Dr. Seon

The applicant sought a Non-Earner Benefit and payment for various treatment and assessment plans following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's ongoing pain was caused by pre-existing degenerative disc disease rather than the accident.

The Tribunal agreed with the respondent, finding that MRI results and independent medical examinations confirmed the symptoms were degenerative.

The Tribunal also found insufficient evidence of a psychological impairment caused by the accident.

The application was dismissed in its entirety, including claims for an award and interest.

The applicant sought statutory accident benefits following a motor vehicle accident but was denied by the respondent 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 chronic pain and psychological impairments.

The Tribunal found the medical evidence, including clinical notes and psychological assessments, did not support removal from the MIG.

The Tribunal also found the respondent's denial notices complied with section 38 of the Schedule.

The application was dismissed.

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

She also claimed entitlement to non-earner benefits and two treatment plans.

The Tribunal found the applicant's evidence insufficient to establish that her pre-existing conditions prevented recovery within the MIG.

The Tribunal preferred the respondent's expert evidence, concluding the applicant sustained only minor soft tissue injuries and no diagnoseable psychological impairment.

The claims for non-earner benefits and treatment plans outside the MIG limit were dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident 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, arguing for removal from the MIG due to a pre-existing condition, chronic pain, and a psychological impairment.

The Tribunal found that the applicant failed to provide sufficient evidence of a pre-existing condition preventing recovery, and preferred the insurer's medical examinations over the applicant's self-reports and expert evidence regarding chronic pain and psychological impairments.

Consequently, the Tribunal held that the applicant's injuries were predominantly minor, and dismissed the claims for four treatment plans and interest, as the plans exceeded the MIG limit and were not proven reasonable and necessary.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits (IRBs) and a neurological assessment.

The Tribunal found that the applicant failed to prove she met the disability test for IRBs, as the medical evidence did not establish a substantial inability to perform the essential tasks of her self-employment.

However, because the respondent insurer issued deficient notices suspending and terminating the IRBs, the Tribunal ordered the respondent to pay IRBs totaling $9,783.83 for the period before a compliant notice was issued.

The claim for a neurological assessment was dismissed as not reasonable and necessary.

The Tribunal denied a special award but granted $500 in costs to the applicant due to the respondent's late service of an accounting report.

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

The respondent denied various treatment plans, arguing 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 that the applicant failed to meet the burden of proving chronic pain with a functional impairment under the AMA Guidelines, noting normal physical exams and lack of compelling evidence of functional decline.

The Tribunal also found insufficient evidence of a psychological condition, citing multiple assessments indicating symptom exaggeration and malingering.

The application was dismissed, and the applicant remained subject to the $3,500 MIG limit.

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

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

The Tribunal found that the applicant suffered from chronic pain syndrome with functional impairment, removing him from the MIG.

The Tribunal ordered the respondent to pay for a chronic pain assessment and a psychological assessment, finding them reasonable and necessary.

The applicant's claim for an award for unreasonable delay was dismissed, but interest on overdue payments was granted.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident.

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

The Tribunal found the applicant suffered from chronic pain syndrome with functional impairment, removing him from the MIG.

The Tribunal ordered the respondent to pay for the chronic pain and psychological assessments, plus interest, finding them reasonable and necessary.

The applicant's claim for an award for unreasonable delay was dismissed, as the respondent had relied on its section 44 assessors.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to several treatment plans for physiotherapy, psychological, chronic pain, and vocational assessments.

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 failed to meet the burden of proving his injuries warranted removal from the MIG, noting a lack of persuasive medical evidence for chronic pain or psychological impairment.

As the MIG limits were exhausted, 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, claiming entitlement to non-earner benefits and medical benefits for psychological and chiropractic services.

The insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that she failed to comply with section 33 requests for information.

The Tribunal found that the applicant's non-compliance with section 33 relieved the insurer of liability for non-earner benefits.

Furthermore, the Tribunal concluded the applicant sustained predominantly minor injuries, as she failed to prove pre-existing conditions, psychological impairments, or chronic pain that would warrant removal from the MIG.

