Licence Appeal Tribunal File Number: 25-007788/AABS
In the matter of an application pursuant to subsection 280(2) of the Insurance Act, RSO 1990, c I.8, in relation to statutory accident benefits.
Between:
Laura Lopez Applicant
and
TD General Insurance Company Respondent
DECISION
ADJUDICATOR: Timothy Porter
APPEARANCES:
For the Applicant: Gus Triantafillopoulos, Counsel
For the Respondent: Sonya Reid, Counsel Maria Bihnam, Paralegal
Court Reporter: Prashanth Thambipihai
Interpreters: Sandra Flores (Spanish Language) Patricia Ribeiro (Spanish Language)
HEARD: by Videoconference: February 17-18, 2026
OVERVIEW
1Laura Lopez, the applicant, was involved in an automobile accident on December 23, 2022, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”). The applicant was denied benefits by the respondent, Insurer, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES
2The issues in dispute are:
i. Are the applicant’s injuries predominantly minor as defined in s. 3 of the Schedule and therefore subject to treatment within the $3,500.00 Minor Injury Guideline (“MIG”) limit? Note: The parties agree the MIG limits have been exhausted.
ii. Is the applicant entitled to an income replacement benefit (“IRB”) in the amount of $400.00 per week from December 23, 2022, to date and ongoing?
iii. Is the applicant entitled to $3,428.30 for physiotherapy services, proposed by Healthmax in a treatment plan/OCF-18 (“plan”) submitted June 19, 2023?
iv. Is the applicant entitled to $2,700.00 for a psychological assessment, proposed by Complex Care in a plan submitted September 19, 2023?
v. Is the applicant entitled to the assessments proposed by Healthmax, as follows: i. $ 2,572.81 for a psychological assessment, in a plan submitted May 25, 2023; and ii. $2,567.16 for a chronic pain assessment, in a plan submitted July 4, 2023?
vi. Is the applicant entitled to $139.22 ($200.00 less 60.78 approved) for an invoice from Healthmax, submitted on a claim form (OCF-21) dated February 15, 2024?
vii. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
viii. Is the applicant entitled to interest on any overdue payment of benefits?
ix. Is the applicant owed costs?
RESULT
3The applicant is not in the MIG.
4The applicant is entitled to income replacement benefits.
5The applicant is entitled to the physiotherapy treatment plan.
6The applicant is entitled to the psychological assessment proposed by Complex Care.
7The applicant is not entitled to the psychological assessment proposed by Healthmax.
8The applicant is entitled to the chronic pain assessment proposed by Healthmax.
9The applicant is not entitled to the partially approved invoice from Healthmax.
10The applicant is entitled to interest on all overdue payments.
11The applicant is entitled to an award.
12Costs are not ordered.
PROCEDURAL ISSUE
13The respondent submitted, at the start of the hearing, that the Tribunal had no jurisdiction to hear the applicant’s dispute regarding the MIG and the IRB as both had been resolved.
14The applicant submitted that this is not the case and that the respondent has failed to make proposals acceptable to the applicant such that she agrees the dispute has been resolved.
15The applicant pointed to correspondence from the respondent that informed the applicant that she would be removed from the MIG, in the days prior to the hearing of this matter. The wording in the correspondence appears to limit the applicant’s removal to only psychological treatment, which is not a position supported by the Schedule. The applicant is not satisfied with the limited removal from the MIG and elected to continue to pursue the matter at hearing.
16I find that the dispute will be heard; the respondent has issued an explanation of benefits that is not entirely clear, further, the respondent has not taken any definitive steps to approve treatment plans that were denied on the basis of being within the MIG. I find that the Tribunal has jurisdiction to hear the dispute.
17With regard to the IRB the respondent submits that it has agreed that the applicant is entitled to IRB and has sent correspondence informing her of such. Submitting that the Tribunal has no jurisdiction, as the dispute is settled, the respondent pointed to 2017 CanLII 140991, 2019 CanLII 58142, and 2025 CanLII 114363, in support of their position that the dispute is resolved as the applicant is approved for IRB.
18The applicant also points to the same cases noted above and highlights that this situation is immediately distinguishable in that the insurer has not paid the IRB but instead requested more financial documentation from the applicant, while also informing the applicant that they have the financial documentation required.
