Dr. Shari Schwartz

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to physiotherapy, a chronic pain assessment, and a psychological assessment outside the Minor Injury Guideline (MIG).

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

The Tribunal found that the applicant's physical injuries were mechanical and myofascial in nature, and his psychological symptoms were minimal and below average.

The Tribunal also found no compelling medical evidence that the applicant's pre-existing seizure disorder precluded recovery within the MIG.

The application was dismissed, and the applicant was held to the MIG limits.

The applicant sought payment for a chronic pain assessment following a 2019 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to provide sufficient medical evidence, such as contemporaneous complaints to her family doctor, to establish grounds for the assessment.

The Tribunal dismissed the application, denying the treatment plan, interest, and a claim for a special award.

The applicant sought statutory accident benefits following a motor vehicle accident, including chiropractic services, a home exercise program, a psychological assessment, and a chronic pain assessment.

The adjudicator found that the applicant failed to prove the chiropractic services, home exercise program, and chronic pain assessment were reasonable and necessary.

The adjudicator rejected the applicant's argument that the treatment plans were payable due to the respondent's late denial notices, holding that the expenses had not been incurred prior to the notices being delivered.

The psychological assessment was found payable in part, and the claims for a special award and costs were dismissed.

The applicant sought payment for a psychological assessment and a chronic pain assessment following a motor vehicle accident.

The Tribunal denied the psychological assessment because the applicant incurred the cost before the treatment plan was properly submitted to the respondent, violating s. 38(2) of the Schedule.

However, the Tribunal granted the chronic pain assessment, finding it reasonable and necessary given the applicant's exacerbation of pre-existing pain and functional limitations.

The claim for an award under s. 10 of O. Reg. 664 was dismissed as the insurer's denials were not unreasonable.

The applicant was injured in a motor vehicle accident and sought various medical benefits under the Statutory Accident Benefits Schedule, which were denied by the respondent insurer.

The applicant applied to the Licence Appeal Tribunal to dispute the denials of treatment plans for acupuncture, physiotherapy, chiropractic treatment, chronic pain programs, a functional abilities evaluation, and disability certificates.

The Tribunal found that the applicant proved the reasonableness and necessity of the acupuncture, physiotherapy, chiropractic treatment, functional abilities evaluation, and the psychological components of the chronic pain programs.

The physical components of the chronic pain programs and the disability certificates were denied.

Furthermore, the Tribunal awarded the applicant a 25 percent special award under O. Reg. 664 for the insurer's unreasonable delay and withholding of specific benefits, noting the insurer failed to properly consider all available medical information, including its own assessors' reports.

The applicant was injured in a rear-end motor vehicle accident and sought medical and attendant care benefits from the respondent insurer.

The adjudicator denied the claim for attendant care benefits, finding the applicant failed to incur the expenses.

However, the adjudicator granted entitlement to four physiotherapy treatment plans, a psychological treatment plan, a functional impairment assessment, and a chronic pain assessment, finding them reasonable and necessary.

The adjudicator also awarded a 20% special award under Regulation 664 regarding the functional impairment assessment, concluding the insurer unreasonably withheld approval by relying on an assessor's unconvincing change of opinion.

The applicant sought medical and rehabilitation benefits, including chiropractic and physiotherapy treatment plans, following a motor vehicle accident.

The adjudicator found that the applicant failed to prove the treatment plans were reasonable and necessary, relying on the respondent's orthopaedic assessments which found no objective evidence of accident-related impairment.

The applicant's claim for a psychological assessment was also dismissed as a duplication of service.

Furthermore, the adjudicator ordered the applicant to repay $8,583.12 in income replacement benefits that were overpaid due to an insurer error, as the applicant failed to establish any exception to the repayment obligation under section 52 of the Schedule.

Claims for a section 10 award and costs were dismissed.