Dr. Mula

The applicant was injured in a motor vehicle accident and sought payment for three chiropractic treatment plans under the Statutory Accident Benefits Schedule.

The respondent denied the plans, and the applicant applied to the Licence Appeal Tribunal.

The Tribunal found that the applicant did not prove on a balance of probabilities that the treatment plans were reasonable and necessary.

The medical evidence indicated that the applicant had received extensive chiropractic treatment over several years with minimal and short-lived improvement.

Both the applicant's and respondent's medical assessors recommended alternative forms of therapy, such as aqua therapy and relaxation exercises, rather than continued chiropractic care.

The application was dismissed.

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

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

The applicant argued she should be removed from the MIG due to chronic pain with functional impairment.

The adjudicator preferred the respondent's medical evidence, finding the applicant's expert report lacked objective corroboration and relied on vague subjective reports.

The adjudicator concluded the applicant failed to prove chronic pain with functional impairment, meaning she remained subject to the MIG.

As the MIG limits were exhausted, the claims for treatment plans and interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to non-earner benefits and various treatment plans outside the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on pre-existing conditions, chronic pain, and psychological impairments.

The Tribunal found that the applicant failed to prove on a balance of probabilities that his injuries warranted removal from the MIG, preferring the respondent's insurer examination reports which found no compelling evidence of chronic pain or a psychological condition.

The Tribunal also dismissed the claim for non-earner benefits, finding the applicant did not suffer a complete inability to carry on a normal life.

The application was dismissed in its entirety.

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

The respondent denied various treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing for removal from the MIG due to chronic pain and psychological impairments.

The Tribunal found that the applicant failed to meet the burden of proving chronic pain with a functional impairment under the AMA Guidelines, noting normal physical exams and lack of compelling evidence of functional decline.

The Tribunal also found insufficient evidence of a psychological condition, citing multiple assessments indicating symptom exaggeration and malingering.

The application was dismissed, and the applicant remained subject to the $3,500 MIG limit.

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

The Tribunal found that the applicant's injuries were predominantly minor and fell within the Minor Injury Guideline (MIG), as he failed to provide compelling medical evidence of a pre-existing condition or chronic pain that would warrant removal.

However, the Tribunal ordered the respondent to pay for two treatment plans (physiotherapy and a chronic pain assessment) because its initial denial notices failed to comply with the procedural requirements of s. 38(8) and (9) of the Schedule.

Claims for subsequent treatment plans and an award for unreasonable delay were dismissed.

The applicant was injured in a motor vehicle accident and sought payment for a chiropractic treatment plan and a chronic pain assessment under the Statutory Accident Benefits Schedule.

The insurer denied the benefits.

The Licence Appeal Tribunal found that the insurer's denial of the chiropractic treatment plan failed to comply with the notice requirements under section 38(8) of the Schedule, making the benefit payable.

The Tribunal also found the chronic pain assessment was reasonable and necessary given the applicant's consistent pain complaints and medical history.

The applicant's request for a special award was denied as the insurer's reliance on its medical assessors did not constitute unreasonable withholding of benefits.

The applicant was severely injured in a head-on motor vehicle collision and applied for statutory accident benefits.

After exhausting non-catastrophic limits, she sought a determination of catastrophic impairment and entitlement to further attendant care, housekeeping, and medical/rehabilitation benefits.

The Tribunal found the applicant catastrophically impaired under Criterion 7, accepting a combined Whole Person Impairment rating of 59% based on physical and mental/behavioral impairments, including a mild traumatic brain injury.

The Tribunal awarded attendant care and housekeeping benefits for incurred amounts, as well as an occupational therapy treatment plan, but dismissed claims for physiotherapy and a special award.

The applicant was also ordered to repay income replacement benefits received while employed.

The applicant was injured in a motor vehicle accident and sought removal from the Minor Injury Guideline (MIG) due to chronic pain and a suspected frozen shoulder, as well as entitlement to an income replacement benefit (IRB).

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor, as medical imaging was unremarkable and no definitive diagnosis outside the MIG was established.

The Tribunal also dismissed the claim for an IRB, finding insufficient objective evidence that the applicant suffered a substantial inability to perform the essential tasks of her pre-accident employment at a restaurant.

Claims for an award and interest were consequently dismissed.

The applicant sought accident benefits following a 2015 motor vehicle accident.

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

The Tribunal found that the applicant's injuries were predominantly minor and that he failed to prove chronic pain or psychological impairments that would remove him from the MIG.

However, the Tribunal held that the respondent failed to provide adequate medical and other reasons for denying the treatment plans, violating s. 38(8) of the Schedule.

Applying Ferawana and Zheng, the Tribunal ordered the respondent to pay for the disputed treatment plans, provided they were incurred before proper notice was given.

The claim for interest was denied.

The applicant sought various medical and assessment benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent denied the treatment plans on the basis that they were not reasonable and necessary.

