Dr. Safir

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

The insurer denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The adjudicator found that the applicant failed to meet the burden of proving that his physical or psychological injuries warranted removal from the MIG.

However, the adjudicator ordered the insurer to pay for a $2,300.00 neurological assessment because the insurer's denial notice failed to comply with s. 38(8) of the Schedule, as it relied on an Insurer Examination that only addressed physical rehabilitation.

The remaining treatment plans were dismissed.

The applicant sought a non-earner benefit and a chiropractic treatment plan following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove a complete inability to carry on a normal life, as medical records and insurer examinations indicated she remained independent in her activities of daily living.

The Tribunal also found the chiropractic treatment plan was not reasonable and necessary, as the family doctor's records did not support the need for treatment related to the accident.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits (IRBs), various treatment plans, and removal from the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to prove her injuries fell outside the MIG, as contemporaneous medical evidence and expert assessments indicated she suffered only soft-tissue sprain/strain injuries.

The Tribunal also dismissed the claim for IRBs, finding the applicant did not demonstrate a substantial inability to perform her pre-accident employment tasks or a complete inability to engage in any employment, noting she had returned to work post-accident and was deemed fit for sedentary duties.

As the applicant remained within the MIG and the limits were exhausted, the disputed treatment plans and claims for interest were denied.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a catastrophic impairment and was entitled to post-104 income replacement benefits, attendant care, and various medical benefits.

The Licence Appeal Tribunal dismissed the application.

The Tribunal gave no weight to the applicant's key expert psychiatrist, who recanted his findings during cross-examination when confronted with evidence of the applicant's actual functional capabilities, including international travel and childcare.

Consequently, the applicant failed to prove she met the criteria for catastrophic impairment or that she suffered a complete inability to engage in suitable employment.

As the non-catastrophic benefit limits were exhausted, all claims were dismissed.

The applicant sought statutory accident benefits following a 2019 motor vehicle accident, claiming he sustained a catastrophic impairment.

The Licence Appeal Tribunal assessed the applicant's impairments under criteria 7 and 8 of the Schedule.

The Tribunal found the applicant's whole person impairment rating was 46%, falling short of the 55% threshold required under criterion 7.

Under criterion 8, the Tribunal rejected the applicant's claim of a marked impairment in social functioning, finding his pre-accident history contradicted the expert's opinion.

The Tribunal also dismissed the applicant's claims for the cost of a catastrophic determination assessment, an award for unreasonable delay, and interest, as the applicant failed to meet his evidentiary onus.

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

The respondent denied several treatment plans for physiotherapy and psychological services, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's physical injuries were minor and that she failed to provide compelling medical evidence of chronic pain or a psychological impairment warranting removal from the MIG.

The Tribunal preferred the evidence of the respondent's assessors over the applicant's psychological assessment.

The applicant was found entitled to the disputed treatment plans only up to the remaining balance of the $3,500 MIG limit, plus interest, but her claim for an award for unreasonable delay was dismissed.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, arguing her injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain and psychological impairment.

The Licence Appeal Tribunal found that the medical evidence, including insurer's examinations, confirmed the applicant sustained only soft tissue injuries.

The Tribunal concluded the applicant failed to demonstrate chronic pain with functional impairment or a psychological condition that would justify removal from the MIG.

As the $3,500 MIG limit had been exhausted, the disputed treatment plans and claim for interest were dismissed.

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

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

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

The Tribunal found that the applicant failed to provide compelling medical evidence to support removal from the MIG.

Consequently, the disputed treatment plans were deemed not reasonable and necessary, and the application was dismissed.

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

The respondent denied non-earner benefits (NEB) and determined the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's claim for NEB was statute-barred because she failed to dispute the clear and unequivocal denial within the two-year limitation period, and she did not establish grounds for an extension under s. 7 of the LAT Act.

Furthermore, the Tribunal concluded that the applicant's injuries were predominantly minor and subject to the MIG, as she failed to provide compelling medical evidence of chronic pain or a pre-existing condition that would warrant removal from the MIG.

Since the $3,500 MIG limit had already been exhausted, the disputed treatment plans were not payable.

The applicant sought payment for two physiotherapy treatment plans following a motor vehicle accident.

The insurer denied the plans based on section 44 assessments indicating the applicant had achieved maximal medical recovery.

The Tribunal found the applicant failed to demonstrate the treatment plans were reasonable and necessary, noting limited evidence of improvement, the applicant's self-reported normal function, and the lack of objective referrals for treatment.

The application was dismissed.

The applicant, an uninsured pedestrian struck by a vehicle, applied to the Motor Vehicle Accident Claims Fund for statutory accident benefits.

The respondent denied a $2,926.83 treatment plan for physiotherapy.

