Dr. Reis

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits (IRBs), various treatment plans, an award, and interest.

The respondent denied the benefits, arguing the applicant's impairments were related to pre-existing conditions and did not cause a substantial or complete inability to work.

The Tribunal applied the "but for" test and found the accident was a necessary cause of the applicant's chronic pain and psychological impairments.

The Tribunal held the applicant was entitled to IRBs for both the pre-104 and post-104 periods, finding he suffered a complete inability to engage in reasonably suited employment due to his physical limitations, age, and lack of transferable skills.

The Tribunal also approved several treatment plans for psychological, chronic pain, and functional assessments, but denied others lacking evidentiary support.

The claim for an award was dismissed as the respondent's conduct was not unreasonable, but interest was awarded on overdue benefits.

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 was involved in a motor vehicle accident and sought post-104 income replacement benefits (IRBs) due to psychological impairments.

The respondent terminated IRBs based on insurer examinations suggesting the applicant could work in alternative roles or teach yoga.

The Tribunal found that the applicant suffered from severe depression and anxiety that prevented her from maintaining regular attendance or performing duties in a competitive, real-world setting comparable to her pre-accident career as a mental health consultant.

The Tribunal ordered the respondent to pay the post-104 IRBs with interest, but dismissed the applicant's claim for a special award under s. 10 of O. Reg. 664, finding insufficient evidence of unreasonable conduct by the insurer.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision, including a non-earner benefit and various medical and rehabilitation benefits for chiropractic, physiotherapy, assistive devices, and an in-home assessment.

The Tribunal found that the applicant failed to prove on a balance of probabilities that she suffered a complete inability to carry on a normal life, noting her evidence was inconsistent and uncorroborated.

The Tribunal also dismissed the claims for medical and rehabilitation benefits, relying on insurer's examinations and finding that the proposed treatment plans were not reasonable and necessary given the lack of functional improvement from prior treatments.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits for a $1,000 orthopaedic mattress following a motor vehicle accident.

The respondent denied the benefit, relying on an insurer's examination report which concluded the mattress was unlikely to assist in managing pain.

The Tribunal found the mattress to be reasonable and necessary, noting that multiple treating practitioners and assessors documented the applicant's ongoing sleep disturbances and fatigue.

The Tribunal afforded less weight to the respondent's expert, whose opinion was inconsistent with other medical evidence.

The applicant was awarded the cost of the mattress plus interest.

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

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

The Tribunal found that the applicant failed to prove her injuries warranted treatment outside the MIG, as there was insufficient evidence of a pre-existing condition or psychological impairment.

However, the Tribunal awarded $200 for a psychological assessment because the respondent failed to provide a compliant denial notice within the required 10 business days under section 38(8) of the Schedule.

Claims for further physiotherapy and an award under Ontario Regulation 664 were dismissed.

The applicant sought statutory accident benefits for physical and psychological injuries allegedly sustained in a motor vehicle accident.

The respondent denied the claims, arguing that the accident was not the cause of the applicant's impairments, pointing to extensive pre-existing medical and psychological issues, including trauma from Syria and family legal troubles.

The Tribunal applied the 'but for' test and found that the applicant failed to prove the accident was a necessary cause of her impairments.

Furthermore, the Tribunal found that the requested medical benefits and catastrophic impairment assessments were not reasonable and necessary, or were duplicative and contrary to the Schedule.

The application was dismissed.