Sareena Samra

The applicant sought various medical benefits, housekeeping and home maintenance expenses, and an award under section 10 of Regulation 664 following a motor vehicle accident.

The Licence Appeal Tribunal found the applicant was entitled to one prescription expense for Apo-Lorazepam, as it was supported by the clinical notes and records, and the respondent agreed to pay one other expense.

The remaining medical expenses and the housekeeping claim were dismissed, as the applicant failed to provide supporting evidence or a required disability certificate.

The claim for an award was also dismissed because the respondent did not unreasonably withhold or delay benefits.

The applicant, who was deemed catastrophically impaired following a motor vehicle accident, sought payment for various treatment plans and an award for unreasonable delay.

Several issues were withdrawn or resolved prior to the hearing.

The Tribunal found that the applicant was not entitled to brokerage fees or provider travel time associated with occupational therapy services, as they were not reasonable and necessary and would effectively increase the hourly rate beyond the permitted maximums.

The Tribunal also denied the request for an award, finding that the respondent acted in good faith and its ability to adjust the file was hindered by the applicant's failure to produce requested documents.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that awarded the applicant various medical and rehabilitation benefits.

The Vice-Chair found that the Tribunal made errors of fact and material breaches of procedural fairness by failing to address the respondent's submissions regarding occupational therapy, physiotherapy, medication, and an eye exam.

The reconsideration was granted in part, and a re-hearing in writing was ordered for the disputed benefits.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found that he was barred from proceeding with a claim for income replacement benefits due to the expiry of the two-year limitation period.

The applicant argued that the Tribunal breached procedural fairness and made errors of law and fact in applying case law regarding clear and unequivocal denials and the extension of time.

The adjudicator dismissed the request, finding that the applicant was attempting to re-litigate the original decision and failed to establish any material breach of procedural fairness or errors of law or fact that would warrant a reconsideration under Rule 18.2.

The applicant was injured in a motor vehicle accident and sought payment for the unapproved portions of a treatment plan for catastrophic impairment assessments totaling $5,411.04.

The Licence Appeal Tribunal found that the applicant failed to prove the unapproved portions, which included file reviews, transportation, and interpretation services, were reasonable and necessary.

The Tribunal noted that file reviews are not independently billable under s. 25(5) of the Schedule.

The application was dismissed, and claims for interest and an award were consequently denied.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for various treatment plans, including chiropractic, physiotherapy, and psychological services.

The respondent insurer partially approved several plans but denied transportation expenses and disputed the hourly rate for a social worker.

The respondent also fully denied a subsequent chiropractic treatment plan based on an insurer's examination which found no objective evidence of continuing impairments.

The Tribunal found that the applicant failed to meet his burden to prove the denied amounts and the fully denied treatment plan were reasonable and necessary.

The Tribunal also found the insurer's denial notices were compliant with the Schedule.

The application was dismissed in its entirety.

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 sought removal from the MIG based on chronic pain and a psychological condition but provided no medical evidence beyond the treatment plans themselves.

The Tribunal found the applicant failed to meet the burden of proof for removal from the MIG.

The Tribunal also found the respondent's denial letters complied with s. 38(8) of the Schedule.

The application was dismissed, and no interest or award was granted.

The applicant sought a special award under s. 10 of O. Reg. 664, alleging the respondent insurer unreasonably delayed payment of attendant care and housekeeping benefits.

The Tribunal found that the delay was the result of an inadvertent clerical error by an adjuster covering the file, and that the respondent immediately paid the outstanding amounts with interest upon being notified.

The Tribunal concluded the insurer's conduct was not excessive, imprudent, or stubborn, and dismissed the application for an award.

The applicant, who sustained a catastrophic impairment in a motor vehicle accident, sought payment for outstanding balances on six treatment plans for psychological services and $400 for housekeeping benefits.

The Licence Appeal Tribunal dismissed the application.

The Tribunal found the applicant failed to justify billing a psychotherapist's services at the higher hourly rate of a psychologist.

The claim for housekeeping benefits was denied because the applicant provided no evidence that the expenses were actually incurred or reasonable and necessary.

The applicant sought accident benefits following a motor vehicle accident, claiming a psychological condition warranted removal from the Minor Injury Guideline (MIG).

The Tribunal found the applicant's evidence, including clinical notes and a social worker's assessment, insufficient to establish a psychological condition caused by the accident, noting the symptoms were more likely related to an unrelated chronic health condition.

As the applicant remained within the MIG and the limits were exhausted, the claim for a psychological assessment was denied, along with claims for interest and a special award.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The respondent denied the claims for chiropractic services and a psychological assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been exhausted.

