Dr. Nesterenko

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

The respondent insurer initially confined the applicant to the Minor Injury Guideline (MIG) and denied various treatment plans and income replacement benefits (IRB).

The Tribunal found the applicant's injuries were non-minor, removing her from the MIG.

The Tribunal awarded IRB for a specific period due to the insurer's non-compliance with s. 36(4) response timelines, but denied post-104 IRB.

The Tribunal approved treatment plans for physiotherapy, a psychological assessment, and a chronic pain assessment, finding them reasonable and necessary.

Notably, the Tribunal ordered a 35% special award against the insurer under s. 10 of Reg. 664, finding its conduct in adjusting the claim—including ignoring clear evidence of psychological injury and delaying IRB responses for over a year—to be imprudent, inflexible, and unyielding.

Costs were not ordered.

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

The respondent denied several treatment plans, and the applicant appealed to the Licence Appeal Tribunal.

As a preliminary issue, the Tribunal extended the two-year limitation period for two disputed plans under s. 7 of the LAT Act, finding a bona fide intention to appeal, minimal delay due to surgery, and no prejudice to the respondent.

On the merits, the Tribunal found the requested physiotherapy, chronic pain assessment, and assistive devices to be reasonable and necessary, preferring the objective corroborating medical evidence of the applicant's treating practitioners over the respondent's paper review and independent medical examinations.

The claim for an attendant care assessment was dismissed for lack of evidence.

Interest was awarded on overdue benefits.

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

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

The applicant sought removal from the MIG on the basis of chronic pain and psychological impairments.

The Tribunal found that while there was evidence of accident-related chronic pain, the applicant failed to demonstrate a functional impairment.

Furthermore, the Tribunal preferred the respondent's psychological assessment over the applicant's, noting a lack of corroboration in the family doctor's clinical notes.

Consequently, the Tribunal held the applicant was subject to the MIG, dismissing the claims for treatment plans, interest, and a section 10 award.

The applicant, a student, was injured in a motor vehicle accident and sought non-earner benefits under the Statutory Accident Benefits Schedule.

The respondent insurer terminated the benefits, relying on section 44 assessments.

The Tribunal found that the applicant suffered a complete inability to carry on a normal life, as he was unable to meaningfully and consistently engage in his pre-accident activities, including school and recreational activities, due to ongoing physical and psychological impairments.

The Tribunal preferred the applicant's medical evidence over the respondent's assessors, who failed to properly apply the legal test.

The applicant was awarded non-earner benefits and interest, but his claim for a special award was dismissed as there was no evidence the insurer acted unreasonably or in bad faith.

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, a pedestrian struck by a vehicle, sought statutory accident benefits including attendant care benefits (ACBs) and various treatment plans.

The respondent initially denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG), but later removed him from the MIG.

The Tribunal found the applicant eligible for $686.92 per month in ACBs based on left shoulder limitations, but held the benefits were not payable because they had not been incurred.

The Tribunal approved a treatment plan for an optometric assessment but denied plans for Botox injections and an occupational therapy assessment.

Finally, the Tribunal ordered the respondent to pay a $3,473.20 award under s. 10 of O. Reg. 664, finding its 18-month delay in removing the applicant from the MIG was stubborn, unyielding, and unreasonable given the medical evidence.

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 medical benefits for chiropractic and psychological treatment, as well as income replacement benefits.

The insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and that she was not substantially unable to perform her employment tasks.

The Licence Appeal Tribunal found that the applicant did not suffer from an accident-related psychological injury or chronic pain condition, preferring the insurer's medical examinations over the applicant's expert.

The Tribunal concluded the applicant sustained a minor injury subject to the $3,500 funding limit and dismissed the claims for additional medical benefits, income replacement benefits, and interest.

The applicant sought income replacement benefits following a motor vehicle accident.

The respondent denied the benefits and raised a preliminary issue that the applicant was statute-barred from claiming pre-104 benefits due to her failure to attend section 44 insurer examinations.

The Tribunal agreed, finding the applicant failed to attend properly scheduled examinations without a reasonable explanation.

Regarding post-104 benefits, the Tribunal found the applicant did not suffer a complete inability to engage in employment, noting she had returned to work and closed her business due to pandemic lockdowns rather than accident-related impairments.

The claims for benefits, interest, and an award were dismissed.

The applicant sought statutory accident benefits for physiotherapy, chiropractic services, psychological treatment, and prescription medications following a motor vehicle accident.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to meet his burden of proving the treatment plans and medication expenses were reasonable and necessary.

The Tribunal preferred the respondent's medical evidence, which indicated the applicant sustained soft-tissue injuries and had achieved maximum medical recovery.

The application was dismissed in its entirety, including claims for interest and a special award.

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

The respondent denied several treatment plans and income replacement benefits.

The Tribunal found that the respondent failed to provide adequate notice under s. 38(8) of the Schedule for several treatment plans, requiring the respondent to pay for those plans during the periods of non-compliance.

