Shivani Mehta

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

The respondent denied a treatment plan for a psychological assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to establish that her injuries fell outside the MIG, noting that the medical evidence provided, including a letter from a psychiatrist, was unpersuasive and lacked objective testing or explanation.

As the MIG limits had been exhausted, the applicant was not entitled to the disputed treatment plan or interest.

The application was dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought a medical benefit of $2,195.00 for a temporomandibular joint (TMJ) assessment.

The respondent insurer denied the treatment plan, arguing the applicant's injuries fell within the Minor Injury Guideline and relying on an insurer's examination that found no TMJ disorder.

The Tribunal preferred the applicant's medical evidence, noting that the applicant had sustained broken teeth in the accident and that the treating dentist's assessment was more thorough than the insurer's examination.

The Tribunal found the TMJ assessment to be reasonable and necessary, and ordered the respondent to pay the benefit with interest.

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

The respondent approved a portion of a psychological assessment plan but denied the remaining balance of $803.12.

The applicant applied to the Licence Appeal Tribunal to dispute the denial.

The Tribunal found that the applicant failed to prove the unapproved balance was reasonable and necessary, as the assessment plan lacked a breakdown of the methodologies, time required, and hourly rates.

The Tribunal preferred the respondent's section 44 assessment, which concluded that the approved amount was reasonable based on the Professional Services Guideline.

The application was dismissed.

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

The respondent denied the treatment plan, asserting the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to provide sufficient medical evidence or analysis to demonstrate that her injuries warranted removal from the MIG.

As the MIG limits had been exhausted, the Tribunal held the applicant was not entitled to the disputed treatment plan or interest.

The application was dismissed.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident, which the respondent insurer denied based on insurer's examinations.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove a substantial inability to perform the essential tasks of his self-employment.

The Tribunal preferred the respondent's medical evidence, noting that the applicant's own clinical records indicated he had returned to work shortly after the accident and lacked objective medical evidence to support his claim.

Claims for interest and an award for unreasonable delay were also dismissed.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision.

The respondent insurer 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 diagnosed psychological injury (Adjustment Disorder) removed them from the MIG, despite the applicant's reported disinterest in psychological treatment.

While the Tribunal approved the psychological assessment and treatment plans, it denied the physiotherapy, assistive devices, and chronic pain plans, finding them not reasonable and necessary based on the medical evidence.

The Tribunal also ordered the respondent to pay an award of $1,110.95 under O. Reg. 664 for unreasonably withholding the psychological benefits by misinterpreting the Schedule.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied entitlement to chiropractic treatment plans and a chronic pain assessment following a motor vehicle accident.

The applicant argued the Tribunal made significant errors of fact and law regarding the medical evidence of causation, the severity of a subsequent accident, and the refusal to extend a limitation period for a denied treatment plan.

The Vice-Chair dismissed the request, finding no significant errors of law or fact that would have likely resulted in a different decision.

The respondent insurer requested a reconsideration of a $300 costs award made against it for allegedly failing to comply with a Tribunal order regarding the disclosure of surveillance evidence.

The Vice-Chair found that the Tribunal made significant errors of fact, as the respondent had not actually breached any disclosure deadlines set out in the prior orders.

Furthermore, the Tribunal erred in law by applying the incorrect version of the Rules of Practice and Procedure.

The request for reconsideration was granted and the costs award was reversed.

The applicant was injured in a motor vehicle accident and sought medical benefits for three chiropractic treatment plans under the Statutory Accident Benefits Schedule.

The respondent insurer denied the plans based on section 44 assessments.

The Licence Appeal Tribunal found the treatment plans reasonable and necessary, noting the applicant's pre-existing osteoarthritis and ongoing pain.

The Tribunal rejected the insurer's medical assessments because they failed to account for key medical evidence, including a diagnostic imaging report.

The applicant was awarded the disputed benefits and interest.

The applicant was struck by a minivan and sought statutory accident benefits for physiotherapy, an in-home assessment, and an orthopaedic assessment.