19In all three cases, the entitlement to IRB and payment of IRB had occurred prior to any hearing by the Tribunal. This case is demonstrably distinguishable; In this situation the respondent has not taken definitive steps to seek the applicant’s consent or issue payments. I find that the dispute between the parties is alive and that the Tribunal has jurisdiction to hear the matter and render a decision.
ANALYSIS
The applicant is not in the Minor Injury Guideline
20In the days prior to the hearing the respondent sent an explanation of benefits that conceded that the applicant’s injuries were not minor.
21The respondent has conceded that the applicant has non-minor injuries and informed the applicant she is no longer confined to the MIG.
22I agree with the respondent, the applicant’s injuries, as a result of the subject accident, are non-minor. I find that the applicant is no longer in the MIG.
IRB entitlement due to s.36(4) non-compliance
23I find that the applicant is entitled to IRBs from December 11, 2024, to February 10, 2026, due to s.36(4) non-compliance by the respondent.
24Section 36(4) outlines that an insurer must respond to an application for specified benefits, such as IRB, within 10 days after receipt of an applicant and completed disability certificate. Section 36(6) details that if the insurer fails to comply with s.36(4) within the time limit that the insurer shall pay the specified benefit for the period starting on the day the insurer received the application and completed disability certificate and ending, on the day the insurer gives notice.
25The applicant’s OCF-3 (Disability certificate) was submitted on December 11, 2024. The applicant submits that the respondent has not responded to this submission until February 10, 2026. The respondent has not pointed me to any evidence that they had responded prior to February 10, 2026. I find that the respondent did not respond to the submission of the OCF-3 until February 10, 2026.
26The respondent replied to the submission of the applicant’s OCF-3 and conceded entitlement to IRB on February 10, 2026. I find that the respondent was not compliant with s.36(4) as of December 21, 2024, and until February 10, 2026; As per s.36(6), the applicant is entitled to IRB from December 11, 2024, to February 10, 2026.
Not entitled to Post-104 IRB
27The applicant is not, on a balance of probabilities, entitled to post-104 IRB.
28To receive payment for a post-104-week IRB under s. 6 of the Schedule, the applicant must demonstrate, on a balance of probabilities, that they suffer from a complete inability to engage in any employment or self-employment for which they are reasonably suited by education, training, or experience.
29The applicant disputed IRB from December 23, 2022, to date and ongoing. In relation to IRB the pre-104 period would run until December 22, 2024; The applicant has been found to be entitled to IRB from December 11, 2024, to February 10, 2026. Entitlement for IRB following February 10, 2026, and beyond would be measured against the post-104 IRB test.
30I have not been pointed to compelling evidence that the applicant suffers a complete inability to engage in any employment or self-employment for which she is reasonably suited by education, training, or experience.
31I find, on a balance of probabilities, that the applicant is not entitled to post-104 IRB.
32The applicant is entitled to 3 of the 4 disputed treatment and assessment plans.
33To receive payment for a treatment and assessment plan under s. 15 and 16 of the Schedule, the applicant bears the burden of demonstrating on a balance of probabilities that the benefit is reasonable and necessary as a result of the accident. To do so, the applicant should identify the goals of treatment, how the goals would be met to a reasonable degree and that the overall costs of achieving them are reasonable.
Physiotherapy treatment plan
34The applicant has met her onus and is entitled to the physiotherapy treatment plan.
35The applicant submits that the basis for all denials of treatment plans was the MIG, as the applicant is no longer in the MIG, the basis of the denials has been eliminated.
36The respondent submits that there is no contemporaneous medical evidence in support for the applicant’s entitlement to physiotherapy and points to the assessment by s.44 assessor Dr. Nesterenko, general practitioner (“GP”).
37The OCF-18 by Healthmax was signed by the applicant on June 13, 2023. The goals of the plan are pain reduction, increase in strength, return to modified work activities and “increase a self-direct approach towards rehab.” The listed barriers to recovery are “difficulty with mood and affect, her gait has been impacted by her lower extremity injuries, sleeping is disturbed. She expresses significant difficulty coping with the accident.” Under Part 9 section d) concurrent treatment the plan identifies that psychological and chronic pain assessments are warranted. The plan proposed physical rehabilitation, manipulation, and therapy on multiple body sites along with documentation. The proposed cost of the plan is $3,428.30.
