Dr. Silverman

The applicant sought statutory accident benefits following a 2022 motor vehicle accident, claiming catastrophic impairment under Criterion 8, income replacement benefits, attendant care benefits, and various treatment plans.

The Licence Appeal Tribunal dismissed the majority of the claims, finding the applicant's self-reports of pre-accident functioning were inaccurate, as he was receiving long-term disability and Canada Pension Plan disability benefits prior to the accident.

Surveillance evidence and testimony contradicted the applicant's claims of severe social and functional isolation.

The Tribunal found the applicant did not sustain a catastrophic impairment, was not entitled to an IRB, and was only entitled to a minor portion of one treatment plan due to a late denial by the insurer.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, which were denied by the respondent insurer.

The applicant applied to the Licence Appeal Tribunal, arguing his injuries fell outside the Minor Injury Guideline (MIG) due to pre-existing conditions, chronic pain, and psychological impairments.

The Tribunal found the applicant failed to provide compelling medical evidence to support removal from the MIG, noting a lack of evidence linking his chronic pain or psychological complaints to the subject accident.

The Tribunal also dismissed the applicant's claim for a non-earner benefit, finding he failed to submit a disability certificate within the required 104-week period and did not meet the test for a complete inability to carry on a normal life.

Claims for medical benefits, examination expenses, and interest were similarly dismissed.

The applicant, a cyclist intentionally struck by a vehicle, sought statutory accident benefits for occupational therapy and chiropractic services, as well as a special award for unreasonable delay.

The Licence Appeal Tribunal partially approved the occupational therapy plan, finding it reasonable and necessary based on a contemporaneous psychiatric report diagnosing severe PTSD and depression.

The chiropractic plan was denied due to a lack of corroborating contemporaneous medical evidence.

The claim for a special award was dismissed as the insurer's denial was not found to be unreasonable.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident.

The adjudicator found that the applicant was barred from proceeding with her claims for non-earner benefits and an OCF-18 for assistive devices because she failed to commence her application within the two-year limitation period under s. 56 of the Schedule.

The adjudicator granted the OCF-18s for a physiatry assessment and chiropractic treatment, finding them reasonable and necessary to address ongoing pain complaints, and noted that the insurer's assessors lacked key medical records.

The remaining OCF-18s and a claim for an OCF-3 were dismissed.

The adjudicator awarded the applicant 10 percent of the payable OCF-18s under s. 10 of Regulation 664, finding the insurer's continued reliance on incomplete assessment reports to be inflexible.

The applicant was involved in a motor vehicle accident and sought various statutory accident benefits, including income replacement benefits (IRBs), attendant care benefits (ACBs), medical benefits, and cost of examination expenses.

The insurer denied the benefits.

The Tribunal found that the applicant did not suffer a substantial inability to perform the essential tasks of his pre-accident employment as an Uber driver, dismissing the IRB claim.

The ACB claim was also dismissed as the applicant failed to establish the benefits were reasonable and necessary beyond the period already paid.

The Tribunal granted funding for assistive devices and an in-home assessment, preferring the evidence of the applicant's in-home assessor.

The claim for psychological services was partially granted due to the insurer's deficient notice under s. 38(8) of the Schedule.

Claims for physiotherapy, chiropractic, dental services, and other assessments were dismissed for lack of persuasive medical evidence.

The request for an award for unreasonably withheld payments was denied.

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

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

The applicant argued her psychological injuries, chronic pain, and radiculopathy removed her from the MIG, and challenged the validity of the insurer's denial letters.

The Tribunal found the denial letters were valid and timely.

Weighing the medical evidence, the Tribunal preferred the respondent's psychological assessments, noting the applicant's experts failed to account for a subsequent motor vehicle accident and relied heavily on subjective reporting.

The Tribunal concluded the applicant failed to prove her injuries were not predominantly minor.

As the MIG limits were exhausted, the claims for further medical benefits were dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) for a six-month period during which the respondent insurer had terminated them.

The adjudicator found that the applicant, who worked as a personal support worker at two locations prior to the accident, suffered physical impairments that rendered her substantially unable to perform the essential tasks of her employment.

Relying on the applicant's medical evidence, including reports from her family doctor and specialists, the adjudicator ordered the respondent to pay the IRBs with interest.

However, the applicant's request for an award under Ontario Regulation 664 for unreasonable delay was denied, as the respondent had actively assessed the file and relied on its own medical assessors.

The appellant, suffering from Type 1 Diabetes, appealed convictions for impaired driving, driving over .08, and failing to stop for police.

She raised a defence of necessity, arguing her actions were due to hypoglycemia.

The trial judge rejected her evidence and that of her expert endocrinologist, Dr. Silverman, finding no imminent risk or lack of reasonable alternatives.

The appeal court found the trial judge's rejection of the expert evidence unreasonable and her analysis of the cause of impairment incomplete, constituting a palpable and overriding error.

The applicant sought payment for an income replacement benefit, chiropractic services, psychological services, and custom orthotics following a motor vehicle accident.

The Licence Appeal Tribunal dismissed all claims.

The applicant failed to prove a substantial inability to perform the essential tasks of his pre-accident employment after May 2017.

The chiropractic treatment plans were not shown to be reasonable and necessary, the psychological services were duplicative, and the custom orthotics expense was incurred before submitting a treatment plan, contrary to section 38(2) of the Schedule.

The applicant sought statutory accident benefits following a 2014 motor vehicle accident, claiming entitlement to non-earner benefits, medical benefits for orthotics and physical therapy, and the cost of examinations for a chronic pain assessment and a Functional Abilities Evaluation.

The arbitrator dismissed all claims.

Relying on surveillance evidence and the insurer's expert reports, the arbitrator found the applicant did not suffer a complete inability to carry on a normal life.

The arbitrator also found the applicant's expert testimony inconsistent and unreliable, concluding that the proposed treatment plans and assessments were not proven to be reasonable and necessary.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, which the insurer denied.

The central issue was whether the applicant's injuries met the threshold for catastrophic impairment.

The arbitrator preferred the evidence of the applicant's experts, finding that the applicant suffered a marked psychological impairment and significant physical impairments, rendering her catastrophically impaired.

The arbitrator awarded various medical benefits, attendant care benefits, housekeeping and home maintenance benefits, and the costs of several assessments.

Claims for a driver desensitization assessment, a worksite assessment, and a special award were dismissed.

Interest was awarded on overdue payments.

The applicant sought expenses following a successful arbitration for statutory accident benefits.

The insurer conceded entitlement but disputed the quantum of legal fees and expert disbursements.

The arbitrator assessed the legal fees, allowing the full time claimed by the junior lawyer who had carriage of the file, but reducing the time claimed by the senior lawyer for duplication.

The arbitrator also assessed the disbursements for various medical experts, reducing some hourly rates to the maximum allowed under Schedule F of the Dispute Resolution Practice Code, and reducing the amounts claimed for certain medical assessments and reports.

The total expenses awarded were $18,888.71.