The Tribunal found that the applicant failed to meet his burden of proving that the proposed chronic pain program, orthopaedic assessment, psychological assessment, and physiotherapy treatments were reasonable and necessary, noting a lack of objective medical evidence and reliance on subjective complaints.

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

The applicant sought medical and rehabilitation benefits following a motor vehicle accident.

The respondent denied the benefits on the basis that the applicant's impairments fell within the Minor Injury Guideline (MIG).

The applicant argued her injuries were not minor, citing chronic pain and psychological impairments.

The Tribunal found the applicant's physical injuries were predominantly soft-tissue sprains and strains.

Relying on the respondent's section 44 assessments, the Tribunal concluded the applicant failed to prove her impairments warranted treatment beyond the MIG.

The disputed treatment plans were deemed not reasonable and necessary, and the application was dismissed.

The applicant sought income replacement benefits and various medical and rehabilitation benefits following a motor vehicle accident.

The adjudicator found that the applicant failed to prove a substantial inability to perform her pre-accident employment tasks, noting evidence that she had returned to work at multiple jobs with no loss of income.

The adjudicator also dismissed the claims for medical benefits, finding that the proposed treatments and assessments were not reasonable and necessary, relying in part on the respondent's medical examinations which concluded the applicant had reached maximum medical improvement.

The applicant sought medical benefits following a rear-end motor vehicle accident.

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

The Tribunal found that the applicant's physical injuries were soft tissue in nature and predominantly minor.

Regarding psychological impairments, the Tribunal preferred the respondent's expert evidence over the applicant's expert, noting issues with the applicant's self-reporting and a lack of objective evidence supporting an accident-related psychological condition.

The Tribunal concluded the applicant's impairments remained within the MIG, and since the $3,500 limit was exhausted, the claims for further medical benefits were dismissed.

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

The respondent insurer denied the benefits, arguing the applicant's injuries were predominantly minor and subject to the $3,500 limit of the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's meniscal tear and unopposed psychological diagnoses warranted removal from the MIG.

However, the Tribunal only approved one treatment plan for $2,800, finding the applicant failed to provide sufficient evidence to prove the remaining claimed expenses were reasonable and necessary.

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 she suffered from chronic pain and psychological impairments that removed her from the MIG.

The Tribunal found insufficient medical evidence to support the applicant's claims of chronic pain or psychological impairment, preferring the respondent's psychological assessment which included objective psychometric testing.

The Tribunal concluded the applicant's injuries were predominantly minor and dismissed the application.

The applicant requested a reconsideration of a Tribunal decision denying his claims for pre-104-week and post-104-week income replacement benefits (IRBs).

The applicant argued the Tribunal erred in law by misapplying the IRB tests and erred in fact by discrediting his medical expert's report.

The adjudicator dismissed the reconsideration request, finding that the Tribunal applied the correct legal tests under the Statutory Accident Benefits Schedule and reasonably weighed the evidence.

The adjudicator noted that the Tribunal was entitled to give less weight to the applicant's expert report because it relied on self-reporting that was inconsistent with the medical records.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, which the respondent denied on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that his physical injuries, including a partial shoulder tear, and psychological impairments, diagnosed as an adjustment disorder, warranted removal from the MIG.

The Tribunal found that the physical injuries were predominantly minor and that the psychological diagnosis was not supported by the psychometric testing or DSM-5 criteria.

The application was dismissed, and no benefits or awards were granted.

The applicant sought statutory accident benefits for two chiropractic treatment plans and an attendant care assessment following a motor vehicle accident.

The insurer denied the plans.

The Licence Appeal Tribunal found that the applicant failed to provide sufficient medical evidence to prove the plans were reasonable and necessary, noting the applicant's own reports of functional independence to the insurer's examiners.

The Tribunal accepted the insurer's medical evidence that further treatment was not required.

The application was dismissed.

The Applicant sought her expenses and a Special Award following a successful arbitration for statutory accident benefits against the Insurer.

The Arbitrator found that the Insurer unreasonably withheld and delayed payments for Non-Earner and Medical Benefits despite compelling medical evidence from the Applicant's experts.

The Insurer's conduct, including an inadequate all-inclusive settlement offer, warranted a Special Award.

The Arbitrator ordered the Insurer to pay the Applicant's expenses fixed at $28,415.06 plus HST, and a Special Award of $13,000.00 inclusive of interest.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement, attendant care, housekeeping, and medical benefits.

The insurer denied the claims, arguing the accident did not occur as described and the applicant was untruthful.

The arbitrator found the applicant proved the accident occurred and was entitled to income replacement benefits due to a substantial inability to perform his pre-accident employment.

However, the claims for attendant care, housekeeping, and medical benefits were dismissed due to insufficient, unreliable, and exaggerated evidence.

The applicant was awarded interest on overdue payments, and both parties were ordered to bear their own arbitration expenses.