38Family physician Dr. Gaymes saw the applicant on June 13, 2023 and related that the applicant had recently been admitted to hospital for 5 days, was complaining of left flank hematoma where she has had pain since the subject accident and that this pain began to worsen in May 2023. I place a high weight on the evidence of Dr. Gaymes because the doctor has insight into the applicant’s medical history. Dr. Gaymes notes that no procedures related to the hematoma were undertaken in hospital and that she received painkillers and is also seeing physiotherapy and chiropractic manipulation. In my mind, Dr. Gaymes is outlining a problem, the hematoma, and the prescription is pain killers and physiotherapy/chiropractic.
39The applicant was assessed by s.44 assessor Dr. Nesterenko, GP, on August 29, 2023 who was to provide an opinion as to whether the applicant had sustained a minor injury and whether the OCF-18 submitted by Healthmax is reasonable and necessary. The applicant reported to Dr. Nesterenko that she has been attending physiotherapy, does self-directed stretches at home and takes Tylenol on a daily basis to deal with neck, back and left shoulder pain, left elbow and bilateral hand/wrist pain, left, hip, knee, and foot/ankle pain. Dr. Nesterenko diagnosed cervical spine sprain/strain, thoracolumbar spine sprain/strain, left shoulder and left elbow sprain/strain and left-lower extremity soft-tissue injury. The assessor opines that the injuries are minor, minor injuries usually resolve within 8-12 weeks and that the minor injury guideline should apply. I provide less weight to the assessment of Dr. Nesterenko because in my mind the assessor is too reliant on the MIG as the defining diagnostic measurement and does not provide any line of sight into her assessment when there is information that does not align with the conclusion that the applicant should be treated within the MIG. For example, Dr. Nesterenko suggests these types of injuries are usually resolved within 8-12 weeks from the subject accident, while her assessment was undertaken more than 8 months following the subject accident, which is not addressed. From my perspective an assessment that occurs 8 months following the subject accident clearly puts the applicant outside the usual timeline for resolution and yet there is no further explanation or discussion.
40I find that the applicant is entitled to the disputed Healthmax physiotherapy treatment plan.
Psychological assessment plans
41The respondent conceded the applicant’s removal from the MIG in the days prior to the hearing. The respondent also concedes that a psychological assessment is necessary and has offered to approve either of the two assessments that have previously been denied. The respondent submits that the treatment plans are duplicative and only one should be undertaken.
42The applicant submitted treatment plans for psychological assessments on May 25, 2023 and again on September 19, 2023. The applicant submits that both plans are reasonable and necessary because they are submitted at different times.
43The respondent has conceded that a psychological assessment is reasonable and necessary. I agree. The respondent is requesting the applicant select one of the two assessments.
44The applicant’s submissions with regard to “two different time frames” lacked evidence or further detail and does not persuade me that two assessments would be reasonable. While I agree that the applicant has met her onus and demonstrated entitlement, in my opinion it would not be reasonable to have two psychological assessments; assessments are not treatment, assessments can set a course for treatment.
45I find that two concurrent psychological assessments, on a balance of probabilities, would not be beneficial in supporting the applicant in returning to normal function.
46The Complex Care OCF-18 was submitted by Farzaneh Pariman, psychologist; at part 6 of the form Ms. Pariman details the injuries she is seeking to assess as panic disorder, other reactions to severe stress and undifferentiated somatoform disorder. The goals of the plan are pain reduction, increase strength and increasing adaptive skills and reducing psychological suffering. Under additional comments Ms. Pariman detailed the subject accident, the applicant’s treatment since that time and opined “In summary, Ms. Yepez Lopez presented as an individual in need of psychological assistance. Her responses also indicated that her psychological symptoms, thoughts, feelings, and coping styles may impede her recovery from the subject accident. Based on her clinical presentation during the direct screening interview and the information that was obtained and provided, it is my impression that from a psychological perspective, her injuries/symptoms fall outside of the Minor Injury Guidelines.”
47The Healthmax OCF-18 was submitted by Zubina Ladak, psychologist; at part 6 of the form Ms. Ladak details the injuries she is seeking to assess as adjustment disorders, somatoform disorders, mixed anxiety and depressive disorder and panic disorder. The goals of the plan suggest a review of the additional comments section; however, goals are not listed. The additional comments section stresses that the applicant has been assessed for anxiety in hospital and provides several pleadings and reasons to remove the applicant from the minor injury guideline.
