Dr. Oshidari

The applicant sought statutory accident benefits following a rear-end collision, claiming his injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain syndrome and psychological impairments.

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor, relying on insurer examinations that concluded his physical and psychological symptoms did not warrant removal from the MIG.

The Tribunal gave little weight to the applicant's pain specialist report, finding it relied entirely on self-reporting and contradicted objective evidence.

The applicant's claims for a $13,667.32 chronic pain program, an award for unreasonable delay, interest, and costs were all dismissed.

The applicant sought entitlement to statutory accident benefits following a motor vehicle accident, including costs for a catastrophic impairment assessment, chiropractic treatment plans, and a psychological assessment.

The Tribunal found that the applicant failed to prove the proposed treatments and assessments were reasonable and necessary, noting the minor nature of the physical injuries, the applicant's return to work and daily activities, and the unreliability of the applicant's medical reports.

The application was dismissed in its entirety, with no interest or special award payable.

The applicant sought statutory accident benefits for chiropractic treatment, hospital expenses, and a psychological assessment 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 adjudicator found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain or a psychological impairment that would take him out of the MIG.

As the applicant had already exhausted the $3,500 MIG limit, the disputed benefits were not payable.

The respondent's request for costs was also denied.

The applicant sought a determination of catastrophic impairment and entitlement to various statutory accident benefits following a 2013 motor vehicle accident.

The respondent denied the benefits and sought repayment of income replacement benefits, alleging willful misrepresentation.

The Tribunal found that the applicant did not sustain a catastrophic impairment, as he failed to establish a 55% Whole Person Impairment or a Class 4 marked psychological impairment, preferring the respondent's medical experts over the applicant's.

Consequently, the claims for medical, attendant care, and housekeeping benefits were dismissed.

The Tribunal also dismissed the respondent's claim for repayment, finding insufficient evidence of fraud or willful misrepresentation by the applicant regarding his employment status.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and attendant care benefits from the respondent insurer.

The Tribunal determined the quantum of IRBs payable, finding that post-accident employment income and CPP disability benefits were deductible, and applied the age 65 adjustment formula.

The claim for attendant care benefits was dismissed as the applicant's limitations were found to be caused by pre-existing conditions and unrelated post-accident strokes rather than the accident.

The Tribunal awarded the applicant interest on outstanding IRBs and a 35% special award under O. Reg. 664, finding the respondent unreasonably delayed payment of IRBs after August 2018 despite having sufficient information to calculate the amounts owed.

The applicant, who was a passenger in a rear-end motor vehicle collision, applied for a non-earner benefit and a medical benefit for physiotherapy.

The adjudicator found that the applicant did not suffer a complete inability to carry on a normal life, noting that her post-accident activities, including attending college and working part-time, contradicted her claims of impairment.

The adjudicator also denied the medical benefit, relying on the insurer's independent medical examination reports which concluded the applicant had reached maximum medical recovery and found no objective medical evidence to support the need for further physiotherapy.

The application was dismissed in its entirety.

The applicant sought medical benefits for chronic pain treatment following a motor vehicle accident, which the respondent insurer denied based on its own medical examinations.

The Tribunal preferred the evidence of the applicant's chronic pain specialist over the insurer's examiners, finding that the applicant suffered from ongoing physical and psychological pain.

The Tribunal ordered the respondent to pay the disputed medical benefit and interest, but declined to order a special award, finding the insurer's denial was not unreasonable.

The applicant was injured in a motor vehicle accident and sought funding for a chronic pain treatment program.

The respondent insurer partially approved the plan for psychological treatment but denied the physical therapy and chronic pain components, relying on an insurer's examination.

The Licence Appeal Tribunal found the applicant credible and preferred the evidence of his treating assessors, who diagnosed chronic pain syndrome caused by the accident.

The Tribunal ordered the insurer to pay the remaining cost of the treatment plan, excluding transportation expenses, plus interest on overdue payments.

The applicant was injured in a motor vehicle accident and sought the cost of three examinations (a functional abilities evaluation, a physiatry assessment, and a chiropractic assessment) five years post-accident.

The respondent denied the assessments as not reasonable and necessary.

The adjudicator found that the applicant had returned to his pre-accident employment as a millwright without modifications and was able to perform his activities of daily living.

Preferring the evidence of the respondent's physiatrist who examined the applicant over the applicant's experts who only reviewed documentation, the adjudicator concluded the assessments were not reasonable and necessary.

The claims for the cost of examinations, an award for unreasonably delayed payments, and interest were dismissed.

The applicant sought medical and rehabilitation benefits for neck and lower back impairments following a motor vehicle accident.

The respondent denied the benefits, arguing the impairments arose from a post-accident drug overdose and assault.

The Tribunal found that the applicant's ongoing chronic pain was causally linked to the accident, noting pre-existing spinal disease and a spinal displacement identified immediately post-accident.

The Tribunal approved the chronic pain assessment and program as reasonable and necessary, along with applicable interest, but denied the requested physiotherapy and physiatry assessment as duplicative.

The applicant sought statutory accident benefits for chiropractic treatment and a chronic pain assessment following a motor vehicle accident.

The respondent denied the benefits, arguing the injuries fell within the Minor Injury Guideline and that a subsequent accident caused the chronic pain.

The Tribunal dismissed the application, finding one treatment plan was statute-barred as it was appealed beyond the two-year limitation period without justification for an extension.

