Nabila Majidzadeh

The applicant sought statutory accident benefits following a motor vehicle accident, arguing that his injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain.

The adjudicator found that the applicant failed to provide sufficient objective medical evidence of a functional limitation or a pre-existing condition that would preclude recovery within the MIG.

Relying on the respondent's independent medical examination, the adjudicator concluded the injuries were predominantly minor.

Consequently, the claims for physiotherapy treatment plans, interest, and an award for unreasonable delay were dismissed.

The applicant was injured in a motor vehicle accident and sought payment for a chronic pain assessment and two physiotherapy treatment plans under the Statutory Accident Benefits Schedule.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the treatment plans were reasonable and necessary.

The Tribunal preferred the evidence of the insurer's examination physician over the applicant's assessor, noting that the applicant's reports of pain were inconsistent and uncorroborated by contemporaneous clinical notes and records.

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

The respondent denied treatment plans for a chronic pain assessment and chiropractic services.

The Tribunal found the chronic pain assessment reasonable and necessary, noting the applicant's persistent pain complaints and the lack of treatment while incarcerated.

The Tribunal gave limited weight to the respondent's medical examination report due to its lack of analysis and failure to review treating physician records.

However, the Tribunal denied the chiropractic services plan as it lacked support from the applicant's treating practitioners.

The claim for an award under s. 10 of Reg. 664 was dismissed as no submissions were provided.

The applicant sought statutory accident benefits following a motor vehicle accident, including occupational therapy services, medical services, and attendant care benefits.

The respondent denied the benefits, relying on insurer examinations which concluded the applicant had reached maximum medical improvement and did not require the claimed services.

The Tribunal found that the applicant failed to provide corroborating medical evidence from his treating physicians to support the need for the treatment plans or attendant care.

The Tribunal noted significant inconsistencies between the applicant's occupational therapy assessment and his family doctor's clinical notes.

All claims for benefits and interest were dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied his claims for attendant care benefits and various treatment plans following a motor vehicle accident.

The Vice-Chair found that the original adjudicator committed a material breach of procedural fairness by striking pages of the applicant's submissions without analyzing the prejudicial impact.

The decision was cancelled and reheard.

On rehearing, the Vice-Chair granted the applicant's claim for attendant care benefits at $2,257.09 per month, preferring the evidence of the applicant's occupational therapist.

However, the claims for the disputed treatment plans were dismissed as the applicant failed to draw specific connections to the medical evidence to show they were reasonable and necessary.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits and various medical and rehabilitation treatment plans.

The respondent denied the benefits, arguing the applicant's impairments were related to a pre-existing condition and a subsequent fall from a ladder.

The Tribunal found that the applicant failed to prove on a balance of probabilities that the requested benefits were reasonable and necessary as a result of the subject accident.

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

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

The insurer denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain syndrome or that the proposed treatment plans were reasonable and necessary.

The Tribunal noted a lack of objective medical evidence and found that the applicant did not meet the criteria for chronic pain under the AMA Guides.

The application was dismissed.

The applicant sought income replacement benefits and funding for a psychological treatment plan following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove she suffered a substantial inability to perform the essential tasks of her employment as a result of the accident.

The Tribunal preferred the respondent's independent medical examination reports, noting the applicant had stopped working prior to the accident due to stress and reduced hours.

The Tribunal also found the respondent's notices and denials substantially complied with the Statutory Accident Benefits Schedule, and denied the claims for interest and a special award.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming $4,948.16 for a chiropractic treatment plan.

The respondent had partially approved the plan but denied the remainder.

The Tribunal found that the applicant failed to prove the denied portions of the treatment plan were reasonable and necessary, preferring the insurer examiner's opinion that further passive modalities were unlikely to provide benefit.

The application was dismissed, and no interest was awarded.

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

The respondent denied several treatment plans for physiotherapy, massage, chiropractic services, and a worksite assessment.

The Tribunal found that the respondent's denial notices for the treatment plans were non-compliant with s. 38(8) of the Schedule because they lacked adequate medical reasons.

Applying the Divisional Court's decision in Suarez, the Tribunal held that the treatment plans were payable once incurred.

The Tribunal also found the worksite assessment to be reasonable and necessary based on the applicant's consistent reporting of back pain aggravated by prolonged sitting.

