Michael A. Yermus

The applicant sought statutory accident benefits following a 2014 motor vehicle accident.

The insurer denied certain treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on physical injuries, psychological impairment, and chronic pain.

The Tribunal found the applicant failed to meet the evidentiary burden to prove her injuries warranted removal from the MIG.

The Tribunal preferred the insurer's medical examinations over the applicant's evidence, noting inconsistencies and a lack of functional impairment.

The application was dismissed, and the disputed treatment plans, interest, and award were denied.

The applicant sought a non-earner benefit following a motor vehicle accident, claiming a complete inability to carry on a normal life due to physical and psychological impairments.

The respondent denied the benefit, arguing the applicant's psychological issues were pre-existing and that she failed to meet the rigid test for a complete inability.

The Tribunal found that the applicant's psychological assessments lacked objective baseline information regarding her pre-accident activities and afforded them less weight.

Relying on pre-accident medical records showing significant pre-existing limitations, the Tribunal concluded the applicant failed to prove her impairments were caused by the accident or that she suffered a complete inability.

The application was dismissed.

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

The respondent denied certain medical benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's physical injuries were minor and that she failed to establish chronic pain or an accident-related psychological impairment warranting removal from the MIG.

As the MIG limits were exhausted, the disputed treatment plans were not payable.

Claims for an award and interest were also dismissed.

The applicant sought statutory accident benefits following a 2014 motor vehicle accident, specifically claiming a chronic pain assessment and a chronic pain treatment program.

The Licence Appeal Tribunal dismissed the claims.

The Tribunal found the assessment expense was incurred prior to the submission of the treatment plan, contravening section 38(2) of the Schedule.

Furthermore, the Tribunal held the applicant failed to prove she suffered from an accident-related chronic pain condition, preferring the respondent's medical evidence which showed she had reached maximum medical improvement and maintained a normal life.

Claims for a Regulation 664 award and interest were also dismissed.

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

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant failed to provide submissions demonstrating that his injuries, including alleged chronic pain and pre-existing conditions, warranted removal from the MIG.

The Tribunal found the applicant did not meet his burden of proof.

As the MIG limits were exhausted, the treatment plan was not payable, and claims for interest and an award for unreasonable delay were dismissed.

The applicant sought medical benefits for chronic pain assessments and programs following a rear-end motor vehicle accident.

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

The Licence Appeal Tribunal found that the applicant's physical injuries were predominantly minor soft tissue injuries and that she failed to establish that her chronic pain or pre-existing psychological condition warranted removal from the MIG.

As the requested treatment plans exceeded the remaining MIG funding limit, they were not payable, and the application was dismissed.

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

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that his impairments were caused by the accident, as his medical complaints were identical to his extensive pre-accident medical history.

Furthermore, the Tribunal found that the disputed treatment plans for a chronic pain program, chiropractic treatment, and massage therapy were not reasonable and necessary, as the applicant had returned to work and was engaging in significant physical activities.

The application was dismissed in its entirety.

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 headaches and accident-related psychological impairments warranted removal from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence that her pre-existing conditions precluded recovery within the MIG, or that she sustained a psychological impairment from the accident.

As the MIG limits were exhausted, the disputed treatment plans were not reasonable and necessary, and the claims for interest and an award for unreasonable delay were dismissed.

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

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

The applicant argued her injuries were outside the MIG due to chronic pain syndrome and pre-existing medical conditions.

The Licence Appeal Tribunal found that the applicant failed to prove her chronic pain caused functional impairment or disability beyond the sequelae of soft tissue injuries.

Furthermore, there was no compelling evidence that her pre-existing conditions would prevent maximal recovery under the MIG limit.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a chronic pain program and assessment.

The respondent insurer denied the benefits, arguing the injuries fell within the $3,500 Minor Injury Guideline (MIG) cap and that the chronic pain was not caused by the accident.

The Tribunal found that the applicant suffered from pre-existing chronic pain that was exacerbated by the accident, preventing maximal medical recovery within the MIG limits.

Relying on medical evidence, including reports from the respondent's own independent examiners, the Tribunal concluded the applicant's injuries were not predominantly minor.

The applicant was removed from the MIG and awarded the disputed treatment plans and assessment, along with interest on overdue benefits.

The applicant sought reconsideration of a Licence Appeal Tribunal decision that found her injuries fell within the Minor Injury Guideline and denied her claims for non-earner and medical benefits.

The applicant argued the adjudicator failed to consider whether the treatment plans were reasonable and necessary.

The adjudicator reviewed the treatment plans for occupational therapy, physiotherapy, and various assessments.

Applying the criteria for reasonable and necessary treatment, the adjudicator found that the applicant had sufficient functional abilities and that further assessments would be duplicative.