The Tribunal further held the remaining chiropractic plans were not reasonable and necessary, as previous similar treatments had been ineffective and the applicant failed to prove his impairments extended beyond minor soft tissue injuries.

Finally, the request for a chronic pain assessment was denied because the applicant failed to establish causation linking the chronic pain to the first accident rather than the second.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming $1,765.20 for a chronic pain assessment.

The respondent insurer denied the claim based on a paper review by a physiatrist who opined that further psychological treatment alone was sufficient.

The Tribunal found the applicant's evidence, including assessments from treating practitioners and a chronic pain assessment report, to be more persuasive than the insurer's paper review.

The Tribunal held that the chronic pain assessment was reasonable and necessary, and awarded the cost of the examination along with interest on the overdue payment.

The respondent's procedural defence regarding an unsigned treatment plan was dismissed as the insurer had waived the requirement by scheduling an examination.

The Applicant was injured in a motor vehicle accident in 2013 and sought statutory accident benefits from the Insurer, claiming he suffered a catastrophic impairment.

The Applicant had a history of severe pre-existing psychological and physical impairments from prior accidents in 2002.

The Insurer denied the catastrophic impairment designation and various medical benefits, arguing that any impairment was due to the pre-existing conditions.

The arbitrator found that the 2013 accident materially contributed to the Applicant's psychiatric condition, worsening his impairment to a Class 4 marked impairment in activities of daily living.

The arbitrator concluded the Applicant suffered a catastrophic impairment and awarded the disputed medical benefits and examination costs, finding them reasonable and necessary for pain relief and assessment.

The claim for a special award was dismissed, but the Insurer was ordered to pay the Applicant's arbitration expenses and interest on overdue benefits.

The applicant sought income replacement benefits and funding for a psychological treatment plan following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove on a balance of probabilities that he suffered a substantial inability to perform the essential tasks of his pre-accident employment as a security guard.

The Tribunal preferred the insurer's psychological assessment, which found no ongoing psychological impairment, and concluded the proposed treatment plan was not reasonable and necessary.

The applicant, who suffered a psychiatric impairment following a motor vehicle accident, sought funding for a $25,425 Catastrophic Impairment Assessment.

The insurer denied the claim, arguing the psychiatric condition was not caused by the accident and relying on multiple insurer examinations.

The Licence Appeal Tribunal found that while causation was questionable, it was reasonable and necessary for the applicant to explore the possibility of catastrophic impairment using his own assessors.

The Tribunal capped the funding at $12,200 pursuant to the Schedule's limits.

Claims for a special award and costs were dismissed.

Following an arbitration hearing where the insurer was substantially successful, the insurer sought its expenses.

The arbitrator found that the applicant's claims for income replacement and medical benefits were vexatious and improper, and that the applicant had unduly prolonged the proceedings by failing to produce documents.

The applicant was ordered to pay the insurer's expenses and disbursements for the hearing, excluding the pre-hearing conference, fixed at $23,055.31.

Each party was ordered to bear their own expenses for the expense hearing.

The Applicant was injured in a rear-end motor vehicle accident in November 2010 and sought a determination that she sustained a catastrophic impairment due to psychological issues.

The Insurer denied the claim, arguing the Applicant's mental health issues were due to a pre-existing bi-polar disorder and that she was malingering.

The Arbitrator found that the Applicant suffered a marked impairment in the area of adaptation and that the accident materially contributed to her current state of mental health.

The Arbitrator preferred the evidence of the Applicant's experts and noted the Insurer's aggressive tactics in summonsing witnesses.

The Arbitrator concluded the Applicant sustained a catastrophic impairment as a result of the accident.

The applicant was injured in a motor vehicle accident and sought income replacement and medical benefits from her insurer.

The insurer denied the benefits, arguing that the applicant's ongoing impairments were caused by a subsequent slip and fall incident rather than the motor vehicle accident.

The arbitrator found the applicant credible and concluded that the motor vehicle accident rendered an asymptomatic condition symptomatic, making her vulnerable to subsequent flare-ups.

The arbitrator awarded income replacement benefits from March 2014 onwards and approved several treatment plans, but denied a special award, finding the insurer had not acted unreasonably given the complex medical evidence.

The applicant was seriously injured in a motor vehicle accident in Georgia and sought a determination that he sustained a catastrophic impairment under the Statutory Accident Benefits Schedule.

The parties' medical experts disagreed on the applicant's whole person impairment (WPI) rating, with the applicant's experts assessing it between 62% and 71%, and the insurer's experts assessing it between 48% and 51%.

The arbitrator preferred the evidence of the applicant's experts, finding that the applicant's physical and psychological impairments, when combined, exceeded the 55% threshold.

The arbitrator also found that the accident materially contributed to the applicant's impairments, including his atrial fibrillation and peripheral neuropathy, despite the insurer's arguments regarding pre-existing susceptibility.

The applicant was found to have sustained a catastrophic impairment.

The appellant appealed a License Appeal Tribunal decision denying him income replacement benefits following a motor vehicle accident.

The adjudicator had preferred the medical evidence of the respondent's physiatrist over the appellant's physiatrist, concluding the appellant did not suffer a substantial inability to perform his pre-accident employment tasks.

The Divisional Court dismissed the appeal, finding that the adjudicator applied the correct legal test and that weighing conflicting medical evidence does not constitute an error of law.