Nicole De Bartolo

The applicant sought statutory accident benefits for chiropractic treatment following a 2016 motor vehicle accident.

The respondent denied the treatment plans, which were authored by the applicant's husband, who is also her treating chiropractor.

The Tribunal addressed procedural issues regarding the applicant's non-compliance with submission page limits and the late filing of a rebuttal report.

On the merits, the Tribunal found that the applicant failed to comply with s. 38(2) of the Schedule for an OCF-6 submitted without a prior treatment plan.

For the remaining treatment plans, the Tribunal concluded that the applicant did not provide sufficient objective medical evidence or contemporaneous clinical notes to prove the treatment was reasonable and necessary, especially given the competing independent medical examinations concluding no further treatment was warranted.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming for psychological services and catastrophic impairment assessments.

The Tribunal found the applicant was entitled to a reduced amount for psychological services, adjusting the hourly rate to that of an unregulated provider.

The claim for catastrophic impairment assessments was denied as the applicant failed to establish grounds suggesting such an impairment existed.

The Tribunal also awarded interest on overdue benefits but declined to order a special award against the insurer.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic services and an in-home attendant care assessment.

The insurer denied the treatment plans.

The applicant argued that the insurer's denial letters were statutorily deficient under s. 38(8) of the Schedule for failing to provide sufficient medical reasons.

The Tribunal found that the denial letters met the requirements of s. 38(8) as they provided specific details about the applicant's condition that formed the basis of the decisions, allowing the applicant to make an informed decision to dispute them.

As the applicant provided no medical evidence to prove the treatment plans were reasonable and necessary, the claims were dismissed.

Claims for an award and interest were also dismissed.

The applicant sought accident benefits following a motor vehicle accident, claiming his injuries, including chronic pain and whiplash-associated disorder, warranted removal from the Minor Injury Guideline (MIG).

The respondent denied the claim, relying on insurer's examinations indicating the injuries were minor soft-tissue strains and the applicant maintained a high level of functionality, working full-time as a dentist.

The Tribunal found the applicant failed to demonstrate his injuries fell outside the MIG or that he suffered from chronic pain with functional impairment.

As the $3,500 MIG limit was exhausted, the disputed treatment plan for chiropractic services was not payable.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied several treatment plans and a claim for an award under the Statutory Accident Benefits Schedule.

The Tribunal dismissed the reconsideration request regarding the award, the psychological assessment, and a chiropractic treatment plan, finding no errors of law or fact that would have changed the outcome.

However, the Tribunal granted the reconsideration in part, finding it had erred by failing to explicitly address a physiotherapy treatment plan dated August 14, 2023.

The Tribunal varied its original decision to approve the physiotherapy plan, noting it was supported by a contemporaneous chronic pain assessment.

The applicant sought entitlement to several treatment plans for chiropractic services and a case management assessment following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's impairments were due to long-standing degenerative conditions rather than the accident.

The Tribunal dismissed the application, finding the applicant failed to meet his burden of proof as he did not submit the disputed treatment plans (OCF-18s) or provide compelling evidence that the treatments were reasonable and necessary.

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

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

The Tribunal found the applicant was removed from the MIG due to pre-existing lupus and chronic pain that prevented maximal recovery.

The Tribunal approved treatment plans for a chronic pain assessment and a multidisciplinary chronic pain program, finding them reasonable and necessary given the applicant's clinical deterioration and diagnosis of chronic pain syndrome.

Claims for chiropractic services, a psychological assessment, prescription medications, and a non-earner benefit were dismissed due to lack of evidence.

The Tribunal declined to order an award against the insurer or costs against the applicant.

The applicant sought statutory accident benefits following a motor vehicle accident, including post-104-week income replacement benefits, attendant care benefits, and various treatment plans.

The respondent insurer denied the benefits based on insurer examinations and non-compliance with requests for information.

The Tribunal found that the respondent's denial notices were compliant with the Statutory Accident Benefits Schedule.

The applicant failed to provide substantive submissions or evidence to demonstrate that the claimed benefits were reasonable and necessary, relying instead on procedural arguments regarding the denial notices.

The application was dismissed in its entirety.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found he had not established removal from the Minor Injury Guideline (MIG) for an alleged psychological impairment.

The applicant relied on Rule 18.2(c) of the Licence Appeal Tribunal Rules, 2023, arguing that new medical evidence justified removal from the MIG.

The Tribunal dismissed the request, finding that the applicant was attempting to re-litigate the case and failed to demonstrate that the updated medical records could not have been obtained previously or would likely have affected the result.

The applicant sought statutory accident benefits following a motor vehicle accident but failed to attend the videoconference hearing or file any evidence.

The Tribunal proceeded in the applicant's absence pursuant to the Statutory Powers Procedure Act.

Finding that the applicant failed to meet his evidentiary burden, the Tribunal dismissed the claims for income replacement benefits and treatment plans, and held that the applicant remained subject to the Minor Injury Guideline.

The Tribunal awarded $250 in costs to the respondent due to the applicant's failure to withdraw the application or attend the hearing.

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 contended that pre-existing conditions and a psychological impairment warranted removal from the MIG.

The Tribunal found insufficient evidence of pre-existing physical conditions precluding recovery within the MIG.

Furthermore, the Tribunal preferred the respondent's medical evidence, which concluded the applicant was not psychologically impaired, over the applicant's evidence.

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

The applicant, who was catastrophically impaired following a motor vehicle accident, sought $27,260.61 for a vehicle chassis upgrade to purchase an SUV, arguing it was necessary for her physical and emotional functioning.

The respondent denied the claim.

The Licence Appeal Tribunal found that the applicant failed to prove the vehicle upgrade was reasonable and necessary, noting inconsistencies between the occupational therapist's recommendation and the driving instructor's positive observations of the applicant driving a sedan.

The Tribunal preferred the respondent's insurer examination reports, which found no accident-related psychological or musculoskeletal impairment necessitating an SUV.

The application was dismissed.

The applicant sought non-earner benefits, interest, and an award under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent denied benefits, arguing the applicant's impairments stemmed from a pre-existing condition.

The Tribunal found that the applicant sustained serious psychological and physical impairments as a result of the accident, which continuously prevented her from engaging in substantially all of her pre-accident activities.

The Tribunal ordered the respondent to pay non-earner benefits for the eligible 104-week period and interest, but denied the claim for an award as the respondent's reliance on its assessments was not unreasonable.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found he was not entitled to removal from the Minor Injury Guideline (MIG) and denied disputed treatment plans.

The applicant argued the Tribunal made errors of law and fact, including failing to consider chronic pain, ignoring the consumer protection nature of the Schedule, and improperly weighing psychological evidence.

The adjudicator granted the reconsideration in part, acknowledging an error of law in failing to address the chronic pain argument in the original decision.

However, upon reviewing the evidence, the adjudicator concluded the applicant still failed to prove chronic pain with functional impairment, as there was no formal diagnosis.

The remainder of the reconsideration request was dismissed, as the other arguments amounted to an attempt to re-litigate the weighing of evidence.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to various medical and rehabilitation treatment plans outside the Minor Injury Guideline (MIG).

The applicant argued that a pre-existing shoulder dislocation and a psychological impairment warranted removal from the MIG.

The Tribunal found that the pre-existing condition was not worsened by the accident and did not preclude recovery within the MIG.

Furthermore, the Tribunal preferred the respondent's psychiatric assessments over the applicant's psychological report, noting the lack of psychological treatment sought by the applicant.

The application was dismissed, and the applicant remained subject to the MIG limit.