Dr. Ratti

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits, physiotherapy, psychological services, and a psychological assessment.

The respondent denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the treatment plans were reasonable and necessary.

The Tribunal also found the applicant did not suffer a complete inability to carry on a normal life, relying on independent medical examinations indicating the applicant continued to work and attend school without significant functional limitations.

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

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

The Tribunal denied the non-earner benefit, finding the applicant failed to prove a complete inability to carry on a normal life.

The Tribunal approved two physiotherapy treatment plans and a psychotherapy treatment plan, finding them reasonable and necessary based on the medical evidence.

A chronic pain treatment plan was denied as the applicant did not meet the criteria for chronic pain with functional limitations.

The Tribunal also ordered a 15% award under s. 10 of Regulation 664, finding the insurer unreasonably withheld benefits by ignoring its own assessor's diagnosis and inflexibly dismissing a treatment plan over a signature issue.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline (MIG).

The Tribunal excluded the applicant's late-filed medical records due to non-compliance with production orders.

The Tribunal found insufficient evidence of a concussion, chronic pain, or psychological impairment to warrant removal from the MIG.

The applicant was held to the $3,500 MIG limit and was only entitled to the remaining balance of $458.67 for incurred benefits, plus interest.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that chronic pain and physical impairments warranted removal from the MIG.

The Tribunal found that the applicant failed to provide sufficient medical evidence to establish non-minor injuries, preferring the respondent's insurer examination reports which concluded the injuries were uncomplicated soft tissue strains.

The application for treatment plans, interest, and an award was dismissed.

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 that the applicant failed to prove she suffered a substantial inability to perform the essential tasks of her employment as a result of the accident.

The Tribunal preferred the respondent's independent medical examination reports, noting the applicant had stopped working prior to the accident due to stress and reduced hours.

The Tribunal also found the respondent's notices and denials substantially complied with the Statutory Accident Benefits Schedule, and denied the claims for interest and a special award.

The applicant was injured in a head-on motor vehicle collision, sustaining a severe ankle fracture that developed into progressive post-traumatic arthritis.

He sought post-104 income replacement benefits, funding for three treatment plans, and a special award for unreasonable delay.

The Tribunal found that the applicant was not entitled to post-104 income replacement benefits because he had successfully retrained and was working as a real estate agent, failing to meet the "complete inability" test.

However, the Tribunal approved the disputed treatment plans, finding them reasonable and necessary to manage the applicant's chronic pain and progressive arthritis.

Finally, the Tribunal ordered the respondent to pay a special award of $1,211.40 under s. 10 of O. Reg. 664, finding that the respondent's repeated delays in responding to treatment plans and incorrect demands for repayment constituted excessive and imprudent behavior.

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

The respondent denied various treatment plans for physiotherapy and psychological services 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 her injuries fell outside the MIG due to a psychological impairment and pre-existing conditions.

The Tribunal found the applicant's physical injuries were soft tissue in nature and her psychological testing did not support a formal diagnosis.

The Tribunal accepted the respondent's section 44 assessors' conclusions that the injuries were minor.

As the MIG limit was exhausted, the disputed treatment plans and interest were denied.

The applicant was injured in a 2017 motor vehicle accident and sought various statutory accident benefits, including attendant care, psychological treatments, and medical assessments.

The respondent denied the benefits and brought a preliminary motion arguing the applicant was statute-barred for failing to attend insurer's examinations (IEs).

The Tribunal granted the respondent's motion, finding the applicant failed to attend the scheduled IEs.

In the alternative, the Tribunal found the applicant failed to establish entitlement to any of the substantive benefits, as she did not prove the attendant care expenses were incurred and failed to show the proposed treatments and assessments were reasonable and necessary given her pre-existing conditions and post-accident level of functioning.

The application was dismissed.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident, specifically claiming treatment plans for psychological services and chronic pain management.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the treatments were reasonable and necessary.

The Tribunal noted the applicant's immediate return to work, lack of referrals from his family physician, and the insurer's examinations which found no accident-related psychological or physical impairments requiring the proposed treatments.

Claims for interest and a special award were also dismissed.

The applicant sought statutory accident benefits following two motor vehicle accidents.

The insurer denied treatment plans for psychological services and an expense claim for acupuncture.

The Tribunal found that the applicant failed to prove the psychological treatment was reasonable and necessary, noting her own medical evidence indicated her symptoms had improved and she had returned to work.

The acupuncture expense was denied because it was incurred before a treatment plan was submitted, contrary to s. 38(2) of the Schedule.

Claims for interest and a special award were also dismissed.

