Lisa Bishop

The applicant sought various statutory accident benefits following a motor vehicle accident, including attendant care benefits and multiple treatment plans for psychological and physical injuries.

The Licence Appeal Tribunal denied the claim for attendant care benefits because the applicant failed to prove the expenses were incurred.

However, the Tribunal ordered the insurer to pay for several treatment plans, including a psychological assessment and physical therapy, because the insurer failed to provide proper medical reasons for its denials as required by section 38(8) of the Schedule.

The Tribunal also approved a chronic pain assessment and shockwave therapy based on medical evidence of ongoing pain, but denied other treatment plans for lack of evidence of reasonableness and necessity.

The claim for a special award was dismissed.

The applicant was a pedestrian struck by a motor vehicle and sought statutory accident benefits for injuries sustained.

The respondent determined the injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 funding limit.

The applicant applied to the Licence Appeal Tribunal, arguing that a partial shoulder tear and a pre-existing hip injury removed her from the MIG.

The Tribunal found insufficient medical evidence to support these claims, concluding the injuries were predominantly soft tissue and fell within the MIG.

The Tribunal ordered the respondent to fund the disputed chiropractic treatment plan up to the $3,500 MIG limit, with interest, but denied the applicant's request for a special award under Ontario Regulation 664, finding the respondent did not unreasonably withhold or delay payments.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including attendant care, physiotherapy, and a psychological assessment.

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

The Licence Appeal Tribunal found that the applicant sustained predominantly minor injuries and failed to provide compelling medical evidence of a pre-existing condition or psychological impairment that would warrant removal from the MIG.

Consequently, the applicant was not entitled to the claimed treatment plans, attendant care benefits, or an award for unreasonable delay.

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

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

The adjudicator found that the applicant's injuries, which included radiculopathy and possible myeloradiculopathy as noted by the respondent's own neurological assessor, exhibited neurological signs that removed him from the MIG.

The adjudicator approved two physiotherapy treatment plans, finding one reasonable and necessary for pain relief, and the other payable because the respondent failed to provide adequate medical reasons for its denial under s. 38(8) of the Schedule.

An attendant care needs assessment was also approved.

However, the applicant's claim for a special award under Regulation 664 was dismissed as there was insufficient evidence that the respondent acted unreasonably.

The applicant sought entitlement to statutory accident benefits for chiropractic services, a gym membership, and aqua fit classes following a motor vehicle accident.

The applicant argued the respondent failed to comply with the 10-day notice requirement under s. 38(8) of the Schedule, but the Tribunal found the respondent's denials were timely.

On the merits, the Tribunal held the applicant failed to prove the treatment plans were reasonable and necessary, noting a lack of contemporaneous medical evidence, normal range of motion findings by the respondent's assessor, and the applicant's self-reported return to pre-accident activities.

The claims for benefits, interest, and an award were dismissed.

The insurer requested reconsideration of a decision awarding the applicant non-earner benefits, a psychological assessment, and a special award.

The adjudicator admitted late correspondence from the insurer as new evidence.

Based on this new evidence, the adjudicator varied the start date for the non-earner benefits from September 22, 2016, to October 25, 2016, and rescinded the special award regarding the non-earner benefits, finding the insurer's conduct was not unreasonable.

The adjudicator dismissed the insurer's arguments regarding the psychological assessment, finding no error in giving little weight to an insurer's examination report that was not in existence when the treatment plan was denied.

The applicants were involved in a motor vehicle accident and sought attendant care benefits (ACBs) from their insurers.

Following a reconsideration decision that found an error of law in calculating the quantum of ACBs, the matter was sent back for a written hearing.

The Tribunal determined the quantum of ACBs using the 'minimum award approach' because the applicants failed to provide a breakdown of the actual hours spent on each level of care.

The Tribunal awarded S.K. $5,073.50 and R.K. $5,606.98 in ACBs, plus interest on overdue payments.

Additionally, the Tribunal found that the insurers unreasonably withheld payment of the minimum benefits owing after the reconsideration decision and ordered a lump sum award of $1,500 for each applicant under s. 10 of O. Reg. 664.

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

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

The applicant argued that pre-existing conditions and accident-related psychological injuries removed her from the MIG.

The Tribunal found insufficient evidence that pre-existing conditions precluded maximal recovery within the MIG.

Furthermore, the Tribunal preferred the respondent's psychological assessment over the applicant's, concluding the applicant did not suffer a psychological injury.

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

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

The insurer denied certain treatment plans and requested insurer examinations under section 44 of the Schedule.

The applicant failed to attend multiple scheduled examinations.

The Tribunal held that pursuant to section 55(1)(2) of the Schedule, the applicant was barred from proceeding with her application due to her non-compliance with the examination requests.

The application was dismissed.

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

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

The applicant argued that pre-existing shoulder issues, psychological impairments, and chronic pain warranted removal from the MIG.

The Tribunal found insufficient evidence to support the applicant's claims, preferring the respondent's section 44 assessment reports which concluded the injuries were predominantly minor.

As the MIG limits had been exhausted, the application for further benefits, interest, and an award was dismissed.

