Michael A. Yermus

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

The adjudicator found that the applicant failed to prove functional impairment due to chronic pain, noting inconsistencies in his self-reported activities of daily living and placing little weight on his physician's chronic pain diagnosis.

Relying on the respondent's psychological assessment, the adjudicator also found no psychological condition warranting removal.

As the injuries were deemed predominantly minor, the disputed treatment plans were not considered, and claims for an award and interest were dismissed.

The applicant, a minor injured in a motor vehicle accident, sought various statutory accident benefits that were denied by the respondent insurer.

The Tribunal found the applicant was entitled to treatment plans for psychological services, occupational therapy, a neuropsychological assessment (subject to the $2,000 statutory cap), and other goods and services including karate and skating lessons.

The Tribunal denied the claim for physiotherapy services, finding the reported pain was psychosomatic and decreasing.

The Tribunal also awarded $2,000 under section 10 of Regulation 664, finding the respondent unreasonably delayed and withheld benefits by ignoring medical recommendations and failing to provide ordered productions.

The respondent requested a reconsideration of a Tribunal decision that removed the applicant from the Minor Injury Guideline (MIG) due to psychological impairment and approved treatment plans.

The respondent argued the Tribunal breached procedural fairness and made errors of law and fact by ignoring evidence and misapplying case law.

The Adjudicator dismissed the request, finding no breach of procedural fairness or errors of law or fact, noting that the respondent was improperly attempting to re-litigate the case and re-weigh the evidence.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied additional Attendant Care Benefits.

The applicant argued the Tribunal committed a material breach of procedural fairness by ignoring evidence, made errors of fact and law regarding the assessment of care needs, and demonstrated a reasonable apprehension of bias.

The Tribunal dismissed the request, finding that the original decision properly weighed the competing Form 1s and accompanying reports, correctly applied the requirement that expenses be incurred, and that the applicant failed to establish any specific grounds for bias beyond mere disagreement with the outcome.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident.

The Licence Appeal Tribunal considered whether the applicant was entitled to treatment plans for psychological services, an MRI, and a chronic pain program, as well as an award under s. 10 of Regulation 664.

The Tribunal found the psychological services reasonable and necessary, relying on expert evidence that the accident exacerbated the applicant's pre-existing psychological issues.

However, the Tribunal denied the MRI request because the applicant failed to demonstrate why it could not be obtained through OHIP.

The chronic pain treatment was also denied, as the Tribunal found the supporting medical reports relied heavily on self-reporting and failed to account for the applicant's significant pre-accident impairments.

The claim for an award was dismissed, but interest was granted on the overdue psychological benefits.

The applicant was involved in a motor vehicle accident while driving for Uber and reported the accident to the insurer the next day, stating he suffered no injuries.

Over a year later, he submitted an application for accident benefits.

The insurer denied the claim due to late notice.

The Tribunal found that the applicant failed to notify the insurer of his intention to claim benefits within the seven-day limit under section 32(1) of the Schedule.

The Tribunal rejected the applicant's explanation that he was misled by Uber, finding it lacked credibility and evidentiary support.

The application was dismissed pursuant to section 55(1).

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

The adjudicator found that the applicant failed to meet her burden of proving the treatment plans were reasonable and necessary, noting that she did not submit the plans into evidence or provide specific submissions on their goals.

Relying on insurer examination reports which indicated the applicant had uncomplicated soft tissue injuries and was working 13 hours a day without restrictions, the adjudicator dismissed the claims for treatment, interest, and a special award.

The applicant sought medical benefits for a chronic pain assessment and treatment program following a motor vehicle accident, arguing his injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain syndrome.

The Tribunal found the applicant's evidence of chronic pain inconsistent and insufficient to meet the AMA Guides criteria, concluding his injuries were predominantly minor and subject to the $3,500 MIG limit.

Additionally, the Tribunal ordered the applicant to repay $7,036.98 in income replacement benefits, finding he willfully misrepresented his receipt of employment insurance and disability benefits.

The applicant sought various statutory accident benefits following a motor vehicle accident, including increased attendant care benefits, multiple treatment plans, and expenses for eyeglasses.

The Licence Appeal Tribunal dismissed all claims.

The Tribunal found the applicant failed to provide evidence of incurred past attendant care expenses and preferred the respondent's occupational therapy assessment for ongoing care, concluding that 24/7 care was not justified.

The claims for treatment plans and assessments were dismissed due to a complete lack of supporting evidence, and the claims for eyeglasses were denied because the expenses had not been incurred.

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

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

The applicant applied to the Licence Appeal Tribunal.

The adjudicator found that the applicant should be removed from the MIG due to a psychological impairment, supported by expert evidence of post-traumatic stress disorder and depression.

