Dr. R. Day

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

The Respondent denied claims for attendant care benefits, an accounting report, various treatment plans, and prescription cannabis.

The Tribunal found that the attendant care benefits were not incurred and the accounting report was not reasonably required.

The disputed treatment plans were found not reasonable and necessary, largely based on uncontroverted insurer's examination reports indicating the Applicant had reached maximum medical recovery or that further facility-based treatment was not supported.

The Respondent agreed to pay for one treatment plan and the incurred prescription cannabis expenses.

The claim for an award for unreasonable delay was dismissed.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision.

The insurer denied funding for various assessments and psychological treatment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 limit.

The Tribunal found that the applicant suffered from chronic pain causing functional impairment, removing her from the MIG.

The Tribunal ordered the insurer to fund the proposed chronic pain assessment, psychological assessment, and psychological services, finding them reasonable and necessary.

However, the request for MRIs was denied as they were reasonably available under OHIP.

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

The respondent denied the benefits on the basis that the applicant did not suffer a substantial inability to perform the essential tasks of her pre-accident employment and that the proposed treatments were not reasonable and necessary.

The Tribunal dismissed the application, preferring the evidence of the respondent's assessors that the applicant's psychological and physical impairments did not meet the substantial inability test, and finding that the applicant had already received adequate treatment for her accident-related injuries.

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).

The applicant argued he sustained psychological impairments that removed him from the MIG.

The Tribunal found the applicant's evidence uncompelling, preferring the respondent's insurer's examinations which concluded the applicant suffered no significant physical or psychological impairments as a result of the accident.

The Tribunal held the applicant sustained a predominantly minor injury and was subject to the $3,500 funding limit.

As the disputed plans exceeded this limit, the claims were dismissed.

The applicant sought statutory accident benefits for two chiropractic treatment plans totaling over $17,000 following a motor vehicle accident.

The respondent insurer denied the plans on the basis that the physical injuries were soft tissue in nature and resolved, noting a prior workplace injury to the same areas.

The Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, citing inconsistencies in the medical records, a two-year gap in treatment, and the significant role of the prior workplace injury.

The application was dismissed.

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

The insurer initially paid the benefit but terminated it following insurance examinations.

The applicant argued the termination notice was deficient under the Schedule.

The Tribunal found that while the notice lacked medical reasons, this did not automatically entitle the applicant to ongoing benefits.

On the merits, the Tribunal found the applicant failed to prove a complete inability to carry on a normal life, noting inconsistencies in his self-reporting, pre-existing conditions from a prior workplace accident, and evidence that he had returned to work.

The application was dismissed.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision.

The insurer denied various benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's physical injuries were minor and had resolved, as evidenced by normal imaging and his return to work.

The Tribunal rejected the applicant's claim of chronic pain syndrome, finding he did not meet the AMA Guides criteria.

Claims for Income Replacement Benefits, attendant care, and various treatment plans were dismissed because the applicant failed to prove impairments beyond the MIG or an inability to work.

The Tribunal also dismissed claims for an award under O. Reg. 664, noting that technical deficiencies in the insurer's notices do not automatically entitle an applicant to benefits.