Patrick Sinclair

The applicant, who sustained a catastrophic impairment in a motor vehicle accident, sought $14,900 for housekeeping and home maintenance expenses incurred prior to the catastrophic impairment determination.

The services were provided by her adult son.

The Tribunal found that the expenses were not 'incurred' under section 3(7)(e)(iii) of the Schedule because the son did not provide the services in the course of his ordinary employment or sustain an economic loss.

The Tribunal also declined to deem the expenses incurred under section 3(8), finding that the insurer did not unreasonably withhold or delay payment.

The application was dismissed.

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 her pre-existing psychological conditions and chronic pain warranted removal from the MIG.

The Tribunal found that the applicant failed to demonstrate that her physical or psychological impairments required treatment beyond the MIG limits.

As the MIG limits were exhausted, the disputed treatment plans and assessments were deemed not reasonable and necessary.

The application was dismissed.

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

The respondent insurer took the position that the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied several treatment plans.

The applicant argued she should be removed from the MIG due to pre-existing conditions and chronic pain.

The Tribunal found the applicant failed to prove that her pre-existing conditions prevented maximal recovery within the MIG or that her chronic pain adversely affected her well-being and function under the AMA Guides criteria.

However, the Tribunal ordered the respondent to pay for a physiatry assessment because the respondent failed to provide proper medical reasons for its denial, triggering the consequences of s. 38(11) of the Schedule.

The remaining treatment plans were dismissed as they proposed treatment outside the MIG limits.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits.

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

The applicant argued for removal from the MIG due to pre-existing knee injuries, chronic pain, and psychological impairments.

The Tribunal found that the applicant failed to provide compelling medical evidence that his pre-existing conditions precluded recovery under the MIG, failed to establish functional impairment from chronic pain, and failed to prove a psychological impairment, preferring the respondent's psychological assessment which noted invalid testing and feigning of symptoms.

As the MIG limits were exhausted, the disputed treatment plans and interest were denied.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, arguing that chronic pain warranted removal from the Minor Injury Guideline (MIG).

The Tribunal preferred the respondent's section 44 medical examination, which diagnosed myofascial strain injuries treatable within the MIG, over the applicant's expert reports, which were found to be unsupported by objective medical evidence and the applicant's functional abilities.

The Tribunal concluded the applicant did not meet the burden of proving his injuries fell outside the MIG.

The disputed treatment plans were deemed not reasonable and necessary, and the application was dismissed.

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

The respondent insurer determined the injuries fell within the Minor Injury Guideline (MIG) and denied treatment plans exceeding the $3,500 limit.

The applicant argued he should be removed from the MIG due to a diagnosis of chronic pain syndrome.

The Tribunal found the applicant's evidence, including an expert report diagnosing chronic pain, lacked sufficient analysis and objective support.

The Tribunal concluded the applicant sustained minor soft tissue injuries and an aggravation of pre-existing degenerative changes, which did not warrant removal from the MIG.

As the MIG limits were exhausted, the disputed treatment plans and assessment were dismissed.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident.

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

The applicant argued her injuries were not minor, citing chronic pain and psychological impairments.

The Tribunal found the applicant's physical injuries were predominantly soft-tissue sprains and strains.

Relying on the respondent's section 44 assessments, the Tribunal concluded the applicant failed to prove her impairments warranted treatment beyond the MIG.

The disputed treatment plans were deemed not reasonable and necessary, and the application was dismissed.

The applicant sought interest and an award under O. Reg. 664 for a $2,486.00 treatment plan that the respondent insurer failed to respond to for over two and a half years.

The Tribunal found the insurer breached s. 38(8) of the Schedule and unreasonably withheld and delayed payment.

The Tribunal ordered the insurer to pay interest on the overdue benefit and a 40% award, noting the insurer's stubborn and unyielding conduct in failing to correct its error once discovered.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to medical benefits for chiropractic services, optometric services, and post-concussive therapy.

The Licence Appeal Tribunal dismissed the application, finding insufficient evidence that the chiropractic and post-concussive treatments were reasonable and necessary.

The Tribunal also found that the optometric expenses were incurred prior to the submission of a treatment plan and were related to pre-existing cataracts rather than an impairment sustained in the accident.

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

The applicant sought a non-earner benefit under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove a complete inability to carry on a normal life.

Medical evidence and surveillance demonstrated that the applicant had substantially returned to his pre-accident routine, including working as a plumber and engaging in social and leisure activities.

Claims for interest and a special award were consequently dismissed.

The applicant, a self-employed real estate agent, sought dispute resolution for statutory accident benefits following a motor vehicle accident.

