Maggie Morgan

The applicant sought entitlement to statutory accident benefits for physiotherapy and psychological services following a motor vehicle accident.

The adjudicator found that the applicant failed to provide objective medical evidence, such as contemporaneous recommendations from her primary care physician, to demonstrate that the disputed physiotherapy was reasonable and necessary.

The adjudicator also accepted the respondent's expert evidence that the applicant had reached maximal psychological recovery and would not benefit from further psychological services.

The application was dismissed in its entirety.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied seven of eight disputed treatment plans following a motor vehicle accident.

The applicant argued the adjudicator erred in weighing medical evidence, particularly by focusing on inconsistencies in her self-reporting, and failed to properly apply s. 38(8) of the Schedule regarding the insurer's denial letters.

The Tribunal dismissed the request, finding that the applicant was attempting to re-litigate arguments and re-weigh evidence already considered at the initial hearing.

The Tribunal concluded that the adjudicator made no error of law or fact, nor any breach of procedural fairness, that would warrant reconsideration.

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

The matter proceeded to a written hearing, but the applicant failed to file any submissions or evidence.

The Tribunal found the applicant failed to meet his evidentiary burden and dismissed the claims.

The respondent's request for costs was also dismissed as it failed to provide evidence of unreasonable conduct or specify the requested amount.

The applicant sought various statutory accident benefits following a motor vehicle accident, including treatment plans for physiotherapy, chiropractic and massage services, and several assessments (orthopaedic, attendant care, neuropsychological, neurological, and a SPECT scan).

The respondent denied the benefits.

The Tribunal found that the respondent's denial notices complied with section 38(8) of the Schedule.

On the merits, the Tribunal concluded that only the attendant care assessment was reasonable and necessary, given the applicant's consistent reporting of difficulties with housekeeping and personal care tasks due to chronic pain.

The remaining treatment plans and assessments were denied for lack of contemporaneous medical evidence or failure to establish reasonableness and necessity.

The applicant was awarded interest on the attendant care assessment, but her claims for a special award and costs were dismissed.

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

After the applicant's representative removed himself from the record, the applicant failed to file any written submissions or evidence for the scheduled written hearing.

The Licence Appeal Tribunal proceeded in the applicant's absence pursuant to section 7(2) of the Statutory Powers Procedure Act.

The Tribunal found that the applicant failed to meet the burden of proving entitlement to the claimed benefits and dismissed the application.

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

The respondent insurer denied multiple treatment plans for chiropractic care, assistive devices including a tablet and mattress, and various medical assessments.

The Licence Appeal Tribunal dismissed the application, finding that the applicant's ongoing complaints were attributable to pre-existing degenerative changes rather than the accident.

The Tribunal preferred the evidence of the respondent's assessors, concluding that the proposed goods and services were not reasonable and necessary.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her entitlement to non-earner benefits beyond November 26, 2019, and to disputed treatment plans.

The applicant argued the Tribunal made an error of law in interpreting the Statutory Accident Benefits Schedule and sought to introduce new case law as new evidence.

The adjudicator dismissed the request, finding no error of law and holding that new case law does not constitute new evidence under Rule 18.2(c).

The applicant sought $1,977.05 for a physiotherapy treatment plan following a motor vehicle accident.

The respondent denied the plan.

The Tribunal found that the applicant failed to meet her burden of proving the treatment was reasonable and necessary, as she did not provide sufficient specific medical evidence linking her ongoing symptoms to the proposed treatment.

The Tribunal preferred the respondent's orthopedic assessment, which concluded the applicant had reached maximal medical improvement.

The application was dismissed.

The applicant sought entitlement to various treatment and assessment plans following a motor vehicle accident.

The applicant argued that the respondent's denial letters were deficient under s. 38(8) of the Statutory Accident Benefits Schedule.

The Tribunal found that the respondent's notices were compliant, as they clearly indicated the denial of the entire plans and provided sufficient medical reasons.

The Tribunal also found that the applicant failed to prove the attendant care assessment was reasonable and necessary.

The application was dismissed, and claims for interest and a special award were denied.

The defendants, Suhaib Alekozai and Behzad Dalf-Ajresh, sought costs following a ten-day jury trial where they were entirely successful on the issues of causation and damages.

The plaintiff, Rhonda Anderson, did not make costs submissions.

The defendants requested costs on a partial indemnity basis, totaling $72,655.65.

The court, applying section 131 of the Courts of Justice Act and Rule 57.01 of the Rules of Civil Procedure, found the requested legal fees fair and reasonable given the trial's complexity and the plaintiff's initial claims versus the jury's zero damages award.

However, the court disallowed certain disbursements for lack of explanation or proportionality, ultimately awarding the defendants costs totaling $68,137.68.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically requesting $2,486.00 for a psychological assessment.