The request for reconsideration was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found their injuries fell within the Minor Injury Guideline (MIG) and denied medical benefits.

The applicant argued that the adjudicator made an error of fact, as the respondent had already removed the applicant from the MIG prior to the hearing.

The Vice-Chair agreed that the adjudicator made a factual error by deciding an issue that was no longer in dispute, which resulted in the treatment plans not being adjudicated.

The request for reconsideration was granted, and the matter was remitted to the original adjudicator to issue a new decision solely on the reasonableness and necessity of the treatment plans based on the existing evidence.

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

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

The applicant argued she should be removed from the MIG due to chronic pain and chronic pain syndrome.

The Tribunal found that the applicant had not been diagnosed with chronic pain syndrome and failed to prove that her ongoing pain was accompanied by functional impairment or disability.

As the applicant sustained predominantly minor injuries and the $3,500 MIG limit was exhausted, the application for benefits and interest was dismissed.

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

The respondent denied the benefits, arguing the applicant did not meet the requisite disability tests and the treatments were not reasonable and necessary.

The Tribunal found the applicant suffered a substantial inability to perform the essential tasks of her pre-accident employment for the first 104 weeks, entitling her to income replacement benefits for the disputed period up to the 104-week mark.

However, the applicant failed to prove a complete inability to engage in any suitable employment thereafter.

The Tribunal also found the disputed physiotherapy and psychological treatment plans to be reasonable and necessary, ordering their payment with interest.

The applicant sought statutory accident benefits following a motor vehicle accident, including physiotherapy, massage therapy, and psychotherapy.

The insurer initially denied the treatment plans but paid a portion of the incurred amounts on the eve of its written submissions.

The Tribunal found all six disputed treatment plans to be reasonable and necessary for treating the applicant's chronic pain and psychological impairments.

The Tribunal also found that the insurer unreasonably delayed payment of the benefits after receiving sufficient medical information, and ordered a special award of 25% of the initial claim value, plus interest.

The applicant's request for costs was denied.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits for chiropractic services.

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

The applicant argued that her chronic pain condition took her outside the MIG and that the respondent had conceded the MIG limits by previously paying benefits in excess of the cap due to an administrative error.

The Tribunal found that the administrative error did not remove the applicant from the MIG.

Furthermore, the Tribunal rejected the applicant's chronic pain evidence as unpersuasive due to unexplained gaps in treatment and a lack of supporting medical documentation.

The Tribunal concluded that the applicant's injuries were predominantly minor, dismissed the claim for benefits, and denied the request for an award for unreasonable delay.

The applicant was injured in a motor vehicle accident and sought Income Replacement Benefits (IRBs).

The insurer suspended and later terminated the benefits, arguing the applicant failed to provide requested financial documentation under s. 33 of the Schedule and no longer met the disability test.

The Tribunal found that the applicant breached s. 33 without a reasonable explanation, disentitling her to benefits for the period of non-compliance.

Furthermore, the Tribunal held that the applicant failed to prove on a balance of probabilities that she suffered a substantial inability to perform the essential tasks of her employment as a restaurant owner, relying on the insurer's multidisciplinary assessments.

The application and request for costs were dismissed.

The applicant was struck by a motor vehicle as a pedestrian and sought statutory accident benefits for chiropractic services.

The respondent insurer denied the treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's injuries, which included chronic pain, fell outside the MIG based on the detailed medical evidence of her chronic pain specialist.

The Tribunal ordered the respondent to pay the disputed medical benefits, finding them reasonable and necessary, along with interest on the overdue amounts.

Following the dismissal of the plaintiff's action against her own insurer (TD) on a summary judgment motion, the court determined the costs payable to TD.

The plaintiff had entered into a Pierringer Agreement with the co-defendants and unsuccessfully pursued TD for excess coverage, adding an unjustified claim for punitive damages.

TD had made an Offer to Contribute $150,000 which the plaintiff rejected.

The court awarded TD costs of the entire action, fixing them at $72,070.93, applying a substantial indemnity scale from the date of the offer and a partial indemnity scale prior to that date.

The Appellant insurer sought a stay of an Arbitrator's order requiring it to pay income replacement benefits, attendant care, housekeeping, and medical benefits to the Respondent insured, pending an appeal.

The Director's Delegate denied the stay request, finding that under subsection 283(6) of the Insurance Act, a stay is the exception rather than the rule.

The Delegate held that the Appellant failed to establish that the pre-arbitration status quo ought to be preserved, noting that the appeal was restricted to questions of law and that staying the payment orders would constitute a hardship to the Respondent that outweighed any hardship to the Appellant.