Dr. Weisleder

The applicant sought $1,818.25 for chiropractic services following a motor vehicle accident.

The respondent denied the treatment plan, arguing the applicant had reached maximum medical recovery and the treatment was for unrelated issues.

The adjudicator found the applicant failed to meet her burden of proof, as she provided only case law and no contemporaneous corroborating evidence to support the treatment plan.

The applicant's request for $1,000 in costs due to the respondent exceeding page limits in its submissions was also dismissed, as the respondent's conduct was not found to be unreasonable, frivolous, vexatious, or in bad faith.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing her injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain, a pre-existing condition, and psychological impairment.

The Licence Appeal Tribunal found that the applicant's injuries fell within the MIG, as the medical evidence did not establish chronic pain with functional impairment, a significant aggravation of her pre-existing back pain, or a psychological impairment.

The Tribunal also dismissed the claim for non-earner benefits, finding the applicant did not suffer a complete inability to carry on a normal life.

The respondent's request for costs based on the applicant's prior withdrawal of a similar application was denied, as both parties had engaged in similar procedural behaviour and no bad faith was established.

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

The respondent denied benefits, arguing that the applicant's traumatic brain injury was caused by an intervening event—a fall from an examination table during medical treatment months after the accident.

The Tribunal agreed, finding the fall broke the chain of causation.

Consequently, the claim for a non-earner benefit and assessments related to the brain injury were dismissed.

However, the Tribunal found that treatment plans for chiropractic, physiotherapy, and aqua therapy services related to the accident injuries were reasonable and necessary, and ordered their payment with interest.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming income replacement benefits (IRBs) and a treatment plan for physiotherapy.

The Tribunal found the applicant met the pre-104 test for IRBs, as her accident-related physical and psychological impairments, combined with her age and pre-existing conditions, resulted in a substantial inability to perform her essential tasks as a cleaner.

However, the IRB amount was adjusted to $4.75 per week due to the age 65 ramp-down provision.

The applicant failed to prove entitlement to post-104 IRBs, as she did not establish a complete inability to engage in suitable employment.

Claims for an award and costs were dismissed, and the treatment plan was found to be no longer in dispute.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits (IRBs), attendant care benefits (ACBs), and various medical and rehabilitation benefits.

The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's right wrist pathology pre-dated the accident and was not exacerbated by it, and rejected the applicant's claim of an accident-related psychological injury.

Consequently, the Tribunal held that the applicant sustained a minor injury subject to the $3,500 funding limit, disentitling him to the disputed treatment plans and ACBs.

The Tribunal also dismissed the claim for IRBs, finding insufficient medical evidence to demonstrate a substantial inability to perform the essential tasks of his employment.

Claims for interest and an award were also dismissed.

The applicant sought entitlement to various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident, including a functional abilities evaluation, chiropractic services, physiotherapy, massage therapy, and occupational therapy.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to meet her burden of proving the proposed treatments were reasonable and necessary.

The Tribunal relied on the respondent's section 44 medical assessments, which indicated the applicant had returned to work and was functional in her activities of daily living, and noted a lack of objective medical evidence from the applicant to support the need for ongoing passive facility-based treatment.

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

The respondent denied the claims, asserting the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on physical injuries, psychological impairments, and chronic pain.

The Tribunal found the applicant failed to establish that her injuries warranted removal from the MIG, noting a lack of evidence connecting a shoulder tear to the accident, subclinical psychological test results, and failure to meet the AMA Guides criteria for chronic pain.

Consequently, the disputed treatment plans were deemed not reasonable and necessary, and the claims for an award and interest were dismissed.

The applicant sought statutory accident benefits for a $1,000 orthopaedic mattress following a motor vehicle accident.

The respondent denied the benefit, relying on an insurer's examination report which concluded the mattress was unlikely to assist in managing pain.

The Tribunal found the mattress to be reasonable and necessary, noting that multiple treating practitioners and assessors documented the applicant's ongoing sleep disturbances and fatigue.

The Tribunal afforded less weight to the respondent's expert, whose opinion was inconsistent with other medical evidence.

The applicant was awarded the cost of the mattress plus interest.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including attendant care benefits and physiotherapy treatment plans, which the respondent insurer denied.

The respondent raised a preliminary issue that the applicant's disputes were statute-barred by the two-year limitation period under s. 56 of the Schedule.

The Tribunal found that the attendant care benefit dispute was commenced within the limitation period because the initial denial was not clear and unequivocal.

For the $3,500.10 physiotherapy treatment plan, the Tribunal found the dispute was filed 45 business days late but granted an extension of time under s. 7 of the LAT Act, finding no prejudice to the respondent and some merit to the claim.

On the merits, the Tribunal found the $3,500.10 physiotherapy treatment plan was reasonable and necessary, but dismissed the claims for the $1,540.10 treatment plan and the remaining attendant care benefits for lack of evidence.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) from the respondent insurer.

The insurer denied the claim, arguing the applicant did not suffer a substantial inability to perform the essential tasks of her pre-accident employment as a waitress and usher.

The Tribunal found the applicant's medical evidence, including reports from an orthopaedic surgeon and a chiropractor, persuasive in establishing her functional limitations due to a fractured wrist, shoulder strain, and back pain.

The Tribunal placed little weight on the insurer's assessments, noting they were incomplete and failed to account for pain during testing.

The applicant was awarded IRBs of $315.27 per week for the disputed period, plus interest.