The Licence Appeal Tribunal found that the applicant's right knee fracture had not fully healed and that the proposed treatment was reasonable and necessary to reduce pain and improve functional ability.

The Tribunal ordered the respondent to pay for the disputed treatment plan along with interest on overdue payments.

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

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

The Tribunal found that the applicant's physical injuries were soft-tissue in nature and that there was insufficient evidence of chronic pain or psychological impairment to warrant removal from the MIG.

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

The applicant sought entitlement to statutory accident benefits following a motor vehicle accident, including three treatment plans for chiropractic services, the cost of an attendant care assessment, and the cost of an orthopaedic assessment.

The Tribunal found the chiropractic treatment plans to be reasonable and necessary, preferring the evidence of the applicant's orthopaedic surgeon over the respondent's assessors.

However, the claims for the attendant care and orthopaedic assessments were dismissed due to insufficient evidence and flawed factual foundations, particularly given surveillance showing the applicant's physical capabilities.

The claim for a special award was also dismissed, but interest was awarded on the payable benefits.

The applicant was injured in a motor vehicle accident and sought payment for two chiropractic and physiotherapy treatment plans totaling approximately $4,000.

The insurer denied the plans based on an insurer's examination concluding the applicant had reached maximum medical recovery.

The Tribunal found the treatment plans were reasonable and necessary, preferring the evidence of the applicant's treating practitioners who diagnosed chronic pain and noted ongoing functional impairments.

The Tribunal ordered payment of the treatment plans with interest, but declined to order a special award, finding the insurer's reliance on its medical assessment was not unreasonable.

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

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

The applicant argued that chronic pain and psychological impairments, including Adjustment Disorder and Specific Phobia, warranted removal from the MIG.

The Tribunal found that the physical injuries were soft-tissue in nature and that the applicant failed to provide sufficient medical evidence of functionally-disabling chronic pain or a diagnosable psychological impairment that would prevent maximal medical recovery within the MIG.

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

The applicant sought a preliminary order deeming him catastrophically impaired under Criterion 7 of the Statutory Accident Benefits Schedule, relying on a section 44 insurer examination by Dr. Waseem that concluded he met the 55% Whole Person Impairment threshold.

The respondent insurer opposed the motion, relying on conflicting section 44 assessments and an executive summary that concluded the applicant's wheelchair dependency was caused by pre-existing diabetes complications rather than the accident.

The Tribunal dismissed the applicant's request, holding that an insurer is not bound by the opinion of a single section 44 assessor and that a full hearing was required to weigh the complex medical evidence regarding causation.

The Tribunal also ordered the applicant to attend a section 44 psychiatric examination before proceeding with the application.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision, claiming entitlement to income replacement benefits (IRBs), medical benefits, and the cost of a psychological assessment.

The respondent argued the applicant suffered only minor injuries subject to the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained a mild concussion, removing him from the MIG.

However, the Tribunal dismissed the claim for IRBs, finding insufficient evidence that the applicant's soft tissue injuries or concussion caused a substantial inability to perform the essential tasks of his pre-accident employment as a cabinet-maker.

Claims for physiotherapy, chiropractic treatment, and assistive devices were denied as not reasonable and necessary.

The Tribunal granted the cost of a psychological assessment, finding it reasonable based on an initial screening.

The Tribunal also awarded $150 in costs to the respondent due to the applicant's breach of a direction not to communicate with a witness during the hearing.

This decision addresses a threshold motion brought by the defendants in a motor vehicle accident claim.

The plaintiff, Barry O'Brien, sought damages for injuries sustained, including a pilon fracture of his left ankle, depression, PTSD, and an exacerbation of low back symptoms.

A jury had previously awarded general damages and past loss of income but no future loss of income.

The defendants argued that the plaintiff's injuries did not meet the 'permanent serious impairment' threshold under s. 267.5(5) of the Insurance Act, RSO 1990, c I.8, and Regulation 461/96, thereby barring his claim for non-pecuniary loss.

The court, while considering the jury's verdict, independently assessed the medical and other evidence.

It concluded that the plaintiff's left ankle fracture resulted in a permanent serious impairment of an important physical function related to his employment, substantially interfering with his ability to continue heavy labour, especially considering the future deterioration due to arthritis.

However, the court found that the impairment did not substantially interfere with most of his usual activities of daily living.

Consequently, the defence's threshold motion was dismissed.

The applicant was injured in a motor vehicle accident and sought payment for a psychological assessment and physiotherapy services.

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

The Tribunal found that the applicant failed to provide sufficient medical evidence to prove her chronic pain, fibromyalgia, and psychological impairments were caused by the accident or removed her from the MIG.

The application was dismissed, and the applicant was denied the claimed benefits, interest, and costs.