The applicant argued he suffered from psychological injuries and a chronic pain condition that removed him from the MIG.

The Tribunal found the applicant's evidence insufficient to establish a psychological injury or chronic pain condition, noting he missed no time from work and had minimal medical treatment.

The Tribunal concluded the applicant sustained a minor injury subject to the MIG, dismissed the claims for medical benefits, and denied the requests for interest and an award.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB) and funding for chiropractic, physiotherapy, and psychological treatment plans.

The respondent denied the benefits, relying on insurer's examinations which concluded the applicant did not suffer a substantial inability to perform his pre-accident employment and that the proposed treatments were not reasonable and necessary.

The adjudicator found that the applicant failed to provide sufficient medical evidence to meet his burden of proof for the IRB and the treatment plans.

The adjudicator also dismissed the claims for interest and an award for unreasonable delay, as no benefits were found to be overdue or unreasonably withheld.

The application was dismissed in its entirety.

The applicant sought income replacement benefits (IRBs) and medical benefits following a motor vehicle accident.

The respondent denied the IRBs on the basis that the applicant had returned to work and made a material misrepresentation.

The applicant filed an application with the Tribunal more than two years after the denial.

The Tribunal found that the respondent's denial letter was clear and unequivocal, triggering the two-year limitation period under s. 56 of the Schedule.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act, noting the substantial delay and surveillance evidence showing the applicant working.

The Tribunal also dismissed the claims for medical benefits, finding the applicant failed to prove they were reasonable and necessary.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including treatment plans for a hospital bed rental, a catastrophic impairment assessment, physiotherapy, and psychological services.

The Tribunal found the hospital bed rental payable because the insurer's denial failed to comply with the medical reasons requirement under s. 38(8) of the Schedule.

The physiotherapy plan was deemed reasonable and necessary based on the treating physician's recommendation.

However, the catastrophic assessment and the disputed portion of the psychological services plan were denied.

Claims for a special award were dismissed, but interest was awarded on the overdue benefits.

The applicant sought statutory accident benefits, including income replacement benefits and medical benefits, following a motor vehicle accident.

The adjudicator found the applicant to be an unreliable witness who misrepresented her post-accident employment status.

The applicant's claim for a chiropractic treatment plan was barred by the two-year limitation period.

The claims for income replacement benefits and other medical benefits were dismissed as the applicant failed to prove she suffered a substantial inability to perform her employment tasks or that the treatments were reasonable and necessary.

Claims for interest and a special award were also dismissed.

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

After the respondent approved the disputed treatment plans for physiotherapy and psychological services, the only remaining issues were the applicant's entitlement to a special award under s. 10 of O. Reg. 664 and interest on overdue payments.

The Tribunal found it had jurisdiction to hear the stand-alone issues.

The Tribunal dismissed the claim for a special award, finding the respondent's withholding of benefits was reasonable due to the applicant's failure to attend scheduled insurer's examinations.

However, the Tribunal ordered the respondent to pay interest on the portions of the treatment plans that had been incurred.

The applicant was struck by a truck while crossing an intersection on her mobility scooter and sought statutory accident benefits.

The respondent insurer denied several treatment plans for occupational therapy, physiotherapy, and psychological services, as well as claims for out-of-pocket expenses.

The Licence Appeal Tribunal found the applicant entitled to certain occupational therapy services due to a defective denial notice, as well as reimbursement for medication, damaged glasses, and dental repairs.

The Tribunal also ordered a special award under s. 10 of Regulation 664, finding the insurer acted unreasonably by expecting a family member to install a bed rail gratuitously instead of paying the installation cost.

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 Tribunal found the applicant failed to meet his evidentiary burden to prove his injuries warranted removal from the MIG.

Consequently, the disputed treatment plans for chiropractic services and a psychological assessment were not payable.

The Tribunal also dismissed the claims for an income replacement benefit, interest, and an award, noting the applicant's non-compliance with requests for information.

The application was dismissed in its entirety.

The applicant sought a Non-Earner Benefit (NEB), interest, and an award under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove a complete inability to carry on a normal life, noting inconsistencies in his self-reports and a lack of evidence regarding his pre-accident activities.

The Tribunal preferred the respondent's insurer examination reports over the applicant's psychological assessments, which failed to review medical records or delineate the impact of multiple accidents.

The application was dismissed in its entirety.

The applicant sought entitlement to a treatment plan for chiropractic services in the amount of $4,383.90, along with interest and a special award, following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to provide corroborating, contemporaneous medical evidence to establish that the proposed treatment plan was reasonable and necessary.

The application was dismissed, and the claims for interest and a special award were denied.