Dr. Paul Tepperman

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

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

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

The Tribunal found the applicant did not meet the burden of proving chronic pain with functional impairment or a psychological condition, relying on the respondent's insurer examinations.

The Tribunal also reviewed the respondent's denial letters for compliance with s. 38(8) of the Schedule.

It found one denial letter non-compliant and ordered the respondent to pay for the associated physiotherapy treatment plan once incurred.

The remaining treatment plans and the claim for an award under s. 10 of Reg. 664 were dismissed.

The applicant sought entitlement to statutory accident benefits for chiropractic and massage services, cognitive devices, and physiatry and orthopaedic assessments following a 2019 motor vehicle accident.

The adjudicator found that the applicant failed to prove the treatment plans for chiropractic and massage services were reasonable and necessary, noting a lack of recommendation from her treating physicians and conclusions from assessors that she had reached maximum medical improvement.

The adjudicator partially approved the treatment plan for cognitive devices, awarding $89.95 for a Lumosity subscription but denying the cost of a tablet, as the applicant did not establish why a cell phone could not be used.

The requests for physiatry and orthopaedic assessments were denied as they were not recommended by treating practitioners and were duplicative of an already approved chronic pain assessment.

The applicant sought statutory accident benefits, including an income replacement benefit (IRB) and a medical benefit for physiotherapy, following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove she suffered a substantial inability to perform the essential tasks of her employment, as she continued to work part-time and insurer's examinations found no substantial impairment.

The Tribunal also denied the physiotherapy treatment plan, preferring the insurer's medical evidence which found no musculoskeletal injuries prior to an intervening second accident.

Claims for interest and a special award were consequently dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a chronic pain assessment in the amount of $2,460.00.

The respondent insurer denied the treatment plan based on an insurer's examination report which concluded the applicant suffered only minor soft tissue injuries.

The Licence Appeal Tribunal found the insurer's medical report failed to adequately consider the clinical notes and records of the applicant's family physicians, which included a chronic pain diagnosis.

Relying on the applicant's psychological assessments and the AMA Guides criteria for chronic pain, the Tribunal concluded the chronic pain assessment was reasonable and necessary.

The Tribunal ordered the respondent to pay for the assessment and interest on the overdue payment, but dismissed the applicant's claim for a special award under section 10 of O. Reg. 664, finding the insurer's conduct did not meet the threshold of being excessive or imprudent.

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

The Licence Appeal Tribunal found that the proposed cognitive training was reasonable and necessary based on a functional cognitive assessment.

However, the Tribunal dismissed the claims for a driver reintegration assessment, psychological services, and chiropractic treatment, preferring the respondent's medical evidence that the applicant's psychological and soft tissue injuries had resolved.

The Tribunal awarded interest on the overdue cognitive training benefit but declined to make a special award, finding no egregious conduct by the insurer.

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

The respondent determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied several treatment plans as the $3,500 limit was exhausted.

The applicant argued for removal from the MIG based on chronic pain and psychological impairment.

The Tribunal found insufficient medical evidence to support chronic pain or a psychological impairment, noting the applicant's physical injuries were predominantly soft-tissue and had largely resolved.

The Tribunal concluded the applicant remained within the MIG, dismissing the claims for treatment plans, interest, and an award.

The respondent's request for costs due to late submissions was also denied.

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

The insurer 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 prove on a balance of probabilities that he suffered physical or psychological injuries warranting removal from the MIG.

The Tribunal preferred the evidence of the insurer's assessors, noting the lack of objective medical evidence supporting non-minor physical injuries and the absence of the applicant's psychological reports in the submissions.

The application was dismissed.

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

The respondent determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied several treatment plans as the $3,500 limit was exhausted.

The applicant applied to the Licence Appeal Tribunal, arguing she suffered from chronic pain and psychological impairments warranting removal from the MIG.

The Tribunal found the applicant's evidence, largely based on subjective self-reporting, insufficient to establish chronic pain or a psychological condition caused by the accident.

The Tribunal preferred the respondent's independent medical examinations, which concluded the applicant suffered uncomplicated soft-tissue injuries.

The application was dismissed, and the applicant was found not entitled to the disputed treatment plans, an award, or interest.

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

The respondent determined her injuries fell within the Minor Injury Guideline (MIG) and denied five treatment plans for chiropractic services.

The Tribunal found the applicant failed to prove she suffered from chronic pain or a psychological impairment warranting removal from the MIG, preferring the insurer's examination report over the applicant's chiropractic records.

