Dr. Ramunas Saplys

The applicant sought statutory accident benefits following a 2018 motor vehicle accident.

In a previous 2020 decision, the Tribunal found the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant brought a second application seeking removal from the MIG based on alleged new medical evidence and claiming entitlement to additional treatment plans.

The Tribunal held that the doctrine of res judicata barred the applicant from relitigating the MIG issue, as the new medical reports did not constitute fresh evidence that would conclusively impeach the original result.

The Tribunal also found the respondent provided proper notice of denial for the disputed treatment plans.

The application was dismissed.

The applicant sought statutory accident benefits, including income replacement benefits (IRBs) and funding for seven physiotherapy treatment plans, following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application in its entirety.

The adjudicator found the applicant's self-reporting to medical assessors unreliable due to symptom magnification and surveillance evidence showing the applicant working long hours at a restaurant.

Consequently, the applicant failed to prove a substantial inability to perform the essential tasks of his employment for pre-104 week IRBs, or a complete inability to engage in any employment for post-104 week IRBs.

The physiotherapy plans were deemed not reasonable and necessary, as the applicant contemporaneously reported to his family doctor that the treatments were ineffective.

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

The respondent denied several treatment and assessment plans 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 for removal from the MIG due to post-concussion syndrome, pre-existing scoliosis, and psychological injuries.

The Tribunal found that the applicant did not sustain a concussion or psychological injury warranting removal, and failed to provide compelling medical evidence that her pre-existing conditions precluded recovery within the MIG.

The Tribunal also found the respondent's denial notices were compliant with the Schedule.

The application was dismissed.

The self-represented applicant sought a non-earner benefit following a motor vehicle accident.

At the hearing, the Tribunal denied the applicant's oral request for an adjournment, finding she had not taken reasonable steps to secure new counsel.

The Tribunal also denied the respondent's motion to dismiss the application as abandoned.

On the merits, the Tribunal found the applicant failed to prove she suffered a complete inability to carry on a normal life, preferring the respondent's multidisciplinary assessments over the applicant's oral testimony and unsupported claims.

The application was dismissed, and the applicant was ordered to pay $100 in costs for her unreasonable conduct and failure to comply with Tribunal orders.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claims for chiropractic, massage, and chronic pain treatment plans.

The applicant argued the Tribunal acted outside its jurisdiction and made errors of law and fact by determining she did not suffer from chronic pain and that her injuries fell within the Minor Injury Guideline.

The Tribunal dismissed the reconsideration request, finding it had jurisdiction to assess the severity of the injuries and the reasonableness of the treatment plans, and that it made no error in weighing the medical evidence to conclude the applicant had reached maximum medical recovery.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to various treatment plans for chiropractic, psychological, and chronic pain services.

The Licence Appeal Tribunal dismissed the application, finding that the cost of personal protective equipment was not covered, the proposed hourly rate for a psychotherapist was not justified, and the applicant had reached maximum medical recovery.

The Tribunal preferred the respondent's medical evidence, concluding that the applicant did not meet the criteria for chronic pain and that her ongoing knee issues were related to pre-existing conditions rather than the accident.

The applicant sought various medical and rehabilitation benefits following a motor vehicle accident, which were denied by the respondent insurer.

The Tribunal excluded the applicant's late-filed written submissions due to non-compliance with the case conference report and order, finding that admitting them would breach procedural fairness and prejudice the respondent.

Relying on the respondent's insurer examination reports, the Tribunal found the applicant failed to meet her evidentiary burden to establish that the proposed treatment plans for visual therapy, occupational therapy, psychological services, and chiropractic/massage treatment were reasonable and necessary.

The application was dismissed in its entirety, with no entitlement to an award or interest.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident.

She applied for a catastrophic impairment determination based on psychological and neurological impairments.

The Tribunal found the applicant was not catastrophically impaired, as her mental and behavioural disorders resulted in only mild impairments in social functioning and concentration, persistence, and pace, and there was insufficient evidence of a mild traumatic brain injury to meet the 55% whole person impairment threshold.

The Tribunal allowed the applicant to change her election from a non-earner benefit to an income replacement benefit, finding the initial election invalid because the insurer failed to provide a proper explanation of benefits.

The insurer was granted a repayment of the non-earner benefit due to deductible collateral benefits.

The Tribunal approved one occupational therapy treatment plan and awarded a 10% special award under s. 10 of O. Reg. 664, finding the insurer unreasonably maintained its denial despite acknowledging the plan should have been reassessed.

Claims for a massage chair, attendant care benefits, and other assessments were dismissed.

The applicant sought various statutory accident benefits following a 2017 motor vehicle accident, including attendant care benefits, occupational therapy, assistive devices, and assessments.

The Licence Appeal Tribunal found that the applicant's ongoing impairments were caused by pre-existing degenerative conditions rather than the accident, relying on the respondent's orthopaedic assessment.

The Tribunal denied further attendant care benefits and most treatment plans, but approved a psychological assessment, an attendant care assessment, and an inner bathmat.

The claim for a special award was dismissed as the respondent did not act unreasonably or in bad faith.

The applicant sought statutory accident benefits for housekeeping and home maintenance expenses, as well as a rehabilitation benefit for a knee brace, following a 2010 motor vehicle accident.

The Licence Appeal Tribunal denied the housekeeping expenses because they were incurred more than 104 weeks after the onset of disability and the applicant had not sustained a catastrophic impairment.

The Tribunal also denied the knee brace, finding it was not reasonable and necessary, as medical evidence indicated the applicant's ongoing knee issues were related to pre-existing osteoarthritis rather than the accident.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically funding for psychotherapy services and a chronic pain assessment.

The adjudicator found the psychotherapy treatment plan reasonable and necessary, relying on the respondent's own psychological assessment which indicated the applicant needed further treatment to reach maximal recovery.

However, the claim for a chronic pain assessment was dismissed, as the applicant had returned to full-time work, had large gaps in treatment, and the respondent's medical examinations concluded further assessment was unnecessary.

The applicant was awarded the psychotherapy benefits with interest.

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 the injuries fell within the Minor Injury Guideline (MIG).

The adjudicator found that the applicant's psychological impairments (adjustment disorder and specific phobia) removed him from the MIG.

The adjudicator ordered the respondent to pay for several chiropractic and physiotherapy treatment plans, finding them reasonable and necessary, and noting the insurer's failure to comply with the 10-day notice requirement under s. 38(8) of the Schedule for some plans.

Claims for a driving re-integration assessment and a chronic pain assessment were dismissed as not reasonable and necessary.

The applicant was awarded interest on overdue payments, but both parties' claims for costs under Rule 19.1 were dismissed.