Dr. Monique Costa El-Hage

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 for removal from the MIG due to chronic pain, a pre-existing rotoscoliosis condition, concussion symptoms, and psychological impairment.

The Tribunal found that the applicant failed to provide compelling medical evidence to establish any of these conditions warranted removal from the MIG.

As the applicant remained within the MIG, the disputed treatment plans were not assessed, and the application was dismissed.

The applicant, who was 14 years old at the time of the motor vehicle accident, sought statutory accident benefits including non-earner benefits (NEBs) and various treatment plans.

The adjudicator found that the applicant demonstrated a complete inability to carry on a normal life due to chronic pain and psychological impairments, entitling her to NEBs of $185 per week for the disputed period.

A treatment plan for psychological services was also approved as reasonable and necessary.

However, the adjudicator denied plans for an attendant care assessment and driving reintegration services, finding insufficient evidence to support them.

The claim for an award for unreasonable delay was dismissed, but interest was awarded on the payable benefits.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs).

The respondent insurer terminated the IRBs based on section 44 assessments.

The Tribunal found that the applicant suffered a substantial inability to perform the essential tasks of his employment, which involved heavy physical labour, and ordered the respondent to pay IRBs of $400 per week ongoing.

The Tribunal also found that the respondent unreasonably delayed adjusting the claim and awarded the applicant a 30% special award under section 10 of Regulation 664, amounting to $2,280.00.

The applicant's request for costs was denied.

The applicant sought statutory accident benefits, including income replacement benefits, attendant care benefits, and a treatment plan for psychological services following a motor vehicle accident.

The applicant was represented by his spouse and failed to provide any medical documentation or expert testimony to support his claims.

The adjudicator relied on the respondent's section 44 assessment reports and surveillance evidence, which contradicted the applicant's claimed impairments and demonstrated his ability to perform daily activities independently.

The application was dismissed in its entirety.

The applicant requested a reconsideration of a Tribunal decision that denied his entitlement to a post-104 week Income Replacement Benefit (IRB) and found that the quantum for his pre-104 week IRB could not be determined.

The Vice-Chair dismissed the request to admit new tax documents to determine the IRB quantum, finding the applicant failed to show the evidence could not have been obtained previously.

However, the Vice-Chair found the original adjudicator committed an error of law by failing to explicitly engage with the expert evidence regarding the post-104 week IRB test.

Upon reviewing the evidence, the Vice-Chair concluded the applicant suffers from a complete inability to engage in reasonably suited employment due to chronic pain and cognitive struggles.

The decision was varied to find entitlement to the post-104 week IRB, though no benefit is currently payable as the quantum remains undetermined.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed physical and psychological impairments warranted removal from the MIG, relying solely on his own testimony.

The Tribunal found the applicant failed to meet his burden of proof, noting the absence of objective medical evidence and the presence of expert reports attributing his impairments to prior workplace injuries and trauma.

The Tribunal concluded the applicant remained within the MIG, denied the disputed treatment plans, and declined to award costs to the respondent.

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

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor, noting that his self-reported symptoms were inconsistent and did not demonstrate functional impairment.

The Tribunal preferred the respondent's s. 44 assessors over the applicant's pre-screening report.

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

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

The respondent denied several expenses and treatment plans.

The adjudicator found the applicant was entitled to medication expenses as they do not require a prior treatment plan.

The claim for a left knee brace was dismissed because the expense was incurred before a treatment plan was submitted, contrary to s. 38(2) of the Schedule.

The adjudicator granted the treatment plans for a chronic pain assessment and an attendant care assessment because the respondent failed to provide proper notice under s. 38(8) after the applicant was removed from the Minor Injury Guideline.

The treatment plans for an occupational therapy assessment, occupational therapy services, and an OT jobsite analysis were found to be reasonable and necessary based on the applicant's functional limitations and supporting medical evidence.

Interest was awarded on all overdue benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a non-earner benefit and various treatment plans for chiropractic and psychological services.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the applicant suffered a complete inability to carry on a normal life due to chronic pain and psychological impairments, entitling her to the non-earner benefit for the maximum 104-week period.

The Tribunal also partially approved several treatment plans for physical rehabilitation, acupuncture, and a psychological assessment, finding them reasonable and necessary.

Claims for an award under s. 10 of Reg. 664 were dismissed, but interest on overdue benefits was granted.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB) and various treatment plans outside the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal dismissed the application.

The Tribunal found the applicant was not entitled to an IRB because his post-accident short-term disability income fully negated the benefit quantum under s. 7(3)(a) of the Schedule.

Furthermore, the Tribunal held the applicant's injuries remained within the MIG, rejecting claims of psychological impairment and chronic pain due to evidence of malingering, lack of contemporaneous clinical reporting, and treating physician records indicating full functional capacity.

As the MIG limits were exhausted, the disputed treatment plans were denied.

The applicant sought statutory accident benefits following a motor vehicle accident and disputed the denial of income replacement benefits.

The respondent raised a preliminary issue that the applicant was barred from proceeding because he failed to attend a scheduled psychological insurer's examination under s. 44 of the Schedule.

The Tribunal found that the requested examination was reasonably necessary given a new psychological diagnosis by another assessor, and that the applicant did not have a reasonable explanation for non-attendance.