As the applicant remained within the MIG and the disputed treatment plans proposed treatment outside it, the application was dismissed.

The applicant sought a non-earner benefit, a special award, and interest following a motor vehicle accident.

The Tribunal applied the test for a complete inability to carry on a normal life, comparing the applicant's pre- and post-accident activities.

Despite some reported pain and adjustments to her routine, the Tribunal found the applicant was still capable of performing most of her pre-accident activities, including working, studying, and personal care.

The Tribunal concluded the applicant did not suffer a complete inability to carry on a normal life and dismissed the application for the non-earner benefit, the special award, and interest.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs), medical benefits, and cost of examinations.

The respondent denied the benefits, arguing the applicant had returned to work and suffered only minor injuries.

The Tribunal found the applicant was entitled to IRBs up to June 2018, but made no order for payment as the applicant failed to provide post-accident income information.

The Tribunal also found the applicant was entitled to various medical benefits, including physiotherapy, psychological services, shockwave therapy, and a chronic pain program, as the evidence demonstrated she suffered from chronic pain caused by the accident.

The claims for cost of examinations and a Regulation 664 award were dismissed.

The applicant was injured in a rear-end motor vehicle collision and sought medical benefits for chiropractic and psychological treatment under the Statutory Accident Benefits Schedule.

The respondent insurer denied the treatment plans, arguing the applicant had reached maximum medical improvement and that his ongoing symptoms were related to extensive pre-existing degenerative conditions.

The Tribunal applied a two-step causation test and found the applicant failed to prove his current impairments were caused by the accident, preferring the insurer's medical examination evidence over the applicant's chiropractor.

The application for further benefits was dismissed.

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

The insurer denied the treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing she should be excluded from the MIG due to pre-existing conditions, psychological impairment, and chronic pain.

The Tribunal found insufficient evidence of a pre-existing condition or a psychological impairment resulting from the accident.

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

The applicant was injured in a motor vehicle accident and sought an income replacement benefit and a chronic pain assessment under the Statutory Accident Benefits Schedule.

The respondent denied the benefits, arguing the applicant did not suffer a substantial inability to perform his pre-accident employment and questioning his credibility and reported income.

The Tribunal found that the applicant's accident-related left knee pain caused a substantial inability to perform the essential physical tasks of his restaurant manager position.

The Tribunal also accepted the applicant's updated Canada Revenue Agency filings to calculate the quantum of the benefit and found the chronic pain assessment to be reasonable and necessary.

The application was allowed.

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

The respondent insurer denied treatment plans for psychiatric, social work, and chronic pain assessments on the basis that 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 injuries.

The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain or psychological injuries caused by the accident, preferring the insurer's expert evidence over the applicant's.

As the applicant's injuries did not fall outside the MIG and the $3,500 funding limit was exhausted, the application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic and physical therapy.

The insurer denied the treatment plan, arguing the applicant's injuries fell within the $3,500 limit of the Minor Injury Guideline (MIG).

The arbitrator found that while the applicant's impairments were predominantly minor injuries, she had documented pre-existing conditions, including scoliosis and degenerative disc disease, that constituted compelling evidence she could not achieve maximal recovery within the MIG limits.

The arbitrator ordered the insurer to pay the $3,487.60 treatment plan plus interest.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a chronic pain management program and an orthopaedic assessment.

The respondent insurer denied the treatment plans, arguing they were not reasonable or necessary.

The Licence Appeal Tribunal found the applicant's medical evidence, which included diagnoses of chronic pain syndrome and recommendations for multidisciplinary treatment, to be more persuasive than the insurer's assessments.

The Tribunal ordered the respondent to pay for the chronic pain program and the orthopaedic assessment, along with interest on incurred expenses.

However, the Tribunal dismissed the applicant's claim for a special award under Regulation 664, finding no evidence that the insurer acted unreasonably or in bad faith.

The applicant was injured in two motor vehicle accidents and sought ongoing income replacement benefits (IRBs) beyond the initial period paid by the insurer.

The insurer suspended and later denied further IRBs after the applicant initially failed to attend an Examination Under Oath (EUO).

The Tribunal found that the insurer did not act in bad faith in scheduling the EUO.

On the substantive issue, the Tribunal held that the applicant failed to prove on a balance of probabilities that he suffered a substantial inability to perform the essential tasks of his employment beyond the initial recovery period.

The application for ongoing IRBs, interest, costs, and a special award was dismissed.