Dr. Nagib Yahmad

The applicant sought a determination of catastrophic impairment and entitlement to attendant care benefits and hearing aids following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant was statute-barred from claiming attendant care benefits because she failed to dispute the insurer's denial within the two-year limitation period, and the justice of the case did not warrant an extension.

On the issue of catastrophic impairment, the Tribunal applied the AMA Guides to assess the applicant's physical and psychological impairments, ultimately finding a combined Whole Person Impairment (WPI) of 56%, which exceeds the 55% threshold under Criterion 7.

The Tribunal denied the claim for hearing aids because the applicant incurred the expense without first submitting a treatment plan, contrary to section 38(2) of the Schedule.

The claim for a special award was also dismissed as the insurer did not unreasonably withhold or delay benefits.

The applicant sought $1,602.05 for medication expenses, an award for unreasonable delay, and interest following a motor vehicle accident.

The applicant claimed the accident caused a re-emergence of epileptic seizures and psychological symptoms.

The Tribunal dismissed the application, finding the applicant failed to prove the medications were reasonable and necessary to treat accident-related injuries.

The Tribunal preferred the evidence of the insurer's neurologist, who found no traumatic neurological injury explaining the seizures, and noted the applicant's treating neurologist also found no connection to the accident.

As no benefits were payable, the claims for interest and an award were also dismissed.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, which the respondent insurer denied on the basis that her injuries fell within the Minor Injury Guideline (MIG).

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

The Tribunal found that the applicant failed to provide sufficient medical evidence linking her psychological complaints or ongoing pain to a functional impairment caused by the accident.

As the $3,500 MIG limit was exhausted, the disputed treatment plans were denied.

The Tribunal also found the insurer complied with the notice requirements under s. 38(8) of the Schedule and dismissed the claims for an award and interest.

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

The insurer denied an income replacement benefit (IRB) and two treatment plans.

On a rehearing, the Tribunal found the applicant was entitled to the IRB, as medical evidence supported a substantial inability to perform the essential tasks of his pre-accident employment due to chronic pain and a right shoulder impairment.

The Tribunal denied the April 11, 2022 treatment plan as it was submitted while the applicant was in the Minor Injury Guideline (MIG) and duplicated an approved OCF-23.

The September 21, 2022 treatment plan was approved as reasonable and necessary.

The Tribunal denied the applicant's request for a special award, finding the insurer's reliance on its assessors' reports was not unreasonable.

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).

The Tribunal found that the applicant failed to establish that his injuries, including alleged post-concussion syndrome, psychological impairments, and chronic pain, warranted removal from the MIG.

The Tribunal preferred the evidence of the respondent's insurer examinations over the applicant's self-reported symptoms and chiropractor's report.

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

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and treatment plans for orthopedic, neurological, and psychological assessments.

The adjudicator dismissed the application in its entirety.

The adjudicator found that the insurer's denial notices complied with section 36(4) of the Schedule and that the applicant failed to prove a complete inability to carry on a normal life.

Furthermore, the requested medical assessments were deemed not reasonable and necessary, and the applicant failed to justify an enhanced hourly rate for psychological services.

Claims for a section 10 award and interest were also dismissed.

The applicant requested reconsideration of a Licence Appeal Tribunal decision that denied his claims for an income replacement benefit and treatment plans following a motor vehicle accident.

The Vice-Chair found that the original adjudicator made significant factual errors by overlooking a key letter from the applicant's treating physician that connected his injuries to the accident, and by failing to explicitly consider the applicant's psychological expert evidence.

These errors were found to likely have impacted the outcome of the decision.

The request for reconsideration was granted, the original decision was cancelled, and the matter was ordered to be reheard by a new adjudicator based on the existing written record.

The applicant sought various statutory accident benefits following a motor vehicle accident, including attendant care, chiropractic, psychological, and occupational therapy services, as well as the cost of a catastrophic impairment assessment.

The Licence Appeal Tribunal found that the insurer failed to provide timely notice of denial for one chiropractic treatment plan, rendering it payable for the period of delay under s. 38(11) of the Schedule.

The Tribunal also approved an in-home assessment.

However, the Tribunal dismissed the claims for attendant care benefits and the remaining treatment plans, finding the applicant failed to prove they were reasonable and necessary, largely preferring the objective findings of the insurer's examiners over the applicant's subjective complaints.

The claim for a special award under s. 10 of Regulation 664 was also dismissed.

The applicant sought various medical and rehabilitation benefits following a 2018 motor vehicle accident.

The Licence Appeal Tribunal found the applicant was entitled to a treatment plan for cognitive behaviour therapy, a plan for cognitive therapy and concussion-focused counseling, and a psychiatric assessment, as these were supported by medical evidence or previously approved by the respondent.

Claims for a new mattress, optometric services, an EMG assessment, a sleep study, and expenses submitted on OCF-6 forms were denied for lack of contemporaneous medical support or because they were incurred prior to approval.

The Tribunal also ordered the respondent to pay a 25% special award under s. 10 of Regulation 664 for its stubborn and inflexible conduct in failing to pay for the CBT and psychiatric assessment plans that it had already approved.

The applicant sought entitlement to a $2,460 treatment plan for an orthopedic assessment following a motor vehicle accident.

The insurer denied the plan based on insurer's examinations (IEs) concluding the applicant's injuries fell within the Minor Injury Guideline and the assessment was not reasonable and necessary.

The Tribunal dismissed the application, finding the applicant failed to provide contemporaneous medical records supporting ongoing complaints and gave little weight to the applicant's expert who conducted a virtual assessment based solely on self-reporting.

