Olga Zemlinsky

The respondent insurer requested a reconsideration of a Tribunal decision that ordered it to pay for three psychological treatment plans.

The respondent argued the Tribunal acted outside its jurisdiction by ordering payment, as the expenses were only payable if incurred, and no evidence had been led on whether they were incurred.

The Tribunal agreed, finding that ordering the respondent to pay rather than declaring the applicant entitled to the expenses was a jurisdictional error.

The request for reconsideration was granted, and the order was varied to state the applicant is entitled to the disputed expenses.

The applicant sought payment for various treatment plans (OCF-18s) and expenses (OCF-6) following a motor vehicle accident, which the respondent insurer denied.

The Tribunal first rejected the applicant's preliminary argument that the psychological treatment plans should be deemed approved under s. 38(11) of the Schedule, finding the insurer's non-medical reasons for denial were sufficient under s. 38(8).

On the merits, the Tribunal approved three treatment plans for psychological discharge reports, finding them distinct from formal reassessments.

However, the Tribunal denied the remaining plans for physical therapies and relaxation CDs, relying on an insurer's examination by a physiatrist and surveillance evidence showing the applicant had reached maximum therapeutic benefit and was engaging in activities inconsistent with his claimed impairments.

The applicant sought entitlement to a $2,200 psychological assessment, a special award, and interest following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the treatment plan was not reasonable and necessary.

The Tribunal rejected the applicant's psychological evidence, noting it relied on self-reporting that was contradicted by surveillance footage showing the applicant driving frequently and engaging in various activities.

The Tribunal accepted the respondent's insurer examination, which found no psychological symptoms warranting further investigation.

The applicant sought statutory accident benefits following a rear-end motor vehicle accident.

The respondent insurer denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The Tribunal found that the applicant failed to prove that pre-existing conditions, psychological impairments, or chronic pain warranted removal from the MIG.

The Tribunal preferred the insurer's psychological assessment over the applicant's, noting inconsistencies and a lack of reporting to the family doctor.

As the injuries were predominantly minor and the MIG limit was exhausted, the disputed treatment plans were not payable.

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

The respondent denied various medical benefits and examination costs on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The Licence Appeal Tribunal found that the applicant sustained predominantly minor physical injuries, such as uncomplicated myofascial strains and contusions.

The applicant failed to prove on a balance of probabilities that he suffered from a concussion, chronic pain, or psychological impairments that would remove him from the MIG.

As the MIG limit was already exhausted, the claims for additional medical benefits and examination costs were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to optometry services, prescription eyewear, and physiotherapy for a rotator cuff tear.

The Licence Appeal Tribunal denied the claims for optometry services and eyewear, finding insufficient evidence that the applicant's pre-existing vision issues were exacerbated by the accident.

However, the Tribunal granted the claim for physiotherapy, finding that the rotator cuff tear was caused by the accident and that the applicant was not required to exhaust OHIP-funded physiotherapy before seeking accident benefits.

Interest was awarded on the overdue physiotherapy benefits.

The respondent insurer brought a motion seeking the production of various documents from the applicant and an adjournment of the scheduled hearing.

The applicant did not contest the obligation to produce the documents but noted no due date was set at the case conference.

The adjudicator ordered the applicant to produce the requested documents, including tax returns, ODSP file, and particulars of her claim for an award, within seven business days.

The request for an adjournment was denied to ensure timely proceedings, as the adjudicator found the respondent would not be unduly prejudiced by proceeding as scheduled.

The applicant sought statutory accident benefits for attendant care services allegedly provided by a personal support worker following a motor vehicle accident.

The respondent denied the claim, arguing the services were not actually provided during the disputed period.

The Tribunal found the evidence of the applicant, her son, and the personal support worker to be inconsistent and unreliable, particularly when contrasted with hospital records showing the applicant's daughter provided the care.

The application for attendant care benefits was dismissed.