The respondent initially denied the treatment plans with defective notices under s. 38(8) of the Schedule, but later provided proper notice with IE reports.

The Tribunal found that none of the treatment plans were reasonable and necessary, relying on the applicant's family doctor's records and the respondent's IE physician.

However, because of the initially defective notice, the respondent was ordered to pay for any physiotherapy costs incurred between the 11th business day after the plan was submitted and the date proper notice was given.

The claims for the assessments and a special award were dismissed.

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

After a case conference, a written hearing was scheduled.

The applicant's counsel withdrew, and the applicant failed to provide any submissions or evidence, nor did they respond to communications from the Tribunal.

The adjudicator dismissed the application due to the applicant's failure to meet their evidentiary burden.

The respondent was awarded $125 in costs because the applicant's failure to participate or withdraw the application was deemed unreasonable and frivolous.

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

The respondent insurer denied the claim, arguing the applicant was time-barred under section 56(1) of the Statutory Accident Benefits Schedule because he failed to dispute the refusal within two years.

The Tribunal found that the respondent's initial denial letter was clear and unequivocal, thereby triggering the limitation period.

As the applicant initiated his dispute outside the two-year window, his application was dismissed as time-barred.

The applicant sought statutory accident benefits for chiropractic treatment and a chronic pain assessment following a motor vehicle accident.

The respondent denied the benefits, arguing the injuries fell within the Minor Injury Guideline and that a subsequent accident caused the chronic pain.

The Tribunal dismissed the application, finding one treatment plan was statute-barred as it was appealed beyond the two-year limitation period without justification for an extension.

The Tribunal further held the remaining chiropractic plans were not reasonable and necessary, as previous similar treatments had been ineffective and the applicant failed to prove his impairments extended beyond minor soft tissue injuries.

Finally, the request for a chronic pain assessment was denied because the applicant failed to establish causation linking the chronic pain to the first accident rather than the second.

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

The respondent denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that a pre-existing condition of lower back pain should remove him from the MIG.

The Tribunal found that while the applicant had a pre-existing condition, he failed to provide compelling evidence that it would prevent him from achieving maximal recovery within the MIG limits.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits for chiropractic, massage, and physiotherapy treatments under the Statutory Accident Benefits Schedule.

The insurer denied the claims.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that the proposed treatment plans were reasonable and necessary.

Medical evidence indicated the applicant's physical injuries were minor and improving, and the treatment plans did not adequately explain how further treatment would assist with accident-related injuries.

The application was dismissed.

The applicant sought a non-earner benefit and the cost of an in-home assessment following a motor vehicle accident.

The adjudicator found the applicant was not a reliable witness and had failed to disclose significant post-accident activities, such as travelling, working, and doing housework, to her medical assessors.

Consequently, the adjudicator placed little weight on the applicant's medical reports and concluded she did not meet the stringent test for a non-earner benefit.

However, the adjudicator ordered the respondent to pay for the incurred in-home assessment and applicable interest.

The applicant's request for costs was denied.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident, claiming an inability to perform his pre-accident employment as a factory worker.

The adjudicator dismissed the claim, finding that the applicant failed to prove what his essential pre-accident employment tasks were, which tasks he was unable to perform, and the extent of his inability.

The applicant's claim for costs was also dismissed due to a lack of evidentiary basis.

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).

Procedurally, the Tribunal excluded surveillance evidence submitted late by the respondent in breach of a prior order, awarding $300 in costs to the applicant.

Substantively, the Tribunal found that the applicant failed to provide compelling evidence of a pre-existing condition that would prevent maximal recovery within the MIG limits.

Consequently, the applicant's claims for medical and rehabilitation benefits beyond the $3,500 cap were dismissed.

The applicant sought reconsideration of a Licence Appeal Tribunal decision that denied her claim for ongoing attendant care benefits.

The applicant argued that the Tribunal erred in finding it lacked equitable jurisdiction to apply estoppel by convention