The Tribunal accepted the in-person IE assessments which found only minor soft tissue injuries.

The applicant sought statutory accident benefits following a motor vehicle accident, including post-104-week income replacement benefits (IRBs) and various treatment plans.

The respondent denied the benefits.

The Tribunal found that the applicant demonstrated a complete inability to engage in any employment for which she was reasonably suited by education, training, or experience, primarily due to chronic pain syndrome and psychological impairments.

The Tribunal awarded IRBs from June 23, 2023, ongoing.

The Tribunal also approved treatment plans for psychological therapy, Botox for migraines, psychological assessments, and a chronic pain program, finding them reasonable and necessary.

However, the Tribunal denied several physical therapy, chiropractic, and assistive device plans, noting a lack of physical improvement from prior physical treatments.

The claim for a special award was dismissed, but interest was awarded on overdue benefits.

The applicant sought statutory accident benefits for various treatment and assessment plans following a motor vehicle accident, including chiropractic treatment, a chronic pain assessment, a neurological assessment, and a concussion assessment.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to meet her burden of proving the plans were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's insurer's examinations and the applicant's own family doctors' clinical notes, which did not corroborate the need for the proposed assessments or treatments.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of treatment plans for psychological, occupational therapy, and physiotherapy services, as well as transportation costs and a claim for an award.

The Tribunal found the psychological, occupational therapy, and physiotherapy plans reasonable and necessary, preferring the evidence of the applicant's assessors and treating practitioners over the respondent's section 44 assessors.

However, the Tribunal denied the transportation expenses associated with the occupational therapy and physiotherapy plans, as the applicant failed to demonstrate compliance with the Schedule's transportation expense guidelines.

The claim for an award under section 10 of Regulation 664 was also dismissed due to a lack of submissions.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRB), attendant care benefits (ACB), and various treatment plans.

The Licence Appeal Tribunal found the applicant was entitled to an IRB for the pre-104 week period, as his accident-related low back pain caused a substantial inability to perform the essential tasks of his employment as an electrician.

However, the Tribunal denied the post-104 week IRB, finding the applicant failed to prove a complete inability to perform less physically demanding work for which he was reasonably suited.

The claim for ACB was dismissed because the applicant provided no evidence that the services were incurred.

The Tribunal approved treatment plans for an in-home attendant care assessment and physical therapy, but denied plans for an occupational therapy assessment and vestibular physiotherapy due to a lack of evidence connecting the symptoms to the accident.

The applicant was awarded interest on overdue benefits but denied a special award.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to physiotherapy services, a physiatry assessment, and a neurological assessment.

The respondent denied the benefits, relying on s. 44 assessments that concluded the applicant's injuries fell within the Minor Injury Guideline.

The Tribunal found the physiotherapy and physiatry assessment reasonable and necessary based on consistent clinical records from the applicant's treating practitioners.

However, the Tribunal denied the neurological assessment, noting a prior normal neurological consultation and a lack of compelling evidence of neurological impairment.

The applicant was awarded interest on overdue benefits but denied a special award under s. 10 of Reg. 664.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her entitlement to six physiotherapy treatment plans and an occupational therapy assessment.

The applicant argued the adjudicator made errors of fact and law in weighing the medical evidence and in finding that section 38(8) of the Schedule did not apply because an OCF-1 was not in evidence.

The Tribunal dismissed the request, finding that the applicant was attempting to re-litigate the case and introduce new evidence without explaining why it was not previously available.

The Tribunal concluded there were no errors of fact or law in the original decision's weighing of the medical reports or its findings on the treatment plans.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a catastrophic impairment under Criterion 7 (55% whole person impairment).

The Licence Appeal Tribunal reviewed competing medical assessments and preferred the respondent's experts, finding the applicant's combined physical and psychological impairments resulted in a 26% whole person impairment, falling short of the 55% threshold.

The Tribunal also dismissed the applicant's claim for a functional abilities evaluation, finding it was not reasonable and necessary, and consequently denied claims for interest and a special award.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming expenses for social rehabilitation counselling, Botox injections, and a massage chair.

The respondent denied the benefits based on reports from its section 44 assessors.

The Licence Appeal Tribunal found that the respondent's assessors failed to adequately address the rationale provided by the applicant's treating practitioners.

The Tribunal concluded that the applicant met her burden of proving the treatments and expenses were reasonable and necessary, and ordered the respondent to pay the disputed amounts along with interest on overdue payments.

The applicant sought various statutory accident benefits following a motor vehicle accident, including six treatment plans for physiotherapy, an orthopaedic assessment, an occupational therapy assessment, and a psychological assessment.

The Tribunal found that the insurer's denials complied with the medical reasons requirement under s. 38(8) of the Schedule.

On the merits, the Tribunal dismissed the claims for physiotherapy, finding that the applicant's pain was attributable to a somatic symptom disorder rather than a physical impairment, and physiotherapy was not a reasonable treatment for a psychological condition.

The occupational therapy assessment was also denied for lack of evidence linking it to attendant care needs.

However, the Tribunal granted the orthopaedic assessment, as it was reasonable for the applicant to investigate her pain prior to her psychological diagnosis, and the psychological assessment, as it was necessary and not duplicative.

Claims for an award were dismissed, but interest was awarded on the approved plans.

The applicant sought entitlement to statutory accident benefits for physiotherapy services following a 2018 motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the proposed treatment plans were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's insurer's examination assessors, who concluded that further facility-based physical treatment was unlikely to provide any additional therapeutic benefit for the applicant's left elbow injury and chronic pain.

As no benefits were payable, claims for interest and a section 10 award were also dismissed.