The applicant's claim for a bad faith award under s. 10 of O. Reg. 664 was dismissed, as the respondent's reliance on its assessors' reports was not unreasonable.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit, a physiotherapy treatment plan, interest, and an award for unreasonable delay.

The adjudicator found that the applicant failed to demonstrate a complete inability to carry on a normal life, as medical assessments indicated he remained independent in his daily activities, including driving, working, and exercising.

Furthermore, the applicant did not prove the physiotherapy treatment plan was reasonable and necessary, as his own treating surgeon recommended exercise rather than physiotherapy.

The application was dismissed in its entirety.

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

The matter proceeded to a written hearing, but the applicant failed to file her submissions and evidence by the deadline set in the case conference report and order.

The Tribunal declined to extend the deadlines, finding the delay was solely the fault of the applicant's counsel and prejudiced the respondent.

Because the late-filed materials were excluded, the applicant presented no evidence to prove her entitlement to the disputed treatment plans and assessment.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming $3,821.15 for physiotherapy and $2,460.00 for a neurological assessment.

The respondent denied the claims.

The Tribunal found that the applicant failed to prove the treatments were reasonable and necessary, noting that the applicant had returned to full-time work and had pre-existing conditions that contradicted the expert reports submitted on her behalf.

The application was dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including attendant care benefits, non-earner benefits, and a treatment plan for physiotherapy.

The respondent denied the benefits, arguing the applicant's impairments were related to a severe pre-existing workplace injury.

The Tribunal found that the applicant failed to prove his need for attendant care and physiotherapy was caused by the accident, as his pre-accident medical records showed similar functional limitations.

The Tribunal also found the applicant did not suffer a complete inability to carry on a normal life.

However, the Tribunal awarded non-earner benefits for a brief two-week period due to the respondent's failure to pay following the submission of a completed disability certificate.

The application was otherwise dismissed.

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

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

The applicant argued for removal from the MIG based on pre-existing conditions, psychological impairment, and chronic pain.

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

The Tribunal preferred the insurer's psychological and musculoskeletal assessments, finding no diagnosable psychological disorder or chronic pain with functional impairment.

As the applicant's injuries were predominantly minor and the MIG limits were exhausted, the application for additional medical benefits and interest was dismissed.

The applicant sought statutory accident benefits for medical cannabis and chiropractic treatment following a 2017 motor vehicle accident.

The respondent denied the benefits, relying on insurer examination reports indicating the applicant had reached maximal medical improvement and did not suffer from chronic pain or a sleep disorder as a result of the accident.

The adjudicator dismissed the application, finding the applicant failed to provide objective medical evidence to prove the treatment plans were reasonable and necessary.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to physical rehabilitation and a psychological assessment outside the Minor Injury Guideline (MIG).

The applicant argued that she suffered from a psychological impairment and chronic pain with functional impairment.

The Tribunal found that the applicant failed to meet the burden of proof for either condition, noting her continued ability to work, attend university, and participate in sports post-accident.

Applying the AMA Guides criteria for chronic pain, the Tribunal concluded the applicant did not meet the threshold.

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

The respondent's request for costs was also dismissed, as the applicant's conduct did not rise to the level of bad faith.

The applicant sought payment for four physiotherapy treatment plans following a motor vehicle accident.

The respondent denied the plans, arguing that further facility-based treatment was not reasonable and necessary.

The Tribunal found that the applicant failed to meet his burden of proving the treatment was reasonable and necessary, as there was insufficient evidence that the goals of treatment, particularly pain relief, were being met to a reasonable degree despite years of consistent physiotherapy.

The application was dismissed.

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

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

The applicant argued that pre-existing ankle issues, psychological injuries, and chronic pain removed him from the MIG.

The Tribunal found that the applicant's injuries were predominantly minor and that his ongoing symptoms were likely attributable to several subsequent, more severe accidents rather than the subject accident.

The Tribunal also found that while the respondent failed to provide proper notice under section 38(9) of the Schedule, the applicant had not incurred the disputed expenses.

The application was dismissed.

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

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

The Tribunal found that the applicant sustained a minor injury and did not suffer a complete inability to carry on a normal life.

However, because the insurer failed to comply with the notice provisions under sections 36 and 38 of the Schedule, the applicant was awarded non-earner benefits for the period of non-compliance (January 18 to April 30, 2019) and an attendant care assessment plan incurred during the period of non-compliance.

The remaining assessment plans were denied as not reasonable and necessary, and the claim for an award was dismissed.