The insurer denied the treatment plan, arguing it was a duplication of services and that there was no chronic pain issue to investigate.

The Tribunal found that the applicant's ongoing pain, medication use, and psychological symptoms warranted further investigation.

The Tribunal ordered that the psychological assessment was reasonable and necessary, and payable once incurred, with interest applicable on any overdue benefits.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found she was not an 'insured person' under section 3(1) of the Statutory Accident Benefits Schedule.

The applicant argued the Tribunal made errors of law and fact, violated procedural fairness, and failed to consider priority dispute rules under O. Reg. 283/95.

The adjudicator dismissed the request, finding it was an attempt to re-litigate the case and that the priority dispute issue was outside the Tribunal's jurisdiction for this hearing.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, as well as assessments, from the respondent insurer.

The respondent denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) or that further treatment was not reasonable and necessary.

The adjudicator found that the applicant was no longer subject to the MIG and approved two chiropractic treatment plans, noting they were reasonable and necessary given the applicant's ongoing pain.

However, claims for a yoga plan, further chiropractic care, and unapproved balances for psychological services were dismissed for lack of evidence.

The adjudicator also denied the requested chronic pain, functional, and attendant care assessments, finding it unlikely the applicant suffered from chronic pain syndrome.

The respondent's claim for repayment of income replacement benefits was dismissed due to a lack of evidence.

The applicant sought statutory accident benefits for psychological injuries sustained following the death of her common law spouse, who was killed while riding an uninsured e-bike.

The respondent denied the benefits on the basis that the applicant was not an 'insured person' under section 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant did not meet any of the criteria under section 3(1), as she was not a named insured, a specified driver, a spouse or dependant of a named insured, nor was she involved in the accident or an occupant of the vehicle.

The application was dismissed.

The applicant requested a reconsideration of a preliminary issue decision which found she was statutorily entitled to income replacement benefits (IRBs) for a limited period due to the respondent's delayed response, but was otherwise barred from claiming IRBs because her impairments arose more than 104 weeks after the accident.

The applicant argued the adjudicator acted outside his jurisdiction, violated procedural fairness, and made an error of law.

The Tribunal dismissed the request, finding the adjudicator had jurisdiction to determine the remedy for the respondent's non-compliance, procedural fairness was maintained as the applicant had the opportunity to make submissions, and no error of law occurred regarding the application of section 36 of the Schedule.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to a chronic pain assessment and a chronic pain management program.

The Tribunal found the chronic pain assessment was not reasonable and necessary as it duplicated a previous assessment.

However, the Tribunal found the chronic pain management program was reasonable and necessary, awarding a portion of the outstanding balance, as the evidence showed the accident exacerbated the applicant's pre-existing chronic pain.

The claim for a special award under s. 10 of Regulation 664 was dismissed.

The applicant sought income replacement benefits (IRBs) for psychological injuries sustained while caring for her spouse, who was catastrophically injured in a motor vehicle accident.

The insurer raised a preliminary issue that the claim was barred because the applicant failed to apply within 104 weeks of the accident.

The Tribunal found that while the applicant was generally barred from claiming IRBs because her impairment arose more than 104 weeks after the accident, the insurer's failure to respond to her application within the mandatory 10-day period under section 36 of the Schedule entitled her to IRBs for the period between her application and the insurer's eventual response.

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

The insurer denied several treatment plans and a disability certificate.

The Tribunal found that the applicant was statute-barred from pursuing claims for three treatment plans because she failed to commence proceedings within two years of the insurer's clear and sufficient denials.

The Tribunal further held that the remaining treatment plans and the disability certificate were not reasonable and necessary, as the applicant failed to provide sufficient medical evidence to support them and the proposed fees did not comply with the Professional Services Guideline.

The claim for an award under Regulation 664 was also dismissed.

The applicant requested a reconsideration of a decision denying him an income replacement benefit.

He argued the Tribunal erred in law by improperly applying the but-for test and erred in fact by placing too much weight on his pre-existing condition rather than his experts' opinions regarding his chronic pain syndrome.

The adjudicator dismissed the request, finding that the but-for test was properly applied to determine causation and that the weighing of evidence was within the hearing adjudicator's prerogative.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, which the respondent insurer denied.

The Tribunal found that the applicant's injuries fell outside the Minor Injury Guideline (MIG) due to a pre-existing low back condition that impacted his recovery.

The Tribunal partially allowed the claim for physiotherapy services, finding two treatment plans reasonable and necessary based on medical evidence that the applicant had not yet reached maximum medical improvement.

However, the Tribunal dismissed the claims for further physiotherapy, functional and medical assessments, transportation costs, and the cost of an OCF-3, as the applicant failed to prove they were reasonable and necessary.