Dr. Ranalli

The applicant sought entitlement to statutory accident benefits for vision therapy, occupational therapy, a therapeutic mattress, and a psychological assessment following a 2019 motor vehicle accident.

The Licence Appeal Tribunal dismissed all claims, finding that the applicant failed to prove the treatments and assessments were reasonable and necessary.

The Tribunal preferred the respondent's insurer examination reports, which concluded that the proposed vision therapy lacked validated efficacy and that the applicant had the functional ability to perform pre-accident activities without the proposed occupational therapy.

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

The applicant sought a determination that he sustained a catastrophic impairment (CAT) following a 2020 motor vehicle accident, claiming entitlement to extended medical benefits.

The Tribunal assessed the applicant's physical and psychological impairments under Criteria 6, 7, and 8 of the Statutory Accident Benefits Schedule.

The Tribunal found insufficient evidence of radiculopathy and rejected several of the applicant's expert ratings, ultimately determining a 25% physical whole person impairment (WPI).

Combined with psychological impairments, the applicant did not meet the 55% WPI threshold.

The Tribunal also found the applicant did not suffer three marked impairments in his spheres of functioning.

As the applicant did not meet the CAT threshold and the non-CAT limits were exhausted, the application for medical benefits, an award, and interest was dismissed.

The applicant sought a determination of catastrophic impairment and entitlement to various treatment plans following a motor vehicle accident.

The Tribunal found that the applicant did not meet the 55% whole person impairment threshold under either Criterion 6 (physical) or Criterion 7 (combined physical and psychological), assessing his physical impairment at 37% and combined impairment at 43%.

The Tribunal denied the claim for outstanding catastrophic impairment assessments, finding them duplicative.

However, the Tribunal granted the cost of a NuStep cross trainer, finding it reasonable and necessary for the applicant's rehabilitation.

The Tribunal also granted the cost of a neurovisual assessment because the insurer's denial notice failed to comply with the requirements of s. 38(8) of the Schedule.

The applicant's request for costs was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, which were denied by the respondent insurer.

The Licence Appeal Tribunal found that the applicant met her burden of proving that a neurological assessment, a chronic pain assessment, and chiropractic services were reasonable and necessary.

The Tribunal preferred the evidence of the applicant's treating practitioners and experts over the insurer's examiners, noting that the insurer's general practitioner was not qualified to opine on chronic pain and that the insurer's psychologist lacked specific findings to support claims of symptom exaggeration.

The application was granted, and the respondent was ordered to pay the disputed amounts with interest.

The applicant, who has pre-existing global developmental delay, autism spectrum disorder, and a seizure disorder, sought $3,528.83 for home modifications following a motor vehicle accident.

The applicant argued the accident worsened his seizures and aggressive behaviours, necessitating the modifications.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove on a balance of probabilities that the accident caused an exacerbation of his pre-existing impairments.

The adjudicator noted significant inconsistencies between the grandparents' subjective reports of worsened behaviour and contemporaneous pre-accident medical records, and preferred the respondent's medical evidence that the accident did not cause the reported deterioration.

The applicant sought various statutory accident benefits following a 2019 motor vehicle accident, including non-earner benefits, attendant care benefits, and several treatment plans.

The Licence Appeal Tribunal dismissed all claims.

The adjudicator found the applicant failed to prove a complete inability to carry on a normal life, relying on s. 44 assessments and the applicant's self-reports of resuming most pre-accident activities.

Claims for attendant care and treatment plans were denied for lack of evidence establishing they were reasonable and necessary.

The Tribunal also dismissed claims for an award and interest.

The applicant sought a determination that she sustained a catastrophic impairment (CAT) due to a mental or behavioural disorder following a 2017 motor vehicle accident, which she claimed aggravated pre-existing concussion symptoms from a 2014 work incident.

The Tribunal found that while the applicant suffers from somatic symptom disorder and functional limitations, her impairments in activities of daily living do not rise to the level of a marked (Class 4) impairment under the AMA Guides.

Consequently, she did not meet the criteria for CAT status.

As her non-CAT policy limits were exhausted, her claims for various medical and attendant care benefits were dismissed as moot.

The Tribunal awarded the applicant $2,000 in costs due to the respondent's excessive and unnecessary objections during the hearing.

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

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

The applicant argued for removal from the MIG based on physical injuries, psychological impairments, and chronic pain.

The Tribunal found the applicant failed to establish that her injuries warranted removal from the MIG, noting a lack of evidence connecting a shoulder tear to the accident, subclinical psychological test results, and failure to meet the AMA Guides criteria for chronic pain.

Consequently, the disputed treatment plans were deemed not reasonable and necessary, and the claims for an award and interest were dismissed.

The applicant sought various medical and rehabilitation benefits following a 2015 motor vehicle accident.

The Licence Appeal Tribunal reviewed treatment plans for psychological services, an audiometric assessment, an optometric assessment, and a driving assessment.

The Tribunal found that the applicant failed to prove the psychological, audiometric, and optometric plans were reasonable and necessary, largely relying on the respondent's section 44 medical examination reports.

However, the Tribunal approved the driving assessment, finding it reasonable and necessary to address the applicant's well-documented driving anxiety.

The applicant sought income replacement benefits (IRBs) and medical benefits for chiropractic treatment following a motor vehicle accident.

The adjudicator dismissed the application, finding the applicant lacked credibility due to contradictory evidence regarding his return to work and pre-existing chronic back pain.

The applicant failed to prove a substantial inability to perform the essential tasks of his pre-accident employment as a driver.

Furthermore, the adjudicator found the disputed treatment plans were not reasonable and necessary, as the applicant provided insufficient medical evidence linking his ongoing complaints to the accident.

The Co-operators General Insurance Company brought a motion to compel the plaintiff, Annette Brooks, to attend a second independent medical examination with a physiatrist.

The plaintiff opposed, offering to withdraw her own physiatry report.

The court granted the motion, finding that the examination was warranted to ensure a fair determination of the nature and extent of the plaintiff's injuries, despite the plaintiff's offer and the late stage of litigation, as the plaintiff's physiatry report was relied upon by another expert and the proposed examination was not duplicative.

The applicant, a pedestrian injured in a motor vehicle accident, sought statutory accident benefits for vision impairments.

The respondent insurer denied treatment plans for visual training and therapeutic glasses, arguing the vision issues were pre-existing and not caused by the accident.

The Tribunal found that the applicant's vision impairments were caused or exacerbated by the accident, preferring the evidence of her treating practitioners over the respondent's neurological assessor.

The Tribunal concluded that the disputed treatment plans were reasonable and necessary, and ordered the respondent to pay for them with interest.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to optometry services, prescription eyewear, and physiotherapy for a rotator cuff tear.

The Licence Appeal Tribunal denied the claims for optometry services and eyewear, finding insufficient evidence that the applicant's pre-existing vision issues were exacerbated by the accident.

However, the Tribunal granted the claim for physiotherapy, finding that the rotator cuff tear was caused by the accident and that the applicant was not required to exhaust OHIP-funded physiotherapy before seeking accident benefits.

Interest was awarded on the overdue physiotherapy benefits.

The applicant sought to vary a previous arbitration order to increase his attendant care benefits to cover 24/7 care, alleging a material change in circumstances due to worsening mental and physical health following a 2003 motor vehicle accident.

The Director's Delegate found that while the applicant's mental and behavioural disorders had worsened, constituting a material change, he was far less disabled than he presented.

Relying on surveillance evidence and the respondent's occupational therapist, the Delegate concluded that 24/7 care was not reasonable or necessary, as the applicant did not pose a danger to himself or others and demonstrated independent functionality.

The Delegate increased the attendant care benefits to $1,445.75 per month to account for increased emotional support and cuing needs, but dismissed the claim for a special award.

The applicant sought a medical benefit of $6,080.00 for optometric services following a motor vehicle accident.

The respondent denied the treatment plan.

The adjudicator found that the applicant failed to meet her onus of proving the treatment was reasonable and necessary, primarily because she failed to submit the disputed treatment plan (OCF-18) into evidence.

The other medical evidence provided did not adequately identify the goals of the proposed treatment.

The claims for the medical benefit, interest, and costs were dismissed.

The applicant, a self-employed plumber, was injured in a motor vehicle accident and sought statutory accident benefits.

The insurer terminated income replacement and housekeeping benefits and denied various medical benefits.

The arbitrator found that the applicant suffered a complete inability to engage in suitable employment due to his injuries, which aggravated pre-existing conditions, and awarded ongoing income replacement benefits.

The arbitrator also awarded the claimed medical benefits, housekeeping benefits, the cost of an MRI, and interest at 2% per month.

A special award was granted against the insurer for unreasonably withholding payments, with the amount to be determined.

The applicant was found severely injured in a driveway between two houses with no memory of the incident.

He claimed statutory accident benefits, alleging he was struck by a motor vehicle.

The insurer denied the claim, arguing the injuries resulted from an assault.

After hearing extensive medical expert testimony regarding the pattern and severity of the injuries, the arbitrator concluded on a balance of probabilities that the injuries were consistent with a pedestrian-automobile collision and ruled that the applicant was involved in an 'accident' under the Schedule.