However, the Tribunal concluded that the applicant's injuries fell within the Minor Injury Guideline (MIG), as he failed to prove a pre-existing condition, post-concussive syndrome, chronic pain, or a psychological impairment that would remove him from the MIG.

The Tribunal also dismissed the applicant's claim for income replacement benefits, finding he did not suffer a substantial inability to perform the essential tasks of his employment.

The claim for a special award was dismissed.

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

The respondent insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered from chronic pain and psychological impairments as a result of the accident, removing him from the MIG.

The Tribunal ordered the respondent to pay for several treatment plans for physical rehabilitation, a social work assessment, and a disability certificate, finding them reasonable and necessary.

However, the claim for a functional abilities evaluation was dismissed as the applicant had returned to work.

Interest was awarded on the overdue benefits.

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

Following a reconsideration decision that removed the applicant from the Minor Injury Guideline, a rehearing was held to determine entitlement to disputed treatment plans and assessments.

The Tribunal found the applicant was entitled to three physiotherapy treatment plans and a psychological assessment, as the medical evidence, including reports from an orthopaedic surgeon and the respondent's own psychological assessor, established they were reasonable and necessary.

Claims for an attendant care assessment and a TMJ assessment were dismissed due to insufficient medical evidence linking the conditions to the accident or demonstrating necessity.

The applicant's request for a special award was denied as the respondent had not unreasonably withheld or delayed payments.

Both parties requested reconsideration of a decision regarding statutory accident benefits for chiropractic treatment.

The applicant sought to introduce new evidence to approve a denied treatment plan, which the Tribunal rejected as the evidence could have been obtained previously.

The respondent argued the adjudicator erred in approving two treatment plans based solely on pain complaints without evidence of functional improvement or actual pain reduction.

The Tribunal agreed with the respondent, finding a significant error of law and fact in the original decision.

The applicant's request was dismissed, the respondent's request was granted, and all three treatment plans were deemed not reasonable and necessary.

The applicant sought entitlement to statutory accident benefits following a motor vehicle accident, including three treatment plans for chiropractic services, the cost of an attendant care assessment, and the cost of an orthopaedic assessment.

The Tribunal found the chiropractic treatment plans to be reasonable and necessary, preferring the evidence of the applicant's orthopaedic surgeon over the respondent's assessors.

However, the claims for the attendant care and orthopaedic assessments were dismissed due to insufficient evidence and flawed factual foundations, particularly given surveillance showing the applicant's physical capabilities.

The claim for a special award was also dismissed, but interest was awarded on the payable benefits.

The respondent insurer requested a reconsideration of a Tribunal decision that found the applicant's injuries fell outside the Minor Injury Guideline (MIG) and awarded various medical benefits and assessments.

The insurer argued the Tribunal failed to provide adequate reasons, ignored its independent medical examiners, and erred in law by relying on a chiropractor for a chronic pain diagnosis.

The adjudicator denied the request, finding the Tribunal provided adequate reasons, properly weighed the competing medical evidence, and did not require a formal chronic pain diagnosis to determine the injuries were not predominantly minor.

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

The insurer denied certain medical and rehabilitation benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that while the applicant's physical injuries were predominantly minor, his psychological impairments, including depression and post-traumatic stress symptoms, justified removal from the MIG.

The Tribunal ordered the insurer to pay for a psychological assessment but denied the claims for physiotherapy treatment, finding them not reasonable and necessary.

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

The respondent insurer denied the treatment plans.

The Licence Appeal Tribunal found that two of the treatment plans were reasonable and necessary to provide pain relief, relying on the applicant's medical evidence over the insurer's examination report.

A third treatment plan was denied as it was a duplication of a previously approved plan.

The applicant was also awarded interest on the overdue benefits.

The applicant sought income replacement benefits and medical benefits for chiropractic services following a motor vehicle accident.

The adjudicator found that the applicant failed to prove he was employed at the time of the accident or that he suffered a substantial inability to perform the essential tasks of his employment, noting his continued participation in physical sports and lack of business documentation.

The adjudicator also dismissed the claims for medical benefits, relying on an insurer's examination report indicating that maximum medical recovery had been achieved and finding insufficient evidence that further chiropractic treatments were reasonable and necessary.

The application was dismissed.

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

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

The applicant contended that chronic pain syndrome, psychological impairments, jaw injury, and post-traumatic headaches removed her from the MIG.

The Tribunal found the applicant's evidence, including an orthopaedic report diagnosing chronic pain syndrome, lacked objective medical findings and corroboration.

Conversely, the Tribunal accepted the respondent's independent medical examinations, which concluded the injuries were predominantly minor soft tissue sprains and strains.

The Tribunal held the applicant sustained predominantly minor injuries and dismissed the claims for treatment plans, cost of examinations, and an award for delayed payments.

The applicant's request for costs was also denied.