Dr. Moddel

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, claiming catastrophic impairment, income replacement benefits, attendant care benefits, and various treatment plans.

The Licence Appeal Tribunal found that the applicant did not meet the threshold for catastrophic impairment under Criterion 7 (55% whole person impairment) or Criterion 8 (mental and behavioural disorders).

The Tribunal preferred the respondent's medical evidence, noting the applicant's pre-existing conditions and post-accident functioning, including international travel.

Claims for income replacement and attendant care benefits were dismissed as the applicant failed to prove a substantial inability to perform his pre-accident employment and the benefits had expired past the 260-week mark.

The application was dismissed in its entirety.

The applicant sought a determination that she sustained a catastrophic impairment (CAT) under Criterion 7 of the Statutory Accident Benefits Schedule following a motor vehicle accident.

The applicant relied on expert assessments suggesting a combined whole person impairment (WPI) of 63%, while the respondent's experts assessed her at 38%.

The Tribunal preferred the respondent's experts, finding the applicant's neurological and psychological ratings were largely unsupported by medical evidence and heavily influenced by pre-existing conditions.

The Tribunal concluded the applicant's combined WPI was 41%, falling short of the 55% threshold, and dismissed the application.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her entitlement to pre- and post-104-week income replacement benefits.

The applicant argued that the Tribunal erred in law and fact, and committed a material breach of procedural fairness, regarding the sufficiency of the insurer's notice of determination, the onus of proof, and the review of medical documents by an expert.

The adjudicator dismissed the request, finding that the notice complied with the Statutory Accident Benefits Schedule, the onus of proof correctly remained on the applicant, and the medical expert had properly considered the functional abilities evaluation report.

The reconsideration threshold under Rule 18.2 was not met.

The applicant sought a determination of catastrophic impairment and entitlement to various medical, rehabilitation, and transportation benefits following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant did not sustain a catastrophic impairment under either Criterion 7 (55% Whole Person Impairment) or Criterion 8 (mental or behavioural disorder), preferring the respondent's medical evidence which indicated lower impairment ratings.

However, the Tribunal granted the applicant's claims for a psychological treatment plan and an occupational therapy assessment, finding them reasonable and necessary.

The claims for transportation expenses were dismissed for lack of evidence.

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

The Tribunal first dismissed the insurer's preliminary motion to bar the application for non-attendance at an insurer's examination, finding the request was made years after the application was filed.

On the substantive issues, the Tribunal found the applicant entitled to income replacement benefits for the pre-104-week period due to psychological impairments, but not for the post-104-week period as she did not suffer a complete inability to work.

The Tribunal also approved several treatment plans for occupational therapy, chiropractic, physiotherapy, and massage services, finding them reasonable and necessary.

Claims for a social work treatment plan balance and a special award were dismissed.

The applicant sought a determination that she sustained a catastrophic impairment under Criterion 7 of the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Tribunal assessed various Whole Person Impairment (WPI) ratings provided by multiple medical experts for physical and psychological impairments, including complex regional pain syndrome, sleep disturbances, and right upper extremity deficits.

The Tribunal rejected several of the applicant's expert ratings for failing to follow the AMA Guides' methodology and lacking objective medical evidence.

Ultimately, the Tribunal calculated a combined WPI rating of 50%, falling short of the 55% threshold required for a catastrophic impairment designation.

The application was dismissed.

The applicant sought entitlement to pre-104 and post-104 Income Replacement Benefits (IRBs) following a motor vehicle accident.

The respondent insurer terminated the IRBs based on multidisciplinary assessments indicating the applicant could return to her pre-accident employment as an Uber driver.

The adjudicator found that the applicant failed to provide compelling medical evidence to contradict the respondent's assessors, who concluded there were no ongoing objective musculoskeletal or neurological impairments caused by the accident.

Furthermore, the applicant's own psychological records did not support a diagnosis of PTSD or a driving phobia.

The adjudicator also noted the applicant received CERB and CRB during the disputed period and successfully completed education to become a medical esthetician.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits (IRBs) and a neurological assessment.

The Tribunal found that the applicant failed to prove she met the disability test for IRBs, as the medical evidence did not establish a substantial inability to perform the essential tasks of her self-employment.

However, because the respondent insurer issued deficient notices suspending and terminating the IRBs, the Tribunal ordered the respondent to pay IRBs totaling $9,783.83 for the period before a compliant notice was issued.

The claim for a neurological assessment was dismissed as not reasonable and necessary.

The Tribunal denied a special award but granted $500 in costs to the applicant due to the respondent's late service of an accounting report.

The applicant, a pedestrian struck by a motor vehicle, sought a catastrophic impairment designation under Criterion 4 of the Statutory Accident Benefits Schedule for a traumatic brain injury.

The applicant relied on a GOS-E rating of Severe Disability provided by the respondent's occupational therapist.

The Tribunal found that under section 45(2) of the Schedule, a GOS-E assessment must be conducted by a physician or neuropsychologist.

Because the applicant did not provide a qualifying medical opinion to support the occupational therapist's findings, and the respondent's neurologist found a 'good recovery', the applicant failed to meet his onus.

The application was dismissed.

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

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

The Tribunal found that while the applicant's physical injuries initially met the definition of a minor injury, she subsequently developed chronic pain and psychological impairments, including adjustment disorder and somatic symptom disorder, which warranted removal from the MIG.

The Tribunal concluded that the proposed psychological services were reasonable and necessary to address her chronic pain and emotional issues, approving the treatment plan at a reduced rate.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, claiming she sustained a catastrophic impairment due to mental and behavioural disorders.

