Jordan A. Hochman

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming $1,212.63 for psychological services and $6,194.88 for physiotherapy services.

The respondent partially denied the psychological services based on the Professional Services Guideline hourly rates and denied the physiotherapy services on the basis that the applicant had achieved maximal medical recovery.

The Tribunal found that the applicant failed to meet her burden of proof for both claims, as she provided no submissions regarding the disputed hourly rates and no contemporaneous medical evidence to support the need for further physiotherapy.

The application was dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits for chiropractic services and health coordination and triage assessments.

The respondent denied the benefits.

The Tribunal found that the applicant failed to meet her burden of proving that the proposed treatment and assessments were reasonable and necessary.

The medical evidence provided, including clinical notes and records, did not sufficiently support the need for the specific treatments and assessments proposed.

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

The applicant sought statutory accident benefits for chiropractic treatment, an orthopedic assessment, and a psychological assessment following a motor vehicle accident.

The respondent denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the treatments and assessments were reasonable and necessary.

The Tribunal drew an adverse inference from the applicant's failure to produce medical records, noted a lack of contemporaneous medical evidence supporting the chiropractic plans, found the orthopedic assessment unnecessary as the applicant had missed prior OHIP-covered assessments, and deemed the psychological assessment a duplication of services.

The applicant was struck by a vehicle while assisting another motorist and notified his insurer six days later, reporting he was sore and had been taken to the hospital.

The insurer closed the file after resolving the property damage claim without providing an accident benefits application package.

Over a year later, the applicant submitted an application for benefits (OCF-1).

The insurer raised a preliminary issue that the claim was time-barred.

The Tribunal found that the applicant's initial report triggered the insurer's positive obligation under section 32(2) of the Schedule to provide the application forms.

Because the insurer failed to do so, the 30-day deadline to submit the OCF-1 was never triggered.

The Tribunal held the applicant had a reasonable explanation for the delay and was not barred from proceeding with his claim.

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

The Tribunal found the applicant failed to provide compelling medical evidence that her pre-existing depression and anxiety precluded recovery within the MIG.

Furthermore, the Tribunal rejected the applicant's claims of chronic pain with functional impairment and psychological impairment, noting inconsistencies in her reporting and placing little weight on her psychological assessment.

As the MIG limits were already exhausted, the claims for further treatment plans, interest, and an award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing that his psychological impairments and concussion warranted removal from the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant failed to provide sufficient medical evidence to establish accident-related impairments outside the MIG.

The Tribunal gave little weight to the applicant's expert reports, noting that a chiropractor diagnosed psychological conditions outside his scope of practice and the psychological report lacked contemporaneous medical support.

As the applicant remained within the MIG, the disputed treatment plans and interest were denied.

The applicant sought $798.00 for a physiotherapy treatment plan following a motor vehicle accident.

The respondent denied the benefit.

The Tribunal found that the applicant failed to prove the treatment was reasonable and necessary, as the supporting medical recommendation was over a year old and lacked contemporaneous evidence.

The Tribunal also dismissed the applicant's request for costs, finding the respondent's erroneous limitation defence did not meet the threshold for bad faith.

The applicant sought accident benefits following a motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline (MIG) and claiming entitlement to income replacement benefits (IRBs) and physiotherapy treatment plans.

The Licence Appeal Tribunal found that the applicant's soft tissue injuries were predominantly minor and that he failed to prove his pre-existing heart condition precluded his recovery within the MIG limits.

The Tribunal also dismissed the claim for IRBs, finding the applicant did not demonstrate a substantial inability to perform the essential tasks of his pre-accident employment as an Uber driver, noting post-accident stress tests showed physical capabilities similar to his pre-accident state.

All claims were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing that his injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain.

The Licence Appeal Tribunal found that the applicant failed to prove he suffered from chronic pain causing functional impairment as a result of the accident, noting a lack of persistent pain reports to his family doctor and a subsequent workplace injury.

The Tribunal concluded the applicant's injuries were predominantly minor and subject to the $3,500 MIG limit, dismissing his claims for disputed treatment plans and interest.