The applicant was injured in a motorcycle accident and claimed attendant care benefits for services provided by his wife.

The insurer denied payment because the wife, a retired nurse, did not provide the services in the course of her employment and did not sustain an economic loss.

The Licence Appeal Tribunal agreed, finding that the applicant failed to prove an economic loss as required by the Statutory Accident Benefits Schedule.

The Tribunal also found the claimed amounts excessive and unsupported by the evidence, and dismissed claims for a special award and interest.

The applicant was injured in a motor vehicle accident and sought funding for a physiotherapy treatment plan in the amount of $3,078.72.

The respondent denied the treatment plan.

The Licence Appeal Tribunal found that the treatment plan was not reasonable and necessary, noting significant gaps in the applicant's treatment history and a lack of improvement despite previous facility-based treatment.

The Tribunal accepted the respondent's medical examination evidence that the applicant had reached maximum medical improvement and could manage her symptoms with a home-based exercise program.

The claims for an award and interest were also dismissed.

The applicant sought non-earner and medical benefits following a motor vehicle accident.

The respondent insurer requested that the applicant attend insurer's examinations under section 44 of the Statutory Accident Benefits Schedule to assess entitlement.

The applicant failed to attend multiple scheduled examinations, arguing the notices were deficient for failing to provide sufficient medical reasons.

The Tribunal found the notices validly explained that the expected recovery period was inconsistent with the soft tissue injuries diagnosed.

Because the applicant failed to attend the examinations after receiving valid notices, he was barred from proceeding with his application under section 55 of the Schedule.

The respondent's request for costs was denied as the applicant's conduct during the proceeding itself was not found to be unreasonable, frivolous, vexatious, or in bad faith.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her physical and psychological impairments warranted removal from the Minor Injury Guideline (MIG).

The adjudicator found that the applicant's physical injuries were soft-tissue in nature and that she failed to demonstrate functionally disabling pain or a diagnosable psychological condition requiring treatment beyond the MIG.

The adjudicator preferred the respondent's expert reports, noting the applicant continued to work full-time and lacked corroborating medical evidence for her claims.

As the injuries fell within the MIG and the limits were exhausted, the claims for attendant care, medical benefits, and an award for unreasonable delay were dismissed.

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

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

The Tribunal found that the applicant's physical and psychological injuries were predominantly minor and did not warrant treatment beyond the MIG limits.

As the applicant had exhausted the $3,500 MIG limit, the disputed treatment plans and attendant care benefits were not payable.

The application was dismissed, and the claim for a special award was denied.

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

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

The adjudicator found that the applicant failed to meet the burden of proving his physical, psychological, or chronic pain impairments removed him from the MIG.

The adjudicator preferred the respondent's psychological assessment over the applicant's due to the use of an interpreter, and relied on surveillance evidence that contradicted the applicant's claims of chronic pain.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits and medical benefits.

The insurer placed the applicant in the Minor Injury Guideline (MIG) and denied treatment plans beyond the $3,500 limit.

The insurer also suspended income replacement benefits after the applicant failed to attend scheduled insurer examinations.

The Tribunal found that the applicant's injuries were predominantly minor and subject to the MIG limit.

The Tribunal also held that the applicant was not entitled to income replacement benefits because she failed to attend the required insurer examinations, and the Tribunal lacked jurisdiction to consider her explanation for non-attendance until she complied.

The applicant requested a reconsideration of a Tribunal decision finding her injuries fell within the Minor Injury Guideline (MIG).

The respondent argued the request was time-barred.

The adjudicator found the request was filed 9 days late and was therefore time-barred under Rule 18.1 of the Common Rules of Practice and Procedure.

Alternatively, the adjudicator dismissed the request on its merits, finding no violation of natural justice or procedural fairness, and no errors of fact or law that would have led to a different outcome.

The applicant sought reconsideration of a Tribunal decision that found her injuries fell within the Minor Injury Guideline (MIG) and denied two treatment plans.

The applicant argued the adjudicator erred in fact and law by misweighing evidence regarding her psychological condition and failing to address the respondent's allegedly inadequate denial letter.

The Vice-Chair found no error in the adjudicator's weighing of the medical evidence.

While acknowledging a minor factual error regarding when the applicant first complained of psychological symptoms, the Vice-Chair concluded this did not affect the outcome as a diagnosis is required to remove an applicant from the MIG.

The reconsideration request was dismissed as an attempt to re-litigate the case.

The respondent insurer brought a preliminary issue hearing seeking to bar the applicant from proceeding with his application to the Tribunal under s. 55(2) of the Statutory Accident Benefits Schedule, arguing he failed to attend scheduled insurer's examinations (IEs).

The applicant argued the IE notices did not comply with the Schedule.

The Adjudicator found that the IE notices for the attendant care and psychological assessments failed to provide sufficient 'medical and any other reasons' as required by s. 44(5) of the Schedule, and no notice was provided for the physiotherapy treatment plan.

Because the notices were non-compliant, s. 55(1)2 did not apply, and the applicant was not precluded from proceeding with his application.

The preliminary issue was dismissed.