Dr. Moshiri

The applicant sought statutory accident benefits for a physiotherapy treatment plan and the balance of a psychological assessment following a motor vehicle accident.

The Tribunal found that the physiotherapy treatment plan was not reasonable and necessary, preferring the respondent's expert who conducted an in-person examination and concluded the applicant had reached maximum medical recovery.

The Tribunal also denied the balance of the psychological assessment, preferring the respondent's expert who provided a more detailed and specific description of the time and cost necessary for the assessment.

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

The applicant sought statutory accident benefits following a motor vehicle accident, including medical benefits for physiotherapy and the cost of disability certificates (OCF-3s).

The insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the treatments were not reasonable and necessary.

The adjudicator found that the applicant's injuries were predominantly minor and that she did not suffer from a pre-existing condition that would remove her from the MIG.

Relying on video surveillance that contradicted the applicant's reported limitations, the adjudicator concluded the treatment plans were not reasonable and necessary.

The claims for the OCF-3s were also dismissed as they were not requested by the insurer.

The applicant sought statutory accident benefits following a motor vehicle accident, including ongoing income replacement benefits (IRBs) and various medical treatment plans.

The Licence Appeal Tribunal found that the applicant's pre-existing knee impairments were not worsened by the accident and that he did not meet the test for a substantial or complete inability to work.

Consequently, the claims for ongoing IRBs and physical treatment plans were dismissed.

However, the Tribunal found that the insurer had unreasonably delayed payment of the initial IRBs and failed to pay interest.

The Tribunal ordered the insurer to pay interest on the delayed payments along with a 20% special award under O. Reg. 664.

Both parties' requests for costs were denied.

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

The respondent denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that while the applicant's physical injuries were minor, he sustained a psychological injury that exempted him from the MIG limits.

However, the Tribunal dismissed the claims for a psychological treatment plan and an orthopaedic assessment, finding them not reasonable and necessary.

The evidence, including the applicant's high level of post-accident occupational and social activity, contradicted the need for the proposed psychological treatment, and clinical records did not support ongoing physical impairments requiring further orthopaedic assessment.

The claim for an award for unreasonable delay was also dismissed.

The applicant sought the balance of a cost of examination for a psychological assessment following a motor vehicle accident.

The respondent had paid a portion of the claimed amount based on its own assessor's opinion of reasonable hours.

The Tribunal dismissed the application, finding the treatment plan vague and unparticularized, and noting the applicant failed to provide persuasive evidence justifying the full amount of time claimed.

The applicant, a pedestrian struck by a motor vehicle, sought income replacement benefits and funding for chronic pain and physiatry assessments from her insurer.

The Licence Appeal Tribunal found that the applicant failed to prove she suffered a substantial inability to perform the essential tasks of her pre-accident employment, relying on independent medical examinations that found no physical or psychological contraindications to her return to work.

The Tribunal also dismissed the claims for the assessments, finding them not reasonable and necessary given the lack of objective medical evidence supporting ongoing impairment and the applicant's self-reported improvements and return to work as a personal support worker.

The application was dismissed in its entirety.

The applicant sought payment for statutory accident benefits following a motor vehicle accident, including attendant care benefits, a non-earner benefit, and the cost of various assessments.

The Licence Appeal Tribunal found the applicant was not entitled to attendant care benefits or a non-earner benefit, as she failed to prove the expenses were reasonable and necessary or that she suffered a complete inability to carry on a normal life.

However, the Tribunal ordered the respondent to pay for a chronic pain assessment and two Assessments of Attendant Care Needs, finding them to be reasonable and necessary expenses, along with applicable interest.