Dr. Velan Sivasubramanian

The applicant sought statutory accident benefits, claiming she sustained a catastrophic impairment under Criterion 8 (mental or behavioural disorder) following a motor vehicle accident.

The applicant argued she suffered a marked impairment in adaptation, relying on psychiatric and occupational therapy evidence.

The respondent contended the impairment was mild, pointing to pre-existing physical health issues and inconsistencies in the applicant's self-reported functioning.

The Tribunal found the applicant's evidence failed to differentiate between physical and mental impairments, concluding her limitations were primarily physical and pre-existing.

The Tribunal held the applicant suffered only a mild impairment in adaptation and did not meet the threshold for catastrophic impairment.

Both parties' requests for costs were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident while a passenger in a stolen truck.

The Tribunal found that the applicant knew or ought to have known the vehicle was stolen, barring him from receiving income replacement benefits under section 31(1)(c) of the Schedule.

The Tribunal also determined that the applicant did not sustain a catastrophic impairment under Criterion 8, preferring the respondent's medical assessments which indicated his mental and behavioural impairments were largely pre-existing and related to longstanding substance abuse.

The applicant's claims for benefits, interest, and an award were dismissed, and costs of $300 were awarded to the respondent due to the applicant's failure to attend cross-examination.

The applicant insurer sought repayment of $85,181.38 in income replacement benefits (IRBs) paid to the respondent following a 2010 motor vehicle accident.

The insurer alleged the respondent engaged in willful misrepresentation by working post-accident while denying employment to assessors.

The Tribunal found it had jurisdiction to hear the dispute and concluded the respondent willfully misrepresented his employment status.

As the respondent failed to provide evidence to calculate the exact quantum of repayment, the Tribunal ordered the full amount of $85,181.38 to be repaid, plus interest.

The applicant sought a determination of catastrophic impairment and entitlement to income replacement benefits (IRB), attendant care benefits (ACB), and various treatment plans following a 2018 motor vehicle accident.

The Tribunal found the applicant did not meet the 55% whole person impairment threshold under Criterion 7, concluding his combined physical and mental impairment rating was 40%.

The Tribunal also found the applicant failed to prove a complete inability to engage in suitable employment, dismissing the claim for post-104-week IRB.

As the applicant was not catastrophically impaired and had exhausted non-catastrophic limits, the claims for ACB and treatment plans were also dismissed.

The applicant, a law student who was struck by a vehicle while riding a bicycle, sought a determination of catastrophic impairment under Criterion 8 (mental and behavioural disorders) and entitlement to various treatment plans.

The Tribunal found that the applicant did not meet the threshold for catastrophic impairment, as he did not demonstrate a marked impairment in three of four functional domains.

Despite accident-related challenges, the applicant successfully completed law school, passed the bar, and maintained employment as a lawyer.

The Tribunal also dismissed the claims for the disputed treatment plans, finding that the applicant failed to prove they were reasonable and necessary.

The applicant sought a determination that she sustained a catastrophic impairment under Criteria 4 and 8 of the Statutory Accident Benefits Schedule following a motor vehicle accident, as well as entitlement to psychological services.

The Tribunal found that the applicant did not meet Criterion 4 because there were no positive findings of a traumatic brain injury on recognized diagnostic imaging.

The Tribunal also found that the applicant did not meet Criterion 8, as the evidence demonstrated she had been working part-time as a personal support worker, which was inconsistent with a Class 5 extreme impairment in work functioning.

The claim for psychological services was dismissed as not reasonable and necessary.

The respondent's request for costs was also dismissed.

The applicant sought a determination of catastrophic impairment (CAT) under criterion 8 of the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent denied the CAT designation, arguing the applicant's impairments were caused by pre-existing conditions and prior accidents.

The Tribunal applied the "but for" test and found the accident caused the applicant's psychological impairments, including somatic symptom disorder.

The Tribunal concluded the applicant suffered a marked impairment in activities of daily living, concentration, persistence and pace, and adaptation, thereby meeting the CAT threshold.

However, the applicant's claims for travel expenses for his daughter's flight and out-of-town CAT assessments were dismissed for lack of evidence establishing they were reasonable and necessary.

The claim for an award under s. 10 of Regulation 664 was also dismissed.

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

She applied for a catastrophic impairment determination based on psychological and neurological impairments.

The Tribunal found the applicant was not catastrophically impaired, as her mental and behavioural disorders resulted in only mild impairments in social functioning and concentration, persistence, and pace, and there was insufficient evidence of a mild traumatic brain injury to meet the 55% whole person impairment threshold.

The Tribunal allowed the applicant to change her election from a non-earner benefit to an income replacement benefit, finding the initial election invalid because the insurer failed to provide a proper explanation of benefits.

The insurer was granted a repayment of the non-earner benefit due to deductible collateral benefits.

