Dr. Sedigheh Naisi

The applicant sought statutory accident benefits for chiropractic and physiotherapy treatment plans following a motor vehicle accident.

The Tribunal found that neither treatment plan was substantively reasonable and necessary, as contemporaneous medical records did not corroborate the applicant's reports of accident-related physical injuries.

However, the Tribunal concluded that the insurer's denial notice for the physiotherapy treatment plan failed to comply with the specificity requirements of s. 38(8) of the Schedule.

Consequently, the physiotherapy treatment plan was deemed payable under s. 38(11).

The claim for an award under s. 10 of Regulation 664 was dismissed.

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

The applicant argued she should be removed from the MIG due to psychological impairments and chronic pain with functional impairment.

The Tribunal found that the applicant failed to provide sufficient medical evidence linking her psychological complaints or ongoing pain to a functional impairment caused by the accident.

As the $3,500 MIG limit was exhausted, the disputed treatment plans were denied.

The Tribunal also found the insurer complied with the notice requirements under s. 38(8) of the Schedule and dismissed the claims for an award and interest.

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

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 provide sufficient objective medical evidence to establish that her physical or psychological injuries warranted removal from the MIG.

Furthermore, the applicant did not prove a complete inability to carry on a normal life, as she provided limited details regarding her pre- and post-accident activities.

The application for non-earner benefits, a psychological assessment, an award, and interest was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to treatment plans for custom orthotics, a Functional Abilities Evaluation, and a vocational assessment.

The respondent denied the benefits based on Insurer's Examinations which concluded the treatments and assessments were not reasonable and necessary.

The Tribunal found that the applicant failed to provide sufficient contemporaneous medical evidence to support the treatment plans and preferred the respondent's expert evidence.

The application was dismissed, and claims for an award and interest were denied.

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

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

The Tribunal found the applicant suffered from a psychological impairment and chronic pain, removing her from the MIG.

The Tribunal approved treatment plans for an attendant care assessment, psychological services, physiotherapy, and a lumbar back brace, finding them reasonable and necessary.

A psychological assessment was denied as redundant.

The Tribunal also awarded interest on overdue benefits but dismissed the applicant's claim for a special award, finding the respondent relied on expert opinions and did not unreasonably withhold payments.

The applicant sought a determination of catastrophic impairment following a motor vehicle accident, claiming entitlement under Criteria 6, 7, and 8 of the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant did not meet the threshold for catastrophic impairment, preferring the respondent's multidisciplinary assessments which were supported by objective evidence, including surveillance footage and employment records showing the applicant had returned to full-time work.

The Tribunal also dismissed the applicant's claims for the outstanding balance of a catastrophic impairment assessment plan, finding that clinical file reviews were subject to the $2,000 cap per assessment and that transportation expenses were not proven to exceed the 50-kilometre deductible.

Claims for interest and an award for unreasonable withholding of benefits were consequently dismissed.

The applicant sought statutory accident benefits, including an income replacement benefit (IRB) and medication expenses, following a motor vehicle accident.

The respondent denied the benefits and argued the applicant was statute-barred for missing insurer's examinations.

The Tribunal found the applicant was not statute-barred as she attended rescheduled examinations.

However, the Tribunal dismissed the substantive claims, finding the applicant failed to prove a substantial or complete inability to perform the essential tasks of her employment as an Uber driver, relying on the respondent's psychological assessments.

The claims for medication expenses, interest, and a section 10 award were also dismissed.

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

The insurer partially denied several treatment plans for physiotherapy and psychological services, as well as visitor expenses.

The Tribunal found that the insurer failed to provide adequate medical reasons under s. 38(8) of the Schedule for one physiotherapy plan, making the balance payable.

The Tribunal also found the applicant was entitled to a higher hourly rate for a psychotherapist in two psychological treatment plans.

The remaining claims for travel, administrative reports, and visitor expenses were dismissed as they were not reasonable and necessary.

No special award was granted.

The applicant sought a non-earner benefit (NEB) and funding for physiotherapy and psychological services 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 due to significant inconsistencies in his self-reports regarding employment and daily activities.

The Tribunal preferred the respondent's physiatry assessment over the applicant's evidence, concluding the proposed treatment plans were not reasonable and necessary.

Claims for interest and an award were also dismissed.

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

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

The applicant applied to the Licence Appeal Tribunal, arguing for removal from the MIG due to chronic pain and psychological impairments.

The Tribunal found the applicant's medical evidence insufficient to establish functional impairment from chronic pain or a diagnosable psychological injury, preferring the respondent's s. 44 assessments.

As the applicant remained within the MIG and the $3,500 limit was exhausted, the disputed treatment plans and claims for an award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of treatment plans for physiotherapy, psychological services, and chiropractic services.

The Tribunal found the applicant failed to prove the physiotherapy and psychological services were reasonable and necessary, preferring the evidence of the respondent's section 44 assessors over the applicant's medical records.

However, the Tribunal ordered the respondent to pay the incurred expenses for the chiropractic treatment plan because the respondent's denial letter failed to provide specific medical reasons, violating the notice requirements under section 38(8) of the Schedule.

The claim for a section 10 award was dismissed as the respondent's conduct was not unreasonable.

The applicant sought non-earner benefits, interest, and an award under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent denied benefits, arguing the applicant's impairments stemmed from a pre-existing condition.

The Tribunal found that the applicant sustained serious psychological and physical impairments as a result of the accident, which continuously prevented her from engaging in substantially all of her pre-accident activities.

The Tribunal ordered the respondent to pay non-earner benefits for the eligible 104-week period and interest, but denied the claim for an award as the respondent's reliance on its assessments was not unreasonable.

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 Tribunal found that the applicant failed to provide compelling medical evidence of a pre-existing condition, chronic pain, or psychological impairment that would warrant removal from the MIG.

As the $3,500 MIG limit was already exhausted, the disputed treatment plans were denied.

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

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the denial of income replacement benefits (IRBs), removal from the Minor Injury Guideline (MIG), and several treatment plans.

The Tribunal found the applicant was not entitled to IRBs, as she failed to prove a substantial inability to perform the essential tasks of her pre-accident employment.

However, the Tribunal concluded the applicant's injuries fell outside the MIG due to a psychological impairment, preferring the evidence of the applicant's psychologist over the respondent's assessor.

The Tribunal approved a psychological assessment but denied the chiropractic and physiotherapy treatment plans, noting the applicant had previously discontinued such treatments because they were unhelpful.