Rozlien Youkhana Brikha

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits, treatment plans, and various assessments.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that she was barred from claiming non-earner benefits for failing to attend an insurer's examination.

The Tribunal found the respondent failed to prove the applicant missed the examination, allowing the non-earner benefits claim to proceed.

However, the Tribunal concluded the applicant's injuries were minor and resolved shortly after the accident, dismissing her claims for non-earner benefits, chronic pain, and catastrophic impairment assessments.

The Tribunal awarded a maximum of $400 for a psychological assessment under the MIG's supplementary goods and services provision.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including attendant care benefits, medical benefits for multiple assessments (physiatry, psychological, chronic pain, nerve conduction, TMJ, and catastrophic impairment), an award under s. 10 of O. Reg. 664, and interest.

The Licence Appeal Tribunal found that the applicant was entitled to the physiatry and chronic pain assessments, as they were reasonable and necessary to investigate her ongoing impairments.

However, the Tribunal dismissed the claims for attendant care benefits and the remaining assessments, finding the applicant failed to meet her burden of proof.

The claim for a special award was also dismissed, as the insurer's conduct was not excessive or unreasonable.

Interest was awarded on the overdue benefits.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that pre-existing conditions and chronic pain warranted removal from the MIG.

The Tribunal found insufficient objective medical evidence to establish that the applicant suffered from accident-related chronic pain or that pre-existing conditions prevented her recovery within the MIG limits.

The Tribunal also found the disputed physiotherapy treatment plan was not reasonable and necessary.

The application was dismissed.

The applicant sought payment for the unapproved portions of a catastrophic assessment treatment plan and psychological treatment plans following a motor vehicle accident.

The Tribunal found the applicant was entitled to $2,000 for an overall assessment and final rating report, as the respondent had conducted a similar assessment.

However, the Tribunal denied the remaining assessment fees and held that a psychotherapist providing treatment should be paid at the Guideline rate of $99.75 per hour, not the psychologist rate of $149.61 per hour.

The claim for an award was dismissed as no submissions were provided.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits from the respondent insurer under the Statutory Accident Benefits Schedule.

The respondent denied the benefits on the basis that they were not reasonable and necessary.

The adjudicator found that the applicant was entitled to a chronic pain assessment and an occupational therapy assessment, as there was sufficient evidence to suspect the conditions for which the assessments were sought.

However, the adjudicator dismissed the claims for chiropractic services, physiotherapy, attendant care assessment, and social work assessment, relying on the insurer's examination reports which concluded the applicant had reached maximum medical improvement and did not require further treatment.

The applicant sought medical benefits for chiropractic, massage, acupuncture, and shockwave therapy following a motor vehicle accident.

The adjudicator found that the applicant failed to prove the proposed treatment plans were reasonable and necessary, as her family physician had not recommended such facility-based treatments and the insurer's examination concluded they would not be beneficial.

However, the adjudicator found that the insurer's initial denials of the treatment plans were defective under s. 38(8) of the Statutory Accident Benefits Schedule for failing to provide medical reasons.

Consequently, the insurer was ordered to pay for any expenses incurred during the period of non-compliance, along with interest.

The applicant sought various statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs), attendant care benefits (ACBs), transportation costs, and a chronic pain assessment.

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal found the applicant failed to prove a substantial or complete inability to work to qualify for IRBs, noting she had returned to work and later received CERB due to pandemic-related job loss.

Claims for ACBs, transportation costs, and the chronic pain assessment were also dismissed for lack of supporting evidence and failure to meet the respective legal thresholds.

Consequently, claims for interest and a Regulation 664 award were denied.

The applicant was injured in a rear-end motor vehicle accident and sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule, including physiotherapy, a chronic pain program, psychological treatment, aqua therapy, and assessments.

The respondent insurer denied the treatment plans based on Insurer's Examination reports.

The Tribunal found that the applicant failed to provide compelling contemporaneous medical evidence to support the treatment plans.

The Tribunal preferred the respondent's expert evidence, noting the applicant's active work and family life and the lack of objective signs of accident-related impairment.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline.

A written hearing was scheduled, but the applicant failed to file any submissions or evidence.

As the applicant bore the onus of proving his entitlement on a balance of probabilities, the Tribunal dismissed the application due to a lack of evidence.

The respondent's request for costs was denied, as the applicant's failure to file submissions did not meet the high threshold of acting unreasonably, frivolously, vexatiously, or in bad faith.

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

The respondent insurer denied the treatment plans, arguing they were not reasonable or necessary and that the applicant had not shown significant improvement.

The Tribunal found that pain management and reduction of addictive medication use were reasonable treatment goals.

The Tribunal concluded the treatment plans were reasonable and necessary, and ordered the respondent to pay for the treatment subject to the hourly fee limits in the Professional Service Guideline, along with interest on overdue payments.

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

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

The applicant sought removal from the MIG based on chronic pain, psychological impairments, and a pre-existing headache condition.

The Tribunal found that the applicant failed to provide compelling medical evidence to justify removal from the MIG under section 18(2) or the AMA Guides criteria for chronic pain.

As the MIG limits were exhausted, the disputed treatment plans were deemed not reasonable and necessary, and claims for interest and a section 10 award were dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought a Chronic Pain Assessment outside the Minor Injury Guideline.

The respondent insurer denied the benefit, arguing the applicant's ongoing pain was related to pre-existing conditions and post-accident activities rather than the collision.

The Tribunal found that the accident caused a significant exacerbation of the applicant's pre-existing back pain, satisfying the 'but for' test for causation.

The Tribunal concluded the Chronic Pain Assessment was reasonable and necessary, ordering the respondent to pay the $2,314.26 cost plus interest.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident.

The respondent denied the treatment plans and an expense claim form.

The Tribunal found that one of the treatment plans was statute-barred as the applicant failed to apply within the two-year limitation period under s. 56 of the Schedule.

For the remaining plans, the Tribunal held that the applicant failed to prove the treatments were reasonable and necessary as a result of the accident, noting the lack of evidence connecting the physical therapy to his psychological complaints and the impact of an intervening slip and fall injury.

The application was dismissed.

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

The respondent 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 a pre-existing connective tissue disease.

The Tribunal found that the applicant failed to provide compelling evidence that her pre-existing condition prevented maximal recovery within the MIG limits, noting that the diagnosis occurred after the accident and was not mentioned in the treatment plans.

The application was dismissed.

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

The respondent denied a treatment plan for physiotherapy, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been exhausted.

The Tribunal found that the applicant's physical injuries were predominantly minor and that she failed to provide sufficient medical evidence to establish a psychological impairment or chronic pain that would remove her from the MIG.

As the funding limit was already expended, the Tribunal dismissed the claim for the disputed treatment plan and interest.

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

A written hearing was scheduled, and the Tribunal ordered the parties to exchange documents and file written submissions.

The applicant failed to file any submissions or provide an explanation for the delay.

As the applicant bore the onus of proving entitlement to benefits, the Tribunal dismissed the application.

The respondent's request for $8,000 in costs was denied, as the applicant's failure to comply with the order did not amount to unreasonable, frivolous, or vexatious conduct warranting a costs award.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits from the respondent insurer.

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

The applicant argued that her chronic back pain and psychological impairments warranted removal from the MIG.

The Tribunal found that the applicant's physical injuries were soft-tissue in nature and fell squarely within the MIG, and that she failed to provide compelling evidence of a pre-existing condition, a formal diagnosis of chronic pain, or a psychological impairment that would prevent maximal medical recovery within the MIG limits.

As the MIG funding was exhausted, the disputed treatment plans were denied.