The Tribunal approved one occupational therapy treatment plan and awarded a 10% special award under s. 10 of O. Reg. 664, finding the insurer unreasonably maintained its denial despite acknowledging the plan should have been reassessed.

Claims for a massage chair, attendant care benefits, and other assessments were dismissed.

The applicant was injured in a 1994 motor vehicle accident and sought a supervisory level of attendant care benefits (ACB) and several treatment plans after reopening her claim in 2015.

The respondent denied the benefits, arguing a lack of causation and relying on insurer's examinations that recommended minimal care.

The Tribunal found the applicant suffered from conversion disorder causing unpredictable, debilitating tremors, necessitating 24/7 supervisory care for her safety.

The Tribunal awarded the maximum $3,000 monthly ACB, past ACB, and all disputed treatment plans.

Furthermore, the Tribunal ordered a 50% special award against the respondent under s. 10 of Regulation 664, finding the insurer's prolonged reliance on a baseless causation argument to deny benefits was excessive, stubborn, and unreasonable.

The applicant sought a catastrophic impairment designation due to a mental or behavioural disorder following a motor vehicle accident.

The Tribunal found that the applicant did not meet the criteria for a Class 4 (Marked) impairment in three of the four domains under the AMA Guides.

The evidence indicated that many of the applicant's functional limitations, including social withdrawal and learning difficulties, pre-dated the accident.

As the applicant was not catastrophically impaired and the non-catastrophic medical and rehabilitation limits were exhausted, the claims for treatment plans, a section 10 award, and interest were dismissed.

The applicant sought a determination that he sustained a catastrophic impairment following a motor vehicle accident, claiming a whole person impairment of 55% or more.

The Tribunal reviewed extensive medical evidence and expert testimony regarding the applicant's physical and psychological impairments, including gait derangement, spine impairment, traumatic brain injury, and mental/behavioural disorders.

The Tribunal concluded the applicant's combined whole person impairment was 41%, falling short of the 55% threshold.

Consequently, claims for attendant care beyond the 104-week limit were dismissed.

The Tribunal partially approved treatment plans for a chronic pain program, chiropractic spinal manipulation, and psychotherapy, subject to remaining policy limits.

Claims for a special award and costs were dismissed.

The applicant sought a non-earner benefit, a special award, and interest following a motor vehicle accident.

The Licence Appeal Tribunal found the applicant's testimony regarding his post-accident impairments and inability to work lacked credibility, noting social media evidence suggesting he owned and operated a restaurant during the disputed period.

The Tribunal preferred the respondent's medical experts, who consistently concluded the applicant did not suffer a complete inability to carry on a normal life.

The application was dismissed in its entirety.

The insurer requested reconsideration of a decision awarding the applicant non-earner benefits, a psychological assessment, and a special award.

The adjudicator admitted late correspondence from the insurer as new evidence.

Based on this new evidence, the adjudicator varied the start date for the non-earner benefits from September 22, 2016, to October 25, 2016, and rescinded the special award regarding the non-earner benefits, finding the insurer's conduct was not unreasonable.

The adjudicator dismissed the insurer's arguments regarding the psychological assessment, finding no error in giving little weight to an insurer's examination report that was not in existence when the treatment plan was denied.

The applicant sought weekly caregiver benefits following a 2010 motor vehicle accident.

The insurer terminated benefits in September 2012.

The arbitrator found the applicant's evidence lacked credibility, noting numerous inconsistencies regarding her injuries, substance abuse, and the fact that her children had been removed from her care by Family and Children's Services in 2011 for reasons unrelated to the accident.

The arbitrator preferred the evidence of the insurer's assessors and concluded the applicant was not the primary caregiver at the time of the accident, did not suffer a complete inability to carry on a normal life, and did not incur the claimed caregiving expenses.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits, attendant care benefits, and various treatment plans.

The Tribunal found that the insurer failed to properly deny the non-earner benefits and a psychological assessment treatment plan in accordance with the Statutory Accident Benefits Schedule, entitling the applicant to those benefits for the period of the insurer's non-compliance.

However, the applicant failed to prove a complete inability to carry on a normal life for the ongoing period.

The Tribunal also awarded a 25% penalty under O. Reg. 664 due to the insurer's unreasonable delay in adjusting the claim, particularly given the applicant's known vulnerability due to pre-existing schizophrenia.

The applicant sought accident benefits following a motor vehicle accident where a garage door closed on his car.

The insurer denied the treatment plans, arguing the applicant's injuries fell under the Minor Injury Guideline (MIG) and were related to pre-existing conditions.

The arbitrator found no compelling evidence that the applicant suffered an impairment directly related to the accident or that his pre-existing chronic pain was exacerbated by it.

The application for medical benefits, cost of examinations, and interest was dismissed.