Dr. Pilowsky

The applicant sought various medical, rehabilitation, and attendant care benefits following a motor vehicle accident.

The respondent denied the benefits, arguing that the applicant's needs stemmed from extensive pre-existing medical conditions, including Parkinson's disease and dementia, rather than the soft tissue injuries sustained in the accident.

The Licence Appeal Tribunal dismissed all claims, finding that the applicant failed to prove the requested benefits and assessments were reasonable and necessary or causally related to the accident.

Claims for interest and an award for unreasonable delay were also dismissed.

The applicant was injured in a motor vehicle accident and sought $2,520 for an orthopaedic assessment under the Statutory Accident Benefits Schedule.

The respondent had already removed the applicant from the Minor Injury Guideline based on a psychological assessment.

The adjudicator found that the applicant failed to prove the orthopaedic assessment was reasonable and necessary, as the clinical notes from the family physician did not document physical limitations requiring such an assessment.

The claim for the assessment cost, along with claims for interest and an award, was dismissed.

The applicant sought statutory accident benefits for psychological and chiropractic treatment following a motor vehicle accident.

The insurer denied the benefits 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 the insurer failed to provide adequate medical reasons for the denial because it did not arrange an Insurer's Examination (IE).

The Tribunal held that the insurer provided sufficient medical reasons by pointing to the lack of corroborating medical evidence in the applicant's clinical records.

Finding the applicant's psychological evidence lacked credibility, the Tribunal concluded the injuries were predominantly minor and dismissed the application.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB), physiotherapy, catastrophic impairment assessments, and a special award.

The Tribunal found the applicant was substantially unable to perform his pre-accident employment due to chronic pain, entitling him to an IRB up to the 104-week mark.

However, the applicant failed to prove a complete inability to engage in any suitable employment, denying him post-104 week IRBs.

The disputed treatment plans for physiotherapy and catastrophic impairment assessments were deemed not reasonable and necessary.

The claim for a special award was dismissed as the insurer reasonably relied on its medical assessments.

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

The insurer denied treatment plans for chiropractic care and a psychological assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that while the applicant's physical injuries were predominantly minor, she had demonstrated on a balance of probabilities that she sustained psychological and neurological impairments justifying removal from the MIG.

The Tribunal approved the $2,200 psychological assessment as reasonable and necessary, but denied the $2,095.28 chiropractic treatment plan, finding the physical complaints did not warrant further facility-based intervention.

The applicant sought medical benefits following a motor vehicle accident, arguing that psychological injuries should remove her from the Minor Injury Guideline (MIG).

The Tribunal preferred the applicant's expert evidence diagnosing an adjustment disorder and depressed mood, but found the impairment was on the less severe spectrum and did not cause a loss of functional abilities.

The Tribunal concluded the applicant's injuries were predominantly minor and she should remain subject to the MIG limit.

Claims for psychological services and assessments were denied, while chiropractic services were approved up to the $3,500 limit.

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 he suffered psychological injuries, relying on a psychological assessment diagnosing him with PTSD and depression.

The Tribunal found the applicant's self-reported normal daily routine and lack of psychological complaints to his family doctor contradicted the psychological diagnosis.

The Tribunal concluded the applicant's injuries fell within the MIG and dismissed the application for the cost of a psychological assessment.

The applicant sought reconsideration of a Tribunal decision finding that his injuries from a motor vehicle accident fell within the Minor Injury Guideline (MIG) and denying payment for psychological and chiropractic treatment plans.

The applicant argued the Tribunal erred by failing to consider his pre-existing back condition and by improperly weighing conflicting psychological evidence.

The adjudicator dismissed the request for reconsideration, finding no significant errors of law or fact.

The adjudicator noted there was insufficient evidence that the pre-existing condition prevented maximal recovery within the MIG limits, and found no error in the Tribunal's weighing of the expert psychological reports.

The insurer requested a reconsideration of a Tribunal decision that found the insured's psychological impairments fell outside the Minor Injury Guideline (MIG).

The insurer argued the Tribunal erred in fact and law by preferring the insured's psychological assessment, which relied on self-reporting, over the insurer's examination that utilized a broader battery of psychometric tests.

The adjudicator dismissed the request, finding no significant error of law or fact, as the Tribunal was entitled to weigh the evidence and the insurer's cited case law was distinguishable.

The insured's request for costs was also dismissed.

The insurer requested a reconsideration of a Licence Appeal Tribunal decision that found the claimant's psychological injuries fell outside the Minor Injury Guideline and approved a $2,200 psychological assessment.

The insurer argued the adjudicator erred in law and breached procedural fairness by relying on the claimant's psychologist, who had only been licensed for three months and did not comply with the Tribunal's expert witness rules.

