer denied the benefits, relying on surveillance and multidisciplinary assessments that focused primarily on physical impairments.

The Tribunal found that the applicant suffered severe and ongoing psychological impairments, including major depressive disorder and post-traumatic stress disorder, which rendered him substantially unable to perform the essential tasks of his employment for the first 104 weeks, and completely unable to engage in any suitable employment thereafter.

The Tribunal awarded the claimed IRBs and interest.

Furthermore, the Tribunal ordered a 50% lump sum award under O. Reg. 664, finding that the insurer unreasonably withheld benefits by repeatedly ignoring the psychological diagnoses provided by its own assessors.

The claim for physiotherapy was dismissed for lack of evidence.

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

The insurer denied a treatment plan for a psychological assessment and weekly non-earner benefits, taking the position that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing her injuries fell outside the MIG due to psychological impairments and chronic pain.

The Tribunal found that the applicant failed to prove on a balance of probabilities that she suffered from a psychological impairment or chronic pain arising from the accident.

The Tribunal also found the applicant was not entitled to the psychological assessment or non-earner benefits, as she failed to prove a complete inability to carry on a normal life.

The application was dismissed.