Ramy Akladios

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found her injuries fell within the Minor Injury Guideline (MIG) and denied a treatment plan for a chronic pain assessment.

The applicant argued the Tribunal erred in law by improperly weighing the expert evidence and failing to qualify her expert.

The adjudicator dismissed the reconsideration request, finding no error of law.

The original decision appropriately gave less weight to the applicant's expert report because it lacked an Acknowledgement of Expert's Duty form and the chronic pain diagnosis was unsupported by other medical evidence.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her injuries warranted removal from the Minor Injury Guideline (MIG) due to pre-existing conditions, chronic pain, and psychological impairment.

The Licence Appeal Tribunal found the applicant's injuries were predominantly minor and treatable within the MIG, noting a lack of compelling medical evidence to support chronic pain or a psychological impairment caused by the accident.

The application for a chronic pain assessment, an award for unreasonable delay, and interest was dismissed.

The respondent's request for costs was also denied.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident, specifically claiming treatment plans for psychological services and chronic pain management.

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

The Tribunal noted the applicant's immediate return to work, lack of referrals from his family physician, and the insurer's examinations which found no accident-related psychological or physical impairments requiring the proposed treatments.

Claims for interest and a special award were also dismissed.

The applicant sought income replacement benefits following a motor vehicle accident.

The respondent denied the benefits on the basis that the applicant was not employed for at least 26 weeks during the 52 weeks prior to the accident, as required by s. 5(1)1(ii)A of the Statutory Accident Benefits Schedule.

The applicant argued that her 180 days of employment (25.71 weeks) should be rounded up to 26 weeks in accordance with the consumer protection mandate of the Schedule.

The Tribunal held that the statutory language is clear and establishes a strict minimum threshold of 26 weeks.

As there is no provision allowing for rounding up, the applicant was found ineligible for income replacement benefits.

The applicant requested a reconsideration of a decision denying two OCF-18s for passive therapy.

The applicant argued the adjudicator made a significant error of fact by not considering the impact of suspending passive rehabilitation on her pain relief and function.

The Vice-Chair dismissed the request, finding that the applicant was merely attempting to re-litigate the weight assigned to the medical evidence, particularly the preference for the insurer's section 44 examination report over the applicant's medical evidence.

The Vice-Chair confirmed that the original decision properly considered the evidence and the applicant's failure to meet her burden of proof.

The applicant sought a Non-Earner Benefit (NEB) following a motor vehicle accident but failed to submit a completed Disability Certificate (OCF-3) until 121 weeks after the accident.

The insurer denied the claim on the basis that the OCF-3 was submitted beyond the 104-week eligibility period.

The Tribunal held that the applicant was statute-barred from proceeding with the NEB claim under section 36 of the Schedule, as the benefit is not payable for any period prior to the submission of the OCF-3, and the 104-week eligibility period under section 12 had already expired.

The applicant's argument of having a reasonable explanation for the delay was rejected as irrelevant to the mandatory procedural requirements.

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

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor and that there was insufficient medical evidence of chronic pain, psychological diagnosis, or functional impairment to justify removal from the MIG.

As the applicant had not exhausted the MIG limits, the disputed treatment plans were deemed not reasonable and necessary.

The application was dismissed.

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

The respondent denied the benefits and requested a preliminary issue hearing to determine if the applicant was barred from proceeding due to her failure to attend multiple insurer's examinations under s. 44 of the Schedule.

The Tribunal found that the respondent provided proper notice and the applicant failed to provide a reasonable explanation for missing six scheduled examinations.

Consequently, the applicant was barred from proceeding under s. 55 of the Schedule, and the application was dismissed.

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

The respondent insurer limited the applicant's medical and rehabilitation benefits to the $3,500 cap under the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing that pre-existing conditions, chronic pain, and psychological impairments warranted removal from the MIG.

The Tribunal found that the applicant failed to prove her impairments fell outside the MIG, preferring the respondent's section 44 assessment reports which found no functional impairment or DSM-V diagnosis.

As the MIG limits were exhausted, the disputed treatment plans were deemed not reasonable and necessary.

Claims for an award, costs, and interest were dismissed.

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

The respondent insurer denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the claimed benefits exceeded the $3,500 limit.

The applicant argued he should be removed from the MIG due to a pre-existing condition, psychological injuries, and chronic pain.

The Tribunal found the applicant's evidence, including expert reports, to be contradictory and unsupported by the objective medical records.

The Tribunal concluded the injuries were minor and dismissed the application, including claims for an award under Regulation 664.

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

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

The Tribunal found that the applicant's injuries were predominantly minor and did not meet the threshold for chronic pain that would remove him from the MIG.

However, because the respondent failed to provide proper notice under s. 38(8) of the Schedule for a chiropractic treatment plan, it was ordered to pay any incurred expenses for that plan.

The respondent also conceded payment for a chronic pain assessment due to late notice.

The applicant's claim for a special award under O. Reg. 664 was dismissed.

The applicant was a pedestrian struck by a vehicle and sought statutory accident benefits.

The respondent insurer limited the applicant's medical and rehabilitation benefits to the $3,500 cap under the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing that chronic pain and psychological impairment warranted removal from the MIG.

The adjudicator found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain or a psychological impairment, preferring the objective findings of the insurer's examination assessors over the subjective reports of the applicant's experts.

As the injuries fell within the MIG and the maximum benefits had already been approved, the disputed treatment plans were denied.

The claims for an award and costs were also dismissed, as the insurer did not act unreasonably.

The applicant was injured in a motor vehicle accident and sought an income replacement benefit (IRB) and various medical benefits from the respondent insurer.

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

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to provide sufficient medical evidence demonstrating a substantial inability to perform the essential tasks of his employment as a car washer.

Furthermore, the Tribunal held that the insurer validly denied the treatment plans under s. 38(5) of the Schedule because the applicant failed to submit them via an OCF-23 while subject to the MIG, and such denials are not subject to review pursuant to s. 38(6).