Consequently, the disputed treatment plans were not reasonable and necessary as they exceeded the $3,500 MIG limit.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and various medical and rehabilitation treatment plans.

The Tribunal found the applicant suffered a substantial inability to perform her pre-accident employment as a dump truck driver due to chronic pain and an exacerbated shoulder injury, establishing entitlement to pre-104 week IRBs.

However, based on the applicant's pre-accident self-employment income, the quantum of IRBs owed was calculated at nil.

Claims for post-104 week IRBs were dismissed due to a lack of evidence and surveillance showing a return to work.

The Tribunal approved treatment plans for physiotherapy and an orthopaedic assessment as reasonable and necessary, but denied claims for psychological services, medication, and post-fall chiropractic treatment.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits, medical and rehabilitation benefits, and the cost of various assessments.

The insurer denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to demonstrate that the claimed attendant care benefits were incurred or reasonable and necessary, given her self-reported independence with activities of daily living.

The Tribunal also found that the proposed psychological, chiropractic, and neurological assessments and treatments were not reasonable and necessary, preferring the evidence of the insurer's examiners.

As no benefits were payable, claims for interest and a special award were also dismissed.

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

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

The Licence Appeal Tribunal found that the applicant failed to prove her physical or psychological impairments warranted removal from the MIG.

As the MIG limits were exhausted, the treatment plan was not payable and the application was dismissed.

The applicant sought payment for a psychological treatment plan following a motor vehicle accident.

The insurer denied the plan, arguing it was not reasonable and necessary.

The Tribunal found that the applicant failed to demonstrate the treatment was reasonable and necessary, noting that the most recent psychological assessment revealed no diagnosable condition and that the applicant's current complaints appeared related to a subsequent accident.

The application was dismissed.

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

The respondent insurer determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and its $3,500 funding limit.

The applicant argued that pre-existing shoulder and psychological issues, along with accident-related chronic pain and psychological impairment, removed him from the MIG.

The Tribunal found insufficient medical evidence to support the applicant's claims, noting inconsistencies between the applicant's self-reports, his family physician's records, and the insurer's examinations.

The Tribunal concluded the injuries were predominantly minor and subject to the MIG limit, which the respondent had already substantially paid.

The disputed treatment plans were therefore not payable.

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

The respondent denied chiropractic treatment, a psychological assessment, and a chronic pain assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered from meralgia paresthetica and chronic pain as a result of the accident, removing him from the MIG.

In an addendum decision, the Tribunal found the chiropractic treatment and chronic pain assessment to be reasonable and necessary, subject to the $2,000 cap for assessments.

The psychological assessment was denied as not reasonable and necessary.

The applicant was awarded interest on overdue payments but denied an award under O. Reg. 664.

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

The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and that he did not suffer a complete inability to carry on a normal life.

The Tribunal found that the applicant's physical and psychological injuries were predominantly minor and subject to the MIG limit, which had already been exhausted.

The Tribunal also found that the applicant failed to prove a complete inability to carry on a normal life, as he had returned to substantially all of his pre-accident activities.

The application was dismissed.

The applicant sought medical benefits for physiotherapy, psychological treatment, and an orthopaedic assessment following a motor vehicle accident.

The adjudicator found that the insurer complied with the notice requirements under s. 38(8) of the Schedule.

The adjudicator dismissed the claims for physiotherapy, finding the applicant had reached maximum medical recovery and failed to exhaust collateral benefits.

The claim for an orthopaedic assessment was dismissed as it was available through OHIP.

The claim for further psychological treatment was dismissed as the applicant failed to prove the need for treatment beyond what the insurer had already partially approved.

The applicant sought statutory accident 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 suffered from meralgia paresthetica and chronic pain as a result of the accident, which removed him from the MIG.

However, the Tribunal concluded that the applicant did not suffer a psychological impairment.

Because the applicant failed to submit the disputed treatment plans (OCF-18s) into evidence, the Tribunal could not determine whether the claimed medical benefits and examination costs were reasonable and necessary, and allowed the applicant 30 days to submit them.

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.