Jessica Telfer

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

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

The applicant argued that she suffered from chronic pain and psychological impairments warranting removal from the MIG, and sought a non-earner benefit (NEB) and various treatment plans.

The Tribunal found that the applicant failed to prove on a balance of probabilities that her injuries fell outside the MIG, noting a lack of compelling medical evidence linking her chronic pain and psychological complaints to the accident.

The Tribunal also dismissed the claim for an NEB, finding insufficient evidence comparing her pre- and post-accident activities.

The application was dismissed.

The applicant sought $4,383.90 for chiropractic services following a motor vehicle accident, along with interest and an award for unreasonable delay.

The adjudicator found that the applicant failed to prove the treatment was reasonable and necessary, noting a lack of corroborating contemporaneous medical evidence in the family doctor's clinical notes.

The application was dismissed, and no interest or award was payable.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically a treatment plan for chiropractic services, massage, and acupuncture.

The respondent denied the benefits and brought a preliminary motion to exclude late-produced clinical notes from the applicant's family doctor.

The Tribunal admitted the late records, finding them highly relevant and necessary to avoid prejudice to the applicant, noting the applicant had made timely efforts to obtain them.

On the merits, the Tribunal found the applicant partially entitled to the treatment plan, approving the massage and acupuncture based on the family doctor's recommendations, but denying the chiropractic treatment as it was never recommended.

The claim for an award for unreasonable delay was dismissed.

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

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

The applicant claimed she suffered from chronic pain and psychological injuries warranting removal from the MIG, relying on reports from a physician and a psychologist.

The Tribunal found that the expert reports were not corroborated by contemporaneous medical records, which indicated the applicant's injuries had largely resolved within five months of the accident.

The Tribunal concluded the applicant failed to establish her injuries fell outside the MIG, dismissed the claims for the disputed treatment plans, and denied interest.

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

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

The applicant argued for removal from the MIG based on chronic back pain.

The Tribunal found the applicant failed to establish chronic pain with functional impairment, relying on contemporaneous medical records showing resolved muscle pain and minimal medication use.

The Tribunal concluded the injuries were predominantly minor, dismissing the claims for treatment plans and interest.

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

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

The applicant argued for removal from the MIG based on chronic pain and psychological injury.

The Tribunal found the applicant failed to establish chronic pain with functional impairment or a psychological condition warranting further investigation.

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

The applicant sought statutory accident benefits for medical services and other goods and services following a motor vehicle accident.

The respondent denied the benefits and the matter proceeded to a written hearing.

The adjudicator declined to allow the respondent to raise a new preliminary issue regarding the applicant's failure to submit an application for benefits on time, finding it procedurally unfair.

The adjudicator also excluded late-filed medical records and a chiropractor's letter submitted by the applicant, as they were produced after the disclosure deadline without explanation, prejudicing the respondent.

Ultimately, the application was dismissed because the applicant failed to provide copies of the disputed treatment plans or make specific submissions to establish that the proposed services were reasonable and necessary.

The applicant sought a non-earner benefit and approval for several treatment plans following a motor vehicle accident.

The Tribunal found that the applicant failed to prove a complete inability to carry on a normal life, as medical records indicated a return to functional baseline and independence in activities of daily living.

The Tribunal also dismissed the claims for physiotherapy, occupational therapy, and attendant care assessments, finding insufficient medical evidence to establish that the proposed treatments were reasonable and necessary.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to pre-104 and post-104 income replacement benefits (IRBs).

The Licence Appeal Tribunal found that the applicant failed to provide sufficient medical evidence to demonstrate a substantial inability to perform the essential tasks of his pre-accident employment for the pre-104 period.

Furthermore, the applicant did not provide compelling medical evidence to establish a complete inability to engage in any suitable employment for the post-104 period.

The application for IRBs and interest was dismissed.

The applicant sought statutory accident benefits for various treatment and assessment plans following a motor vehicle accident, including chiropractic treatment, a chronic pain assessment, a neurological assessment, and a concussion assessment.

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

The Tribunal preferred the evidence of the respondent's insurer's examinations and the applicant's own family doctors' clinical notes, which did not corroborate the need for the proposed assessments or treatments.

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

The Tribunal found that the applicant sustained a concussion, removing him from the Minor Injury Guideline.

However, the applicant failed to prove a substantial inability to perform the essential tasks of his employment, and his claim for income replacement benefits was dismissed.

The Tribunal approved a treatment plan for physiotherapy but denied plans for psychological services and an attendant care assessment due to insufficient evidence.

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

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

The Tribunal found that the applicant failed to provide sufficient medical evidence to establish that her physical, chronic pain, or psychological impairments warranted removal from the MIG.

The Tribunal preferred the respondent's psychological assessment over the applicant's pre-screening report.

The applicant's claims for medical benefits beyond the MIG limit and for a special award were dismissed.

The applicant sought reconsideration of a Licence Appeal Tribunal decision that denied her claims for various medical and rehabilitation benefits, including a chronic pain assessment and a sleep assessment.

The applicant argued that the Tribunal made errors of fact and law and violated procedural fairness by preferring the respondent's expert witnesses.

The adjudicator dismissed the request for reconsideration, finding that the applicant was attempting to re-argue her case.

The adjudicator held that the Tribunal correctly applied the test for reasonableness and necessity, properly considered the availability of benefits under OHIP pursuant to section 47(2) of the Schedule, and made no significant legal or evidentiary errors that would have altered the outcome.

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

The insurer determined her injuries fell within the Minor Injury Guideline (MIG) and denied several treatment plans.

The Tribunal found that the applicant's injuries were not predominantly minor due to chronic pain, removing her from the MIG.

Furthermore, the Tribunal held that the insurer failed to provide sufficient medical reasons in its denial notices as required by s. 38(8) of the Schedule.

Consequently, the disputed treatment plans for chiropractic care, massage therapy, and a chronic pain assessment were payable.

The applicant's claim for an award under O. Reg. 664 was dismissed, as the insurer's conduct was not found to be excessive or imprudent.

The applicant sought accident benefits following a 2015 motor vehicle accident.

The respondent denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's injuries were predominantly minor and that he failed to prove chronic pain or psychological impairments that would remove him from the MIG.

However, the Tribunal held that the respondent failed to provide adequate medical and other reasons for denying the treatment plans, violating s. 38(8) of the Schedule.

Applying Ferawana and Zheng, the Tribunal ordered the respondent to pay for the disputed treatment plans, provided they were incurred before proper notice was given.

The claim for interest was denied.