Consequently, the applicant is barred from proceeding with his application under s. 55 of the Schedule.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of treatment plans for chiropractic services, a chronic pain assessment, and a psychological assessment.

The Tribunal found the applicant failed to prove the chiropractic and chronic pain treatment plans were reasonable and necessary, noting her failure to produce pre-accident and post-accident clinical notes from her family physician and the lack of objective evidence of impairment in the insurer's orthopaedic examination.

However, the Tribunal approved the psychological assessment, as the respondent conceded it was reasonable and necessary based on its own psychological examination.

The Tribunal also ordered the respondent to pay interest and a special award under section 10 of O. Reg. 664 solely in relation to the delayed payment for the psychological assessment.

The applicant sought statutory accident benefits following a 2010 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant's claims for massage therapy were barred by res judicata due to a prior decision.

The Tribunal granted the applicant's claim for psychological treatment, finding it reasonable and necessary based on the treating psychologist's evidence, provided it was incurred before the 10-year anniversary of the accident.

The claims for occupational therapy, assistive devices, and transportation expenses were dismissed for lack of objective evidence.

The Tribunal also denied the applicant's request for an award under Regulation 664, finding the insurer's reliance on an independent examination report was not unreasonable.

The applicant sought accident benefits following a motor vehicle accident.

The respondent insurer determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied three treatment plans.

The applicant argued she should be removed from the MIG due to a psychological impairment and a pre-existing condition of pregnancy.

The Tribunal found the applicant failed to prove a psychological impairment, giving significant weight to the respondent's psychological assessment and noting the applicant's failure to attend numerous insurer examinations.

The Tribunal also found no evidence that her pregnancy precluded recovery within the MIG.

The applicant was awarded the $305.75 remaining under her MIG limit for one treatment plan, but the other plans and interest were denied.

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

The respondent denied a treatment plan for a chronic pain assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant failed to prove she suffered from chronic pain syndrome or a pre-existing condition that would remove her from the MIG.

However, the Tribunal held that the respondent's denial letter failed to provide adequate medical and other reasons as required by s. 38(8) of the Schedule, as it merely referred to an unspecified 'list of injuries'.

Consequently, under s. 38(11)2, the treatment plan was payable regardless of the MIG limits.

The applicant was awarded $2,460.00 for the assessment plus interest.

The applicant, who has a pre-existing diagnosis of autism, sought statutory accident benefits following a motor vehicle accident.

She claimed entitlement to a non-earner benefit, various medical benefits including occupational therapy, physical therapy, and a chronic pain assessment, as well as an award and interest.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to establish a complete inability to carry on a normal life, as there was insufficient evidence comparing her pre- and post-accident activities.

The Tribunal preferred the respondent's expert evidence, which indicated no objective ongoing accident-related impairments and found the disputed treatment plans were either duplicative or not reasonable and necessary.

The applicant was injured in a rear-end motor vehicle accident and sought medical and rehabilitation benefits.

The respondent insurer denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) $3,500 limit.

The Licence Appeal Tribunal found that the applicant's pre-existing physical conditions, including chronic back pain and degenerative disc disease, prevented her from achieving maximal medical recovery within the MIG limits.

Consequently, the Tribunal approved four physiotherapy treatment plans as reasonable and necessary for ongoing pain relief.

However, the Tribunal dismissed claims for psychological services and a mental health assessment, finding that the applicant's psychological issues were primarily related to pre-existing workplace problems and that she had successfully returned to driving.

Interest was awarded on the overdue physiotherapy payments.

The applicant sought interest and a special award under Regulation 664 for delayed and suspended income replacement benefits (IRBs) following a motor vehicle accident.

The Tribunal found the insurer liable for interest for a brief period in 2018 when it failed to respond to the initial application within the required 10 days under s. 36 of the Schedule.

However, no interest was payable for 2019 as the applicant's self-employment income resulted in a zero IRB entitlement, and the applicant conceded to repaying a $20,856 overpayment for that year.

The Tribunal also awarded interest on a lump-sum back payment for a period in 2020 when benefits were temporarily suspended based on medical assessments but later reinstated.

The claim for a special award was dismissed, as the insurer actively and reasonably adjudicated the file based on the available medical evidence.

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

The respondent denied several treatment plans for chiropractic and psychological care on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant sustained predominantly minor soft tissue injuries and failed to establish that he suffered from chronic pain or a psychological impairment that would remove him from the MIG.

As the $3,500 MIG funding limit had been exhausted, the claims for additional medical benefits were dismissed, along with claims for interest and an award for unreasonable withholding of benefits.

The respondent insurer requested a reconsideration of a previous Tribunal decision that awarded the applicant various medical and rehabilitation benefits, including physical therapy, a chronic pain assessment, a chronic pain program, and a disability certificate.

The insurer alleged several factual and legal errors, including the Tribunal's treatment of expert evidence and the legal test applied.

The adjudicator dismissed the request, finding that while there were minor errors in the original decision, none were significant enough that they would have likely led to a different result.

The adjudicator also clarified that under s. 25(1) of the Schedule, an insurer is not required to request a disability certificate before it becomes payable.