The Vice-Chair denied the reconsideration, applying the Westerhof framework to find that the claimant's psychologist was a participant expert, not a litigation expert, and thus exempt from the strict expert rules.

The Vice-Chair concluded the adjudicator made no material errors of law or fact and reasonably exercised her discretion in weighing the competing psychological evidence.

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

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

The Tribunal found that while the applicant's physical injuries were minor, he sustained a psychological injury that exempted him from the MIG limits.

However, the Tribunal dismissed the claims for a psychological treatment plan and an orthopaedic assessment, finding them not reasonable and necessary.

The evidence, including the applicant's high level of post-accident occupational and social activity, contradicted the need for the proposed psychological treatment, and clinical records did not support ongoing physical impairments requiring further orthopaedic assessment.

The claim for an award for unreasonable delay was also dismissed.

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

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

The Tribunal found that the applicant's psychological symptoms, including post-traumatic stress disorder, removed her from the MIG.

The Tribunal ordered the respondent to pay for the disputed chiropractic and psychological treatment plans, as well as the cost of a psychological assessment, finding them reasonable and necessary.

The applicant's claim for an award for unreasonably delayed payments was dismissed for lack of evidence.

The worker appealed decisions denying entitlement to benefits for chronic pain disability (CPD), psychotraumatic disability, and loss of earnings (LOE) benefits beyond December 7, 2015, following a work-related head injury.

The Appeals Resolution Officer found that the worker met the criteria for CPD and granted a Non-economic Loss determination for this condition.

The worker was not entitled to benefits for a psychotraumatic disability or permanent organic impairment.

Full LOE benefits were granted from December 8, 2015, to January 26, 2017, with further entitlement to be determined by the Operating Area following a work transition assessment.

The applicant sought statutory accident benefits for a psychological examination and treatment following a motor vehicle accident.

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

The Licence Appeal Tribunal found the applicant suffered a psychological impairment outside the MIG, preferring the evidence of the applicant's psychologist over the insurer's expert.

The Tribunal ordered the respondent to pay for the psychological examination and treatment, plus interest, but denied the applicant's claim for a special award for unreasonably delayed payments.

The applicant sought reconsideration of a Licence Appeal Tribunal decision which found that his injuries from a motor vehicle accident fell within the Minor Injury Guideline (MIG), thereby capping his accident benefits at $3,500.

The applicant argued the Tribunal violated natural justice and erred in law by preferring the insurer's psychological report, refusing to take judicial notice of changes in the DSM regarding chronic pain, and failing to properly consider his physical functional limitations and pre-existing injuries.

The Executive Chair dismissed the request for reconsideration, finding no bias in the Tribunal's preference for the more recent psychological report and no error in requiring evidentiary proof rather than taking judicial notice of complex medical diagnoses.

The Chair also upheld the Tribunal's findings that the applicant failed to prove his physical limitations and pre-existing conditions exempted him from the MIG.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and the cost of a psychological assessment.

The adjudicator found that the applicant failed to prove that her inability to work was caused by the accident, noting significant pre-accident and post-accident medical issues unrelated to the collision.

The adjudicator accepted the respondent's medical assessments that the applicant could perform the essential tasks of her pre-accident employment.

While the adjudicator found the psychological assessment was necessary, the claim was dismissed because the applicant failed to prove the proposed fees were reasonable under the Professional Services Guideline.

The application was dismissed.

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

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 psychological injuries, including post-traumatic stress disorder and major depressive disorder, took him outside the MIG.

The Tribunal ordered the respondent to pay for the disputed psychological and physical treatment plans, as well as the cost of a psychological assessment, finding them reasonable and necessary.

The applicant's claim for a special award for unreasonably delayed payments was dismissed due to lack of evidence.

The applicant sought statutory accident benefits following a motor vehicle accident, including psychological treatment, physical rehabilitation, and the cost of a psychological assessment.

The adjudicator preferred the evidence of the applicant's psychologist over the insurer's assessor, finding the psychological treatment and assessment reasonable and necessary.

The physical rehabilitation plan was also approved based on ongoing pain.

However, the adjudicator dismissed the claim for a special award, finding the insurer gave reasonable consideration to the available information when denying the benefits.

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 fell within the Minor Injury Guideline (MIG) and the $3,500 limit was exhausted.

The Licence Appeal Tribunal found that the applicant had a pre-existing elbow condition that was exacerbated by the accident, preventing him from achieving maximal recovery within the MIG limits.

The Tribunal also found the disputed treatment plans for chiropractic, physiotherapy, and a psychological assessment to be reasonable and necessary, ordering the insurer to pay the benefits with interest.