48I am persuaded that the Complex care plan is the superior plan because of the detail contained in the additional comments section that provides an overview of the applicant’s work situation, the subject accident, treatment to date, a provisional diagnosis and reasoning for a psychological assessment.
49The applicant is entitled to the Complex Care assessment plan.
Chronic Pain treatment plan
50The applicant is entitled to the chronic pain assessment.
51The applicant submits that she is entitled to the chronic pain treatment plan and points to the North York General Hospital (“NYGH”) records which repeatedly mention chronic pain in support of her claim.
52The respondent submits that assessor Dr. Nesterenko found no objective impairment attributable to the soft-tissue injuries from the accident and submits that the applicant was referred to an OHIP pain clinic which she did not attend and therefore the applicant is not in need or does not want to attend a pain clinic.
53I note that the original OCF-18 was not explicitly entered into evidence, the denial has been entered into evidence, and I can therefore see that there is a dispute. Presumably, the respondent reviewed this OCF-18 in the course of the denial and therefore it is a document known to both parties and I can only assume it was not entered into evidence as an inadvertence. With this understanding I have reviewed the OCF-18 which was found within applicant submissions.
54The OCF-18 was submitted by Healthmax on July 4, 2023, and proposes a chronic pain assessment for a total cost of $2,567.16. The assessment plan proposes the assessment be conducted by Dr. Kevin Rod. The goals of the plan are pain reduction and to return to the activities of normal living. Under barriers to recovery the assessment proposes that the chronicity of injuries will affect the rate of recovery, and states that the contributing factors to this chronicity should be investigated further and addressed.
55The applicant’s pain complaints have been consistent. During the hearing, the applicant testified she has chronic back pain and can “no longer wear high heels as she is hunched over.” I found the applicant to be consistent in her testimony and that the testimony is corroborated by additional evidence. The NYGH records of May 30, 2023 indicate in discharge instructions that she has been referred to the Silver Pain Centre for management of your chronic pain. NYGH records from December 24, 2023 reference that the applicant is suffering from chronic back pain, for which she takes duloxetine. The subject accident is referenced in the NYGH records. I am persuaded by the NYGH records because there is a presenting problem, investigation, and diagnosis with detail on the time spent in hospital, the investigative techniques and clear discharge instructions. Taken together, the applicant is consistently experiencing pain caused by the subject accident and that pain has been reported for more than year.
56The applicant reported neck, back, left shoulder, elbow, hip, knee, ankle, and foot-pain along with bi-lateral wrist and hand pain to s. 44 assessor Dr. Nesterenko on August 29, 2023. Dr. Nesterenko does not address the pain the applicant is feeling, nor does she address the consistent reports of pain throughout the records she reviewed. I have previously stated that I provide Dr. Nesterenko’s report with a diminished weight and continue to hold that view.
57Assessments by their very nature are speculative, suggesting that symptoms be explored to ascertain whether a particular diagnosis is appropriate. In this situation the respondent asserts that exploring whether the applicant has chronic pain is not reasonable or necessary. I disagree, it is reasonable to assume, based on the above, that the applicant suffers from pain that may be chronic in nature. The pain complaints have been consistent and longstanding, making it necessary in my mind to explore the potential for chronic pain.
58I find that the OCF-18 proposing a chronic pain assessment is reasonable and necessary.
OCF-21 submission
59I have not been pointed to any evidence related to the submission or the denial of the OCF-21. I find that the applicant has not met her onus to demonstrate entitlement to the OCF-21.
Interest
60I find that Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule.
Award
61The applicant sought an award under s. 10 of Reg. 664. Under s. 10, the Tribunal may grant an award of up to 50 per cent of the total benefits payable if it finds that an insurer unreasonably withheld or delayed the payment of benefits.
62The applicant submits that the respondent conduct was stubborn, prolonged, and harmful. Submitting that the respondent ignored overwhelming evidence of psychological injury, unreasonably holding the applicant in the MIG; denied treatment plans while claiming examinations were “in progress” despite issuing no proper insurer’s examination notices; did not respond to the applicants IRB claim for more than a year; and engaged in a sustained pattern of conduct that undermined the statutory scheme. The applicant relies on Adjuster’s Log Notes, CNRs of Oasis Family Health, treatment records at Melrose Physiotherapy and Healthmax as well as NYGH care records.