The applicant sought payment for several assessments, including a $24,400 catastrophic impairment assessment, following a 2009 motor vehicle accident.

The respondent denied the benefits, arguing the assessments were not reasonable and necessary and that any ongoing symptoms were attributable to a second accident in 2012.

The Tribunal found that the current Statutory Accident Benefits Schedule applied to the claim.

The Tribunal dismissed the application, concluding that the applicant failed to establish on a balance of probabilities that the requested assessments were reasonable and necessary for injuries resulting from the 2009 accident, given the lack of contemporaneous medical evidence and the intervening 2012 accident.

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

The respondent denied medical benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The adjudicator found that the applicant's injuries, which included radiculopathy and possible myeloradiculopathy as noted by the respondent's own neurological assessor, exhibited neurological signs that removed him from the MIG.

The adjudicator approved two physiotherapy treatment plans, finding one reasonable and necessary for pain relief, and the other payable because the respondent failed to provide adequate medical reasons for its denial under s. 38(8) of the Schedule.

An attendant care needs assessment was also approved.

However, the applicant's claim for a special award under Regulation 664 was dismissed as there was insufficient evidence that the respondent acted unreasonably.

The applicant sought statutory accident benefits, including an income replacement benefit (IRB) and medical benefits, following an ebike collision.

The Licence Appeal Tribunal dismissed the application, finding the applicant's evidence regarding her pre-accident income and inability to work lacked credibility and was contradicted by surveillance evidence showing her working and riding her ebike.

The Tribunal concluded the applicant suffered predominantly minor injuries subject to the $3,500 treatment cap, which had been exhausted, and that the requested treatment plans were not reasonable or necessary.

The applicant sought statutory accident benefits for physiotherapy and various assessments following a motor vehicle accident.

The respondent denied the claims on the basis that the treatments were not reasonable and necessary.

The Tribunal dismissed the application, finding that the applicant failed to meet the burden of proof.

The Tribunal entirely rejected the applicant's occupational therapy expert report, finding the assessor was biased, partisan, and provided opinions outside the scope of their expertise.

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

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that awarded the applicant the cost of an orthopaedic assessment.

The Tribunal originally found that the insurer failed to provide a 'clear and unequivocal' denial of the treatment plan and that the insurer requested an insurer's examination more often than reasonably necessary.

On reconsideration, the Vice-Chair held that the Tribunal made significant errors of law and fact, noting that section 38(8) of the Schedule does not require a 'clear and unequivocal' denial and that the insurer's notice was compliant.

The Vice-Chair also found a breach of procedural fairness because the insurer was not given an opportunity to make submissions on the frequency of examinations.

Upon reviewing the merits, the Vice-Chair concluded the applicant failed to prove the orthopaedic assessment was reasonable and necessary, and varied the decision to dismiss the application for the assessment.

The applicant sought coverage for four chiropractic treatment plans following a motor vehicle accident.

The respondent denied the plans based on an insurer's examination which concluded the applicant had reached maximum medical recovery.

The adjudicator found that the applicant had significant pre-existing conditions and provided inconsistent reporting regarding his symptoms and ability to work.

Accepting that the applicant's recovery had plateaued, the adjudicator concluded the treatment plans were not reasonable and necessary.

The appeal was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits and medical benefits for chronic pain.

The insurer had paid benefits up to the Minor Injury Guideline (MIG) limit and terminated income replacement benefits based on insurer examinations.

The arbitrator found that the applicant's injuries fell within the MIG, rejecting the chronic pain diagnosis due to credibility issues, positive Waddell signs, and invalid psychometric testing results.

The arbitrator also concluded that the applicant did not suffer a substantial inability to perform the essential tasks of his employment.

The claims for income replacement and medical benefits were dismissed, though the cost of a disability certificate was allowed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The respondent denied claims for a non-earner benefit and several treatment plans for medical treatment and examination expenses.

The Licence Appeal Tribunal found that the applicant was entitled to payment for psychological services, chronic pain assessments, aquatic therapy, and ambulance services, as these were reasonable and necessary given the applicant's pre-existing conditions and the aggravation caused by the accident.

However, the Tribunal denied the claims for chiropractic services, transportation, and orthopaedic, physiatry, and neurology assessments due to insufficient evidence.

The Tribunal also dismissed the claim for a non-earner benefit, finding that the applicant failed to prove a complete inability to carry on a normal life as a result of the subject accident, as her pre-accident activities were already significantly limited by prior accidents.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's physical injuries, including cervical and thoracic strains, were predominantly minor.

The Tribunal also found that the applicant failed to provide compelling evidence of a psychological injury or a pre-existing medical condition that would remove her from the MIG.

Consequently, the applicant is subject to the $3,500 MIG limit, and the claims for additional treatment plans and examination costs were dismissed.

The Appellant was injured in a motorcycle accident and sought ongoing post-104 week income replacement benefits (IRBs) and a special award from his insurer.

The Arbitrator awarded IRBs for a limited period and denied the special award.

On appeal, the Appellant argued he was entitled to ongoing IRBs due to the insurer's procedural non-compliance with termination requirements and that he met the post-104 week disability test.

The Director's Delegate dismissed the IRB appeal, finding no error of law and affirming that procedural errors do not grant benefits in perpetuity.

However, the Delegate rescinded the denial of the special award, finding the Arbitrator failed to provide adequate reasons addressing whether the insurer's continued refusal to pay IRBs was reasonable in light of new medical evidence provided.

The special award issue was remitted for redetermination.