Dr. Shahriar Moshiri

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

The adjudicator found that the applicant suffered soft tissue injuries, fractured ribs, and psychological injuries, but failed to prove a substantial inability to perform the essential tasks of his pre-accident employment after January 21, 2020.

The claims for psychological treatment were dismissed because the treatment plans did not comply with the Schedule, as they listed a psychological associate as the provider while the services were actually provided by an unsupervised psychotherapist.

The adjudicator also found the requested 1.5-hour sessions were not reasonable or necessary compared to the 1-hour sessions recommended by the respondent's assessor.

The applicant was awarded $50.39 for the cost of preparing one treatment plan due to an improper denial, with interest.

The applicant sought a non-earner benefit following a motor vehicle accident, claiming a complete inability to carry on a normal life due to physical and psychological impairments.

The respondent denied the benefit, arguing the applicant's psychological issues were pre-existing and that she failed to meet the rigid test for a complete inability.

The Tribunal found that the applicant's psychological assessments lacked objective baseline information regarding her pre-accident activities and afforded them less weight.

Relying on pre-accident medical records showing significant pre-existing limitations, the Tribunal concluded the applicant failed to prove her impairments were caused by the accident or that she suffered a complete inability.

The application was dismissed.

The applicant, a convenience store owner and cashier, sought income replacement benefits (IRBs) following a motor vehicle accident.

The respondent insurer terminated the benefits after eight months.

The Licence Appeal Tribunal found that the applicant failed to prove she suffered a substantial inability to perform the essential tasks of her employment.

Medical evidence, including insurer examinations, indicated she retained reasonable physical function and her essential tasks were primarily administrative or light physical work.

The application was dismissed.

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 Tribunal found that while the applicant's physical injuries were predominantly minor, he had sustained a psychological impairment (adjustment disorder with depressed mood) that removed him from the MIG.

Consequently, the Tribunal approved the treatment plans for a psychological assessment and psychological treatment, along with interest.

The claims for physical therapy were dismissed as not reasonable and necessary.

The respondent insurer requested a reconsideration of a previous Tribunal decision that found the applicant entitled to various treatment plans, including chiropractic treatment, an attendant care assessment, a chronic pain assessment, and a psychological assessment.

The insurer argued that the Tribunal erred in law by applying incorrect tests to determine whether the treatment plans were reasonable and necessary, relying too heavily on the applicant's subjective reporting.

The adjudicator dismissed the request for reconsideration, finding that the Tribunal had properly applied the Statutory Accident Benefits Schedule, considered the evidence in its totality (including objective medical evidence), and made no errors of law or fact that would have changed the outcome.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a psychological assessment, physical therapy, and psychological treatment.

The respondent insurer denied portions of the treatment plans.

The Tribunal found that the applicant failed to prove the disputed costs for the psychological assessment and treatment were reasonable and necessary, as the insurer's examiners had found the proposed costs excessive or partially unnecessary.

However, the Tribunal awarded the cost of the physical therapy based on the recommendation of the applicant's family doctor, which the insurer failed to rebut with medical evidence.

The applicant sought various statutory accident benefits following a motor vehicle accident, including attendant care benefits and multiple treatment plans for psychological and physical injuries.

The Licence Appeal Tribunal denied the claim for attendant care benefits because the applicant failed to prove the expenses were incurred.

However, the Tribunal ordered the insurer to pay for several treatment plans, including a psychological assessment and physical therapy, because the insurer failed to provide proper medical reasons for its denials as required by section 38(8) of the Schedule.

The Tribunal also approved a chronic pain assessment and shockwave therapy based on medical evidence of ongoing pain, but denied other treatment plans for lack of evidence of reasonableness and necessity.

The claim for a special award was dismissed.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, which the respondent insurer denied.

The applicant applied to the Licence Appeal Tribunal for dispute resolution.

The adjudicator found that the applicant was entitled to a comprehensive chiropractic treatment plan, an attendant care assessment, a chronic pain assessment, and a psychological assessment, as they were reasonable and necessary given the applicant's ongoing pain and psychological impairments.

However, two duplicative chiropractic treatment plans were denied.

The adjudicator also awarded interest on overdue payments but denied the applicant's requests for a special award and costs, finding no evidence of unreasonable conduct by the respondent.

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

The respondent partially approved a psychological assessment plan, reducing the requested fee of $2,267.80 to $1,389.87 based on an insurer's examination.

The Tribunal found that the respondent's assessor failed to provide a rationale for the reduced fee breakdown and that the applicant's assessor was not required to provide an hourly breakdown under the Schedule.

The Tribunal ordered the respondent to pay the outstanding balance of $877.93 plus interest.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for psychological services and a speech language pathology assessment.

The respondent insurer partially denied the psychological treatment plan, arguing that 1-hour sessions were sufficient rather than the 1.5-hour sessions recommended by the treating psychologist.

The respondent also denied the speech language pathology assessment.

The Licence Appeal Tribunal found that the 1.5-hour psychological sessions were reasonable and necessary, preferring the treating psychologist's recommendation.

However, the Tribunal denied the speech language pathology assessment, finding insufficient evidence of a speech impairment, as the pathologist had not examined the applicant before recommending the assessment.

The applicant was awarded the balance for the psychological services with interest.

The applicant sought statutory accident benefits for chiropractic treatment and a psychological assessment following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant had reached maximum medical recovery for her physical injuries and that her ongoing complaints were due to pre-existing rheumatoid arthritis.

The Tribunal also denied the psychological assessment, relying on an insurer's examination that found no psychological injury and the applicant's own statements that she did not need psychological treatment.

Claims for an award and interest were consequently dismissed.

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

The respondent insurer denied several treatment plans for chiropractic, massage, and psychological services on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained predominantly minor physical injuries, such as soft tissue sprains and strains, and that her psychological symptoms did not remove her from the MIG.

As the applicant failed to prove her injuries warranted treatment outside the MIG, the application for the disputed treatment plans was dismissed.

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

The respondent insurer denied treatment plans for psychiatric, social work, and chronic pain assessments 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 injuries.

The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain or psychological injuries caused by the accident, preferring the insurer's expert evidence over the applicant's.

As the applicant's injuries did not fall outside the MIG and the $3,500 funding limit was exhausted, the application was dismissed.

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

The insurer denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant suffered from chronic pain syndrome, removing him from the MIG.

The Tribunal ordered the insurer to pay for a chronic pain assessment but denied the claim for an occupational therapy assessment, as it was not recommended by the applicant's own chronic pain expert.

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

The central issue was whether the applicant's injuries fell within the Minor Injury Guideline (MIG), which caps benefits at $3,500.

The applicant argued that psychological impairments and chronic pain syndrome removed him from the MIG.

The Tribunal found that the applicant failed to prove a psychological injury, preferring the insurer's psychological assessment over the applicant's due to inconsistencies in the applicant's self-reporting.

While the Tribunal accepted that the applicant suffered from chronic pain syndrome, it concluded that the chronic pain symptoms were clinically associated sequelae to his minor soft-tissue injuries, and therefore fell within the MIG definition.

Consequently, the applicant's claims for various treatment and assessment plans were denied as the $3,500 limit applied.

The applicant was struck by a vehicle while crossing an intersection as a pedestrian.

She applied for accident benefits, but the respondent insurer denied treatment plans for psychological and physiotherapy services, arguing her injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's severe major depressive disorder and situational phobia, as diagnosed by her psychologist, removed her from the MIG.

The Tribunal ordered payment for the psychological services as reasonable and necessary, but denied the physiotherapy services due to insufficient evidence supporting their necessity.