Dr. Shafik Dharamshi

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

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

The Tribunal found the applicant did not meet her burden to prove chronic pain with functional impairment or a psychological injury warranting removal from the MIG.

However, because the respondent failed to provide compliant denial notices within the required 10-day period under section 38(8) of the Schedule, the Tribunal ordered the respondent to pay for the incurred treatment plans from the 11th day after submission until the date the defective notices were cured.

The applicant's claim for an award for unreasonable delay was dismissed.

The applicant sought entitlement to statutory accident benefits for psychological and physiotherapy treatment plans, a general practitioner's assessment, and a special award following a 2019 motor vehicle accident.

The Licence Appeal Tribunal found the applicant was partially entitled to one psychological treatment plan, preferring the treating psychiatrist's clinical notes over the respondent's section 44 assessor.

The remaining psychological and physiotherapy plans were denied as the applicant failed to prove they were reasonable and necessary, with the Tribunal finding the applicant had reached maximum medical improvement physically.

The claim for the general practitioner's assessment was barred by issue estoppel from a previous Tribunal decision.

No special award was granted as the insurer's conduct was not unreasonable.

The applicant sought a non-earner benefit, interest, and an award under s. 10 of O. Reg. 664 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.

The Tribunal preferred the respondent's multidisciplinary insurer's examination reports, which showed the applicant retained functional capacity and continued to engage in self-care and childcare, over the applicant's incomplete disability certificate.

As no benefits were payable, the claims for interest and an award were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB) and numerous treatment and assessment plans.

The Licence Appeal Tribunal dismissed the application in its entirety.

The adjudicator found that the applicant failed to prove a substantial inability to perform the essential tasks of his pre-accident employment, relying on the respondent's medical assessments which found no residual physical or neurological impairments preventing his return to work.

The adjudicator also denied all disputed treatment plans, finding that several were not entered into evidence, while others included unpayable expenses such as personal protective equipment (PPE) and unauthorized transportation costs.

As no benefits were payable, the claim for interest was also dismissed.

The applicant sought $4,223.90 for a chiropractic treatment plan following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the proposed treatment was not reasonable and necessary.

The Tribunal accepted the respondent's medical assessment evidence, which indicated that the applicant had achieved maximum medical recovery and had normal ranges of motion, consistent with the clinical notes of the applicant's treating family physician.

Claims for interest and a special award were consequently dismissed.

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

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove a substantial inability to perform the essential tasks of his employment or a complete inability to engage in any employment.

The Tribunal also found the proposed treatment plans were not reasonable and necessary, relying on the respondent's s. 44 assessment reports which the applicant did not dispute.

Claims for an award and interest were consequently dismissed.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including multiple treatment plans for physiotherapy, a TENS unit, a chronic pain program, and various assessments.

The respondent insurer denied the benefits, arguing the physical injuries were minor and the applicant had reached maximum medical recovery.

The Tribunal found that five of the physiotherapy treatment plans were reasonable and necessary, and that one of the respondent's denial notices failed to comply with the medical reasons requirement under s. 38(8) of the Schedule.

However, the Tribunal dismissed the claims for the remaining treatment plans, finding insufficient evidence to support them.

The Tribunal also denied the applicant's request for a special award under s. 10 of Reg. 664, finding no unreasonable withholding or delay by the respondent.

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

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

The Tribunal found that the applicant failed to provide substantive evidence to warrant removal from the MIG.

However, the Tribunal ordered the insurer to pay for a psychological assessment and a psychological pre-screening because the insurer failed to provide compliant denial notices under s. 38(8) of the Schedule before the expenses were incurred.

The remaining treatment plans were denied as they were not incurred prior to the insurer issuing compliant denial notices.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB) and two treatment plans for chronic pain and attendant care assessments.

The Licence Appeal Tribunal dismissed the application.

The Tribunal found the applicant failed to prove entitlement to the IRB and that his application for the benefit was incomplete due to his failure to submit an Election of Income Replacement, Non-Earner or Caregiver Benefit form (OCF-10).

The Tribunal also found no compelling evidence that the proposed treatment plans were reasonable and necessary, relying on the unrefuted opinion of the respondent's physiatrist that the applicant's injuries were soft tissue in nature.

The applicant, who sustained a catastrophic impairment including a traumatic brain injury in a motor vehicle accident, sought various statutory accident benefits.

The Licence Appeal Tribunal found the applicant was entitled to a non-earner benefit for a limited period, as she demonstrated a complete inability to carry on a normal life.