The Licence Appeal Tribunal found that the applicant sustained a marked impairment (Class 4) in Adaptation, qualifying her for catastrophic impairment status.

The Tribunal awarded attendant care benefits, professional organizing services, and vision therapy, but denied aquatherapy sessions.

The Tribunal also denied the applicant's request for a special award under Regulation 664, finding the insurer's denials were not unreasonable.

The applicant was injured in a motor vehicle accident and deemed catastrophically impaired.

They sought various statutory accident benefits, including attendant care benefits, medical and rehabilitation expenses, and an award for unreasonable delay.

The Licence Appeal Tribunal found the applicant entitled to a reduced amount of attendant care benefits, case management services, and chiropractic treatment, as the insurer had previously approved or partially approved these amounts.

The remaining claims for assessments, assistive devices, and other treatments were dismissed for lack of medical evidence proving they were reasonable and necessary.

The Tribunal declined to make an award under section 10 of Regulation 664, finding the insurer did not unreasonably withhold or delay payments.

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

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

The Licence Appeal Tribunal found that the applicant failed to prove her physical or psychological impairments warranted removal from the MIG.

As the MIG limits were exhausted, the treatment plan was not payable and the application was dismissed.

The applicant, who suffered catastrophic injuries as a pedestrian in a motor vehicle accident, sought a medical benefit for a physiotherapy treatment plan.

The respondent insurer denied the plan, relying on its expert assessors who opined that home-directed exercises were sufficient and that the applicant's neurological impairment was fixed.

The Tribunal preferred the evidence of the applicant's treating multidisciplinary team, finding the professionally directed physiotherapy reasonable and necessary to manage and prevent regression of the applicant's conditions.

The treatment plan was approved with interest.

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

She had a rare, pre-existing brainstem cavernoma that was symptomatic prior to the accident.

The insurer argued the post-accident deterioration was the natural progression of her condition.

The arbitrator found that the applicant did not suffer pre-accident loss of consciousness and accepted the applicant's expert evidence that the torsional force of the collision likely caused increased bleeding in the cavernoma.

The arbitrator concluded that the accident materially contributed to the impairment, tipping the balance from a mild impairment to a life-threatening condition.

The applicant was found outside his truck after it struck three parked vehicles.

He suffered a severe stroke and later died.

His estate sought statutory accident benefits, arguing the stroke was caused by the collision or a panic-induced spike in blood pressure resulting from the collision.

The insurer argued the stroke occurred spontaneously prior to the collisions.

The arbitrator found that the applicant's panic reaction to the first impact caused a precipitous rise in blood pressure, which, combined with his susceptibility to stroke and possible head trauma, caused the stroke.

Therefore, the impairments were sustained as a result of an 'accident' under the Schedule.

The applicant was injured in a motor vehicle accident and claimed weekly benefits and yard maintenance expenses from his insurer.

The insurer denied the claims, arguing the applicant's disability was not caused by the accident and that he lacked motivation.

The arbitrator found that the accident aggravated the applicant's pre-existing spinal degeneration, causing a substantial inability to perform his essential daily tasks, including home renovations and strenuous recreational activities.

The arbitrator awarded three years of weekly benefits and partial yard maintenance expenses.

Furthermore, the arbitrator ordered the insurer to pay a $10,000 special award under section 282(10) of the Insurance Act, finding that the insurer's continued denial of the claim after receiving objective MRI evidence was unreasonable.

The applicant was struck by a car while walking on a sidewalk, sustaining a head injury that resulted in chronic severe headaches.

The insurer paid weekly income benefits and medical benefits until November 1994, when it terminated benefits on the basis that the applicant was physically capable of returning to work.

The applicant applied for arbitration, seeking ongoing weekly income benefits and payment for chiropractic treatments.

The arbitrator found the applicant's subjective complaints of severe headaches to be credible and concluded that he was continuously prevented from engaging in any occupation for which he was reasonably suited, entitling him to ongoing weekly income benefits.

The arbitrator remained seized of the issue regarding the reasonableness of the chiropractic expenses due to insufficient evidence.

A post-hearing request by the insurer to reopen the proceedings to admit fresh evidence was dismissed, as the evidence could have been produced with due diligence and would not have changed the outcome.

The applicant, a restaurant cook, was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them.

The applicant claimed he remained disabled due to dizziness caused by the accident.

The arbitrator accepted the uncontradicted medical evidence of an otolaryngologist who diagnosed a post-traumatic labyrinthine concussion.

Finding that the applicant's dizziness prevented him from performing the demanding and hazardous tasks of a cook in a busy kitchen, the arbitrator concluded the applicant was substantially unable to perform his essential tasks.

The insurer was ordered to pay income replacement benefits for the disputed period, along with interest and expenses.

The applicant was struck by a bus while walking to work and sustained a head injury resulting in chronic headaches, depression, anxiety, and cognitive difficulties.

The insurer terminated her weekly income benefits after 104 weeks, arguing she was not disabled from returning to reasonably suitable employment or that her disability was due to pre-existing conditions.

The arbitrator found the applicant credible and preferred the evidence of her treating medical practitioners over the insurer's assessors who only saw her once or twice.

The arbitrator concluded that the applicant's complex of psychological, emotional, and cognitive symptoms substantially disabled her from engaging in any employment for which she was reasonably suited.

The insurer was ordered to reinstate weekly income benefits with interest and pay the applicant's arbitration expenses.