M. Jennifer Cosentino

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 of chronic pain, psychological injury, or a pre-existing condition that would warrant removal from the MIG.

The Tribunal also dismissed the claim for a non-earner benefit, as the applicant did not provide evidence comparing his pre- and post-accident activities to establish a complete inability to carry on a normal life.

The application was dismissed.

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

She disputed the respondent's partial denial of a psychological treatment plan and the denial of a cognitive assessment plan.

The Tribunal found the applicant was not entitled to the unapproved balance of the psychological treatment plan because she failed to demonstrate that the unregistered psychotherapist provided services akin to a psychologist to justify the enhanced hourly rate.

The Tribunal also found the applicant was statute-barred from disputing the cognitive assessment plan because she filed her application more than two years after the denial and failed to attend a scheduled insurer's examination.

The application was dismissed.

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

The respondent denied treatment plans for a chronic pain assessment, assistive devices, and psychological services.

The Tribunal found that the chronic pain assessment and assistive devices were not reasonable and necessary, noting significant delays in seeking treatment and a subsequent accident that raised causation issues.

However, the Tribunal granted the psychological services treatment plan, finding it reasonable and necessary based on the medical evidence, and noted that the respondent failed to provide sufficient reasons for its partial denial in contravention of s. 38(8) of the Schedule.

The applicant's claim for a special award was dismissed as the respondent's conduct was not unreasonable.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to an income replacement benefit (IRB) and medical benefits for psychological and chiropractic treatment.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 limit.

The Tribunal found that the applicant failed to prove he suffered from chronic pain syndrome or chronic pain causing functional impairment, thus his injuries were predominantly minor.

The Tribunal also dismissed the claim for an IRB because the applicant did not miss any work due to the accident and failed to submit a required disability certificate.

As the minor injury limit was exhausted, the claims for medical benefits, interest, and an award for unreasonable delay were dismissed.

The applicant was involved in a motor vehicle accident and received income replacement benefits (IRB) from the respondent insurer.

The respondent sought repayment of $9,028.00 in IRB, alleging the applicant had returned to work as a taxi driver and wilfully misrepresented his employment status.

The applicant also sought payment for a chiropractic treatment plan.

The Tribunal found that surveillance evidence and the applicant's own admissions established he had returned to work and failed to disclose this to the insurer, his doctors, or his legal representative.

Consequently, the Tribunal ordered the applicant to repay the IRB with interest.

The Tribunal also dismissed the applicant's claim for the chiropractic treatment plan, finding insufficient evidence that it was reasonable and necessary.

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

The Licence Appeal Tribunal considered whether the applicant was entitled to treatment plans for social work services, chiropractic/massage/physiotherapy, and a psychological assessment, as well as a special award.

The Tribunal found the treatment plans reasonable and necessary, awarding the claimed amounts (with a minor deduction for the social work plan).

The claim for a special award was dismissed as there was no evidence the insurer unreasonably withheld or delayed payment.

The applicant sought increased attendant care benefits and payment for past attendant care expenses following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant's right arm impairments did not require Level 3 complex care, making the insurer's approved monthly amount reasonable and necessary.

The Tribunal also dismissed the claim for past expenses, finding the applicant failed to prove the expenses were 'incurred' under the Schedule due to insufficient documentation of the services provided.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy, chiropractic services, and an orthopaedic assessment.

The respondent insurer denied the treatment plans, arguing the applicant suffered only soft tissue injuries and had reached maximum medical recovery.

The Tribunal found the treatment plans reasonable and necessary, noting the accident aggravated the applicant's pre-existing chronic pain and arthritis, and accepting the diagnosis of chronic pain syndrome by the applicant's orthopaedic expert.

The Tribunal awarded the medical benefits and the cost of the orthopaedic assessment (capped at $2,000 plus HST), but denied the cost of a redundant OCF-3 and a special award under s. 10 of O. Reg. 664.

The applicant, an elderly woman, was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy, chiropractic services, psychological services, and an orthopaedic assessment.

The respondent insurer denied most of the treatment plans, arguing the injuries were minor soft-tissue injuries and the applicant had received sufficient treatment.

The Licence Appeal Tribunal found the treatment plans for physical and psychological therapy, as well as the orthopaedic assessment, to be reasonable and necessary, accepting the applicant's diagnosis of chronic pain syndrome and severe psychological impairments.

The Tribunal ordered the respondent to pay the disputed medical benefits and assessment costs, along with interest, but denied the request for a special award and the cost of a redundant disability certificate.

The insurer requested a reconsideration of a Licence Appeal Tribunal decision that awarded the applicant an income replacement benefit (IRB).

The insurer argued the Tribunal erred in finding the applicant had a reasonable explanation for failing to provide requested financial information under s. 33(1) of the Statutory Accident Benefits Schedule.

The Executive Chair agreed, finding no evidentiary basis for the applicant's explanation that his age and injuries delayed his compliance.

Consequently, under s. 33(6), the insurer was not liable to pay the IRB for the period of non-compliance.

The Tribunal's decision was varied to limit the IRB entitlement period.