The Tribunal determined the applicant's weekly income replacement benefit (IRB) must account for passive income earned from real estate deals closing during the disputed periods, awarding $2,685.71.

The Tribunal denied the claims for a $2,900 psychological assessment and $1,320.77 for psychological treatment, finding them not reasonable and necessary as previous approved treatments were not utilized and the treatment plan included impermissible administrative costs.

Interest was awarded on the overdue IRB, but a claim for an award under Regulation 664 was dismissed.

The applicant sought statutory accident benefits, including non-earner benefits and medical benefits for psychological services, following a minor rear-end motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove a complete inability to carry on a normal life.

The Tribunal preferred the respondent's independent medical examination reports over the applicant's expert reports, noting that the applicant's experts relied heavily on self-reporting which was contradicted by the applicant's own prior testimony and employment records indicating he was laid off due to a shortage of work rather than disability.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied treatment plans for a bone growth stimulator, a multidisciplinary chronic pain program, and an MRI of the spine.

The applicant argued the Tribunal made errors of fact and law in its appreciation of the evidence.

The Adjudicator dismissed the request, finding that the applicant failed to establish any errors of fact or law that would have led to a different outcome, and noted that the reconsideration process is not an opportunity to reweigh evidence.

The applicant sought statutory accident benefits following a motor vehicle accident, including a chronic pain program, psychological assessment, MRI, and a chronic pain assessment report.

The Tribunal dismissed all claims, finding the applicant's self-reporting to her assessors lacked credibility due to inconsistencies with her medical and employment records.

The Tribunal preferred the evidence of the insurer's examinations, which found no objective evidence of accident-related physical or psychological impairments requiring the proposed treatments.

Claims for interest and a special award were also dismissed.

The applicant was injured in a rear-end motor vehicle accident while operating a taxi and sought statutory accident benefits for bone growth stimulator services, a multidisciplinary chronic pain program, and an MRI of the spine.

The insurer denied the treatment plans.

The Licence Appeal Tribunal found that the applicant failed to prove the bone growth stimulator and MRI were reasonable and necessary, noting the ankle fracture showed good healing and the MRI request lacked sufficient justification.

For the chronic pain program, the Tribunal granted entitlement only to the functional exercise program component, as it was recommended by the insurer's own assessor, but denied the remaining modalities due to insufficient evidence.

Interest was awarded on the overdue payment for the functional exercise program.

The applicant was injured in a motor vehicle accident and sought a medical benefit of $10,600 for a chronic pain treatment program, which the respondent insurer denied.

The Licence Appeal Tribunal found that the applicant proved on a balance of probabilities that the treatment plan was reasonable and necessary, preferring the evidence of the applicant's experts who diagnosed chronic pain over the respondent's assessors who did not specifically evaluate for chronic pain.

The Tribunal ordered the respondent to pay for the treatment plan and interest on overdue amounts, but denied the applicant's request for a special award under Ontario Regulation 664, finding no evidence that the insurer unreasonably withheld or delayed payment.

The applicant was injured in a motor vehicle accident and sought funding for a chronic pain treatment program.

The respondent insurer partially approved the plan for psychological treatment but denied the physical therapy and chronic pain components, relying on an insurer's examination.

The Licence Appeal Tribunal found the applicant credible and preferred the evidence of his treating assessors, who diagnosed chronic pain syndrome caused by the accident.

The Tribunal ordered the insurer to pay the remaining cost of the treatment plan, excluding transportation expenses, plus interest on overdue payments.

The applicant sought a $2,260 benefit for a chronic pain assessment following a motor vehicle accident, as well as a special award under Regulation 664 for unreasonable delay.

The adjudicator found that the applicant failed to prove the assessment was reasonable and necessary, noting that independent medical examinations and treating physicians did not diagnose chronic pain or indicate a need for further assessment.

The adjudicator also dismissed the applicant's request to exclude the respondent's evidence for alleged non-disclosure, finding the request overly broad and lacking evidence of prejudice.

The application for benefits and the claim for a special award were dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits for physiotherapy.

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

The applicant argued she suffered from chronic pain and other conditions that warranted removal from the MIG.

The Tribunal found that the applicant's injuries were predominantly minor and that her ongoing back pain was likely related to degenerative changes and a subsequent workplace fall, rather than the accident.

As the injuries fell within the MIG, the appeal for further medical benefits was dismissed.

The applicant was struck by a truck's mirror while riding her bicycle and sought statutory accident benefits.

The respondent denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered a concussion, which falls outside the MIG, based on consistent reporting of symptoms and elevated SACT-2 scores.

The Tribunal also determined that the disputed physiotherapy treatment plans were reasonable and necessary to address the applicant's accident-related impairments.