63The respondent submits that no award is due, that delays are as a result of the applicant’s non-compliance with reasonably required assessments, document requests and inadvertent mistakes.
64In determining the type of conduct for which an award is appropriate, the adopted standard is set out in the Financial Services Commission of Ontario case: Wayne Allan Plowright v. Wellington Insurance Company, 1993 ONICDRG 66 (“Plowright”). According to Plowright, unreasonable conduct can include “excessive, imprudent, stubborn, inflexible, unyielding or immoderate” behaviour. In November 2024, this approach was reviewed by the Divisional Court in McDonald v. Aviva Insurance Company, 2024 ONSC 6030.
65In my mind, if an insurer has strong and consistent evidence that an insured has a non-minor impairment and fails to remove the insured from the MIG, that could attract an award. I also agree that seeking an IE in the face of strong and consistent evidence of a non-minor impairment might not be “reasonably necessary”.
66The evidence indicates to me that, from the moment the respondent was made aware of the subject accident, they were informed of potential non-minor injuries. Following the accident, the applicant calls to inform the respondent of the subject accident. During the call with the adjuster the applicant referenced panic attacks, as a result of and since the subject accident. On January 6, 2023, the respondent calls the applicant to follow-up and check on her injuries. The applicant once again informs the respondent that she is experiencing persistent panic attacks since the subject accident. In my mind, persistent panic attacks are a potential psychological condition that the respondent should be alive to in the adjusting process.
67I point to the CNRs of Melrose Physiotherapy; the applicant’s first visit for treatment on January 9, 2023, with Melrose Physiotherapy, indicates on the OCF-1 “concussion-related symptoms present – memory, attention, concentration, appetite, fatigue since MVA. ++ anxiety and stress since.” In my mind, there is reason for concern that the applicant has suffered non-minor injuries from the initial filing of the OCF-1 by, it should be noted, a preferred service provider of the respondent.
68I point to the NYGH care notes of May 2023. The applicant was admitted to NYGH on May 27, 2023, until discharge on May 30, 2023. While admitted the applicant was assessed by Dr. Nancy Song for panic disorder. Dr. Song, psychiatrist, notes that there is some self-harm occurring during panic attacks and makes recommendations to adjust medication and seek immediate mental health support. The care notes of Dr. Song are clear and specific, the applicant is suffering a panic disorder and having issues with managing pain in her neck, back, and left flank and these complaints are in relation to the subject accident. In my mind a 3-day admission to hospital should gain the attention of the adjuster, especially considering the notes reference chronic pain and panic disorder along with reference to the subject accident. I place weight on the notes of Dr. Song and the NYGH care notes in general, they are clear and detailed. In my mind the notes outline an applicant who is being referred for further intervention due to psychological sequelae and chronic pain and that these noted impairments are in relation to the subject accident. In my mind, this is an independent OHIP funded, staff psychiatrist with NYGH, it is unclear what further information is required to support a psychological assessment or why the identification of non-minor injuries by Dr. Song is not sufficient to remove the applicant from the MIG. The handling adjuster was not able to provide reasoning underlying decisions in this regard.
69In my mind the insurer is blameworthy for unreasonably holding the applicant in the MIG; the clinical notes and records (“CNRs”) of the family GP and multiple hospitalization care records from NYGH indicate an insured that is experiencing psychological injuries. The family GP and the NYGH records consistently reference the subject accident in relation to the psychological injuries. In particular I draw attention to the adjuster log notes on February 18, 2025, following assignment of the case to a new adjuster the notes indicate that panic attacks are not related to the subject accident. It is unclear how the adjuster could read the exact opposite meaning across multiple care records and direct reports to the insurer. In my mind, the testimony of the handling adjuster regarding this substantial misread of the file was not cogent.
70Moving forward in the claims history I also want to draw particular attention to the applicant’s attendance at NYGH on December 24, 2023, following a panic attack and an overdose of Duloxetine which the applicant takes to ease panic attacks. The applicant at one point during the health episode indicated that the overdose was a suicide attempt to her husband and separately to a triage nurse. I note that this specific panic attack occurred 1 year following the subject accident and the applicant notes that the anniversary is the aggravating factor. There are also notations of self-harm occurring during panic attacks within the hospital care notes. This is a second hospital admission, within a year of the subject accident, noting psychiatric intervention and the records are replete with notations that reference the subject accident. By this point the respondent has denied 2 separate submissions for OCF-18’s recommending a psychological assessment. The handling adjuster was not able to provide coherent reasons for this. Taken together, in my mind, this is evidence of the respondent demonstrating an inflexible and unyielding approach to adjusting the applicant’s claim.