The Tribunal also approved a treatment plan for psychological services, finding it reasonable and necessary given her ongoing psychological impairments.

However, claims for a rehabilitation support worker, occupational therapy, kinesiology, and life skills training were dismissed due to insufficient evidence or because similar previously approved funds remained unutilized.

The claim for a special award was dismissed as the insurer did not act in bad faith.

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

The insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the funding limits had been exhausted.

The applicant argued she should be removed from the MIG due to pre-existing carpal tunnel syndrome, chronic pain, and psychological injuries.

The Tribunal found the applicant failed to provide compelling medical evidence that her pre-existing condition prevented maximal recovery within the MIG, or that her physical and psychological injuries were more than minor sequelae.

As the MIG limits were exhausted, the disputed treatment plans and claim for interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his psychological impairments and chronic pain warranted removal from the Minor Injury Guideline (MIG).

The respondent denied the benefits, arguing the injuries were predominantly minor soft tissue injuries.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from a psychological impairment or chronic pain with functional impairment that would remove him from the MIG.

The Tribunal preferred the respondent's medical assessments, noting the applicant had returned to full-time work and had not reported psychological symptoms to his treating physicians.

The application was dismissed, and the disputed treatment plans were found not payable as they exceeded the $3,500 MIG limit.

The applicant sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent insurer denied the treatment plans.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the disputed treatment plans were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's assessors, noting credibility issues and a lack of contemporaneous medical evidence supporting the applicant's assessors.

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

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 that the applicant's chronic left shoulder pain and resulting functional limitations removed him from the MIG.

The Tribunal preferred the evidence of the applicant's physiatrist and treating physicians over the respondent's section 44 assessors.

The applicant was awarded all disputed treatment plans for chiropractic services and a physiatry assessment, plus interest on overdue payments.

The applicant sought a non-earner benefit and a physiotherapy 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, relying on insurer examination reports that indicated symptom magnification and an ability to perform pre-accident activities.

The claim for physiotherapy was also dismissed as the applicant provided no supporting evidence or submissions.

The respondent's request for costs was denied for failing to comply with the Tribunal's procedural rules.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that pre-existing conditions and chronic pain warranted removal from the MIG.

The Tribunal found insufficient objective medical evidence to establish that the applicant suffered from accident-related chronic pain or that pre-existing conditions prevented her recovery within the MIG limits.

The Tribunal also found the disputed physiotherapy treatment plan was not reasonable and necessary.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including five physiotherapy treatment plans, a chronic pain assessment, and a functional impairment evaluation.

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 physical or psychological injuries fell outside the MIG, preferring the respondent's independent medical examination reports over the applicant's experts.

The Tribunal approved the first two physiotherapy treatment plans as reasonable and necessary, subject to the $3,500 MIG limit, but denied the remaining plans and assessments due to a lack of objective medical evidence.

The applicant was awarded interest on the approved plans but denied a special award for unreasonable delay.

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

The insurer denied claims for physiotherapy and a psychological assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant sustained a psychological impairment, removing her from the MIG.

The Tribunal denied the physiotherapy claims for lack of evidence but granted the psychological assessment and interest on overdue payments.

The applicant sought reconsideration of a Licence Appeal Tribunal decision that found her subject to the Minor Injury Guideline (MIG) and denied several disputed medical benefits.

The applicant argued the Tribunal erred in its application of s. 38 of the Statutory Accident Benefits Schedule, violated procedural fairness by admitting expert reports without cross-examination, and incorrectly assessed her physical and psychological impairments.

The adjudicator dismissed the request for reconsideration in full, finding no significant errors of law or fact, and concluding that the admission of the expert reports was an appropriate exercise of the Tribunal's procedural powers.

The adjudicator also affirmed that the applicant's injuries, including TMJ dysfunction and psychological distress, were properly classified as minor injuries or clinically associated sequelae.

The applicant sought medical benefits following a motor vehicle accident, arguing her physical and psychological injuries, including TMJ disorder and driving anxiety, warranted removal from the Minor Injury Guideline (MIG).

The Tribunal found the applicant's injuries were predominantly minor and subject to the $3,500 MIG limit.

The Tribunal also rejected the argument that the insurer's failure to comply with the section 38(8) timeline permanently barred it from relying on the MIG.

The insurer was ordered to pay the remaining $465.97 under the MIG limit for incurred physiotherapy, but the claims for TMJ and psychological assessments, as well as a claim for an award, were dismissed.