The adjudicator approved the disputed treatment plans for physiotherapy, psychological services, and a psychological assessment as reasonable and necessary.

The claim for an award under section 10 of Regulation 664 was dismissed, as the respondent's reliance on its assessors was not unreasonable.

Interest was awarded on overdue benefits.

The applicant sought removal from the Minor Injury Guideline (MIG) following a motor vehicle accident, claiming chronic pain syndrome and a pre-existing condition of osteoarthritis.

The Tribunal found that the medical evidence, including normal neurological results and the applicant's reported functional abilities, did not support a diagnosis of chronic pain syndrome.

Furthermore, the applicant failed to prove that any pre-existing condition precluded maximal recovery within the MIG.

As the MIG limit was exhausted, the disputed treatment plans were denied, and no interest or award was payable.

The applicant sought entitlement to several treatment and assessment plans (OCF-18s) under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent insurer denied the plans based on insurer's examinations indicating the applicant had reached maximum medical improvement or that her symptoms were related to pre-existing conditions.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to meet her burden of proving the disputed plans were reasonable and necessary.

The Tribunal noted a lack of objective medical evidence supporting the requested treatments and found the applicant's submissions often failed to address the specific goals and costs of the proposed plans.

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

The respondent denied various treatment plans 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 chronic pain syndrome.

The Tribunal found that the applicant's injuries were predominantly minor, noting that he worked full-time, was independent with self-care, and did not use pain medication.

As the applicant remained within the MIG limit, the disputed treatment plans, interest, and an award under s. 10 of O. Reg. 664 were denied.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to various treatment plans including massage therapy, chiropractic care, psychological services, injections, and assessments.

The respondent denied the benefits based on insurer examinations concluding the treatments were not reasonable and necessary.

The Tribunal found that the applicant's ongoing chronic pain and psychological symptoms justified the treatment plans for massage, chiropractic, psychological services, a psychological assessment, and injections.

However, the Tribunal denied the neurological assessment and scans, finding them either unnecessary or available through OHIP.

The Tribunal also awarded interest on the overdue benefits but declined to order a special award, finding no evidence that the insurer acted unreasonably or in bad faith.

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

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

The Tribunal found that the applicant failed to prove she suffered from a pre-existing condition, a concussion, or chronic pain that would warrant removal from the MIG.

Consequently, the applicant was not entitled to the disputed treatment plans as they exceeded the $3,500 funding limit, and no interest was payable.

The application was dismissed.

The applicant sought statutory accident benefits for a chronic pain assessment and multidisciplinary chronic pain treatment following a motor vehicle accident.

The respondent denied the benefits.

The Tribunal found that the applicant failed to prove the treatment and assessment were reasonable and necessary, noting her significant pre-accident medical history of fibromyalgia and chronic pain, her return to full-time work, and the lack of corroborating medical evidence beyond a flawed expert report.

The application was dismissed, and claims for interest and an award under O. Reg. 664 were also denied.

This motion sought court approval for a proposed settlement affecting a minor plaintiff who sustained a wrist fracture from a slip and fall accident at school.

The defendants denied liability, raising issues of causation and damages.

The action settled for $30,000 at mediation.

The court approved the settlement, finding it reasonable, fair, and in the minor plaintiff's best interests, and also approved the counsel's fees and disbursements, noting the role of contingency fee agreements in providing access to justice.

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

The respondent denied certain claims, including a chronic pain assessment and treatment, arguing the injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit was exhausted.

The Tribunal found the applicant failed to prove on a balance of probabilities that her injuries fell outside the MIG due to chronic pain or psychological impairment.

The Tribunal dismissed the application, finding the disputed assessment and treatment plans were not payable as the MIG limit had been exhausted.

The applicant sought statutory accident benefits for a chiropractic treatment plan following a motor vehicle accident.

The respondent denied the plan, arguing the applicant's shoulder impairment was related to a pre-existing condition.

The Tribunal found the treatment plan reasonable and necessary, concluding the accident exacerbated the pre-existing condition based on extensive medical evidence.

The Tribunal denied the applicant's request for an award, finding the respondent did not act unreasonably in its denial, but awarded interest on the overdue benefits.

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

The central issue was whether her injuries fell outside the Minor Injury Guideline (MIG) due to a claimed concussion, psychological disorder, chronic pain, or pre-existing temporomandibular joint condition.

The Tribunal found insufficient medical evidence to substantiate a formal diagnosis of a concussion, adjustment disorder, or chronic pain causing functional impairment.

As the applicant's injuries were deemed predominantly minor and the $3,500 MIG limit had been exhausted, the disputed medical benefits were denied.

Claims for an income replacement benefit were withdrawn, and requests for an award and interest were dismissed.