71In my mind the respondent, in this situation, has used the Schedule to their advantage and I do not see sufficient care taken in the responsibility to support the applicant in their recovery. Deterrence of this approach is warranted. I find that the respondent has behaved in an imprudent, inflexible, unyielding and immoderate way toward the applicant’s claims to entitlement to treatment. In my mind, holding the applicant in the MIG in the face of the NYGH, family doctor and treatment records should receive an Award of 20% of benefits and interest owing, because there is no remedy for the delay in removing the applicant from the MIG, there is a time limit to submit claims and a great deal of that time has been depleted thus infringing on the applicants potential claim period.
72Turning to the respondents handling of the applicant’s IRB claim, the applicant applied for IRB on December 11, 2024, and her claim went unanswered, for more than a year. The applicant soon after this departed the country. In my mind, the respondent ignored the applicant. Following more than a year without responding to the applicant’s application the insurer attempted to avoid adjudication on this matter by approving the applicant for IRB in the days ahead of the hearing, however, consistent with their previous behaviour the respondent did not pay the IRB, they asked for further documentation from the applicant. In my mind, the respondent’s s.36(4) non-compliance was plain to see and no further information from the applicant was required to make the calculation or pay the IRB. The adjuster testified that they were awaiting the result of this hearing before making any payment. In my mind, this is another example of the respondent’s imprudent approach to the applicant.
73The applicant was vulnerable. The applicant was a permanent resident, working in a sales role. Ultimately the applicant returned to Columbia following the subject accident. In my mind this is an expression of the vulnerability of the applicant. The applicant testified that “when treatment started things got better, when they (the respondent) cut me off, my life turned to a piece of @#$% (expletive redacted), I would be better and working, I would have my drivers’ licence, I was forced to leave Canada because it was impossible to work and have a normal life.”
74To intentionally refuse to take notice of or give attention to an applicant is an act of deliberate disregard; and to await the outcome of a hearing instead of the regular adjustment of the file is imprudent behaviour in my mind. This deliberate disregard and imprudent behaviour merit an award of 15% of the benefits and interest owing.
75For the reasons above, I find that an award of 35% is due to the applicant on all benefits and interest owing.
the Applicants request for Costs is denied
76At the beginning of the hearing the applicant requested that costs be added as an issue in dispute.
77Rule 19.1 of the Rules states that the Tribunal may award costs when “another party has acted unreasonably, frivolously, vexatiously, or in bad faith.” Rule 19.5 provides a list of factors the Tribunal shall consider when determining whether to order costs.
78The applicant submits that the respondent rapidly cycled through multiple defenses and changed their positions on the MIG and IRB in the days before the hearing.
79The respondent submits that “last-minute” changes were good faith decisions made once the respondent determined they could not obtain a s.44 assessment.
80The “last-minute” decisions appeared half-hearted to me; for instance, while the applicant was removed from the MIG, the respondent states that this is for psychological treatment and while the applicant was approved for IRB this was immediately followed with s.33 requests which, in my view, were not required to determine entitlement or quantum. While these changes in approach to the dispute would be difficult to prepare for on the eve of a hearing I do not see this as misconduct; the respondent did not breach a direction or order by the Tribunal, and this behaviour did not interfere with the Tribunal’s ability to carry out a fair, efficient and effective process.
81Costs are not ordered.
ORDER
82The applicant is not in the MIG.
83The applicant is entitled to income replacement benefits.
84The applicant is entitled to the physiotherapy treatment plan.
85The applicant is entitled to the psychological assessment proposed by Complex Care.
86The applicant is not entitled to the psychological assessment proposed by Healthmax.
87The applicant is entitled to the chronic pain assessment proposed by Healthmax.
88The applicant is not entitled to the partially approved invoice from Healthmax.
89The applicant is entitled to interest on all overdue payments.
90The applicant is entitled to an award.
91Costs are not ordered.
Released: June 4, 2026
Timothy Porter Adjudicator