The applicant sought a reconsideration of a Licence Appeal Tribunal decision that denied her claims for an income replacement benefit (IRB), attendant care benefits, and various treatment plans following a motor vehicle accident.

The applicant argued the Tribunal made errors of fact and law regarding her concussion diagnosis, surveillance evidence, and the medical assessments of several experts.

The Vice-Chair dismissed the request for reconsideration, finding that while there were minor factual inaccuracies in the original decision, they were not significant enough to have likely changed the result.

The Tribunal's original weighing of the medical evidence and surveillance footage was upheld.

The applicant sought income replacement benefits (IRB), attendant care benefits (ACB), and approval for numerous treatment plans following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal found the applicant failed to prove a substantial inability to perform her pre-accident employment as a cashier or a complete inability to work post-104 weeks, relying on video surveillance showing no physical distress and independent medical examinations.

The ACB claim was dismissed because the care was provided by family members who did not suffer an economic loss, and the benefit was not deemed incurred as it was not unreasonably withheld.

The disputed treatment plans were found not reasonable and necessary, as the medical evidence did not support the claimed injuries, including a concussion, and the applicant had reached maximum medical improvement.

The applicant sought statutory accident benefits following a 2014 motor vehicle accident, specifically claiming a chronic pain assessment and a chronic pain treatment program.

The Licence Appeal Tribunal dismissed the claims.

The Tribunal found the assessment expense was incurred prior to the submission of the treatment plan, contravening section 38(2) of the Schedule.

Furthermore, the Tribunal held the applicant failed to prove she suffered from an accident-related chronic pain condition, preferring the respondent's medical evidence which showed she had reached maximum medical improvement and maintained a normal life.

Claims for a Regulation 664 award and interest were also dismissed.

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

The respondent denied certain treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been reached.

The applicant argued that pre-existing back pain, chronic pain, and psychological impairment removed him from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence of a pre-existing condition that would prevent maximal recovery within the MIG limits.

Furthermore, the Tribunal concluded that the applicant did not prove on a balance of probabilities that he suffered from chronic pain or a psychological impairment as a result of the accident.

Consequently, the applicant's injuries were deemed minor, and his claims for additional medical benefits and interest were dismissed.

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

The respondent denied certain treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been exhausted.

The applicant argued that pre-existing back pain, chronic pain, and psychological impairments removed him from the MIG.

The Tribunal found insufficient medical evidence to support the applicant's claims, noting that his family physician did not diagnose chronic pain or psychological impairment, and preferred the respondent's psychological assessment.

The Tribunal concluded the applicant sustained minor injuries subject to the MIG limit, dismissing the claims for additional medical benefits and examination expenses.

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

The respondent insurer limited the applicant's medical and rehabilitation benefits to the $3,500 cap under the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing that pre-existing conditions, chronic pain, and psychological impairments warranted removal from the MIG.

The Tribunal found that the applicant failed to prove her impairments fell outside the MIG, preferring the respondent's section 44 assessment reports which found no functional impairment or DSM-V diagnosis.

As the MIG limits were exhausted, the disputed treatment plans were deemed not reasonable and necessary.

Claims for an award, costs, and interest were dismissed.

The applicant sought non-earner benefits following a motor vehicle accident, claiming physical and psychological impairments prevented her from carrying on a normal life.

The adjudicator applied the Heath framework and found that while the applicant experienced some changes in her post-accident life, she could still perform many of her pre-accident activities, including childcare and self-care, without significant restrictions.

The application for non-earner benefits, along with claims for an award and interest, was dismissed.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits, which the respondent insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal for dispute resolution.

The Tribunal found that while the initial physical injuries were predominantly minor, the applicant subsequently developed chronic pain with accompanying psychological impairment, removing him from the MIG.

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

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

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

The adjudicator found that the applicant failed to meet the burden of proving his physical, psychological, or chronic pain impairments removed him from the MIG.

The adjudicator preferred the respondent's psychological assessment over the applicant's due to the use of an interpreter, and relied on surveillance evidence that contradicted the applicant's claims of chronic pain.

The application was dismissed.

The applicant sought payment for various medical and assessment benefits following a motor vehicle accident.

The respondent insurer denied the benefits on the basis that the applicant's injuries were predominantly minor and subject to the $3,500 limit under the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's injuries were soft tissue in nature and fell within the MIG.

The Tribunal preferred the evidence of the insurer's examiners over the applicant's assessors, noting the former reviewed comprehensive medical records.

Furthermore, the applicant failed to provide compelling evidence of a pre-existing medical condition that would warrant an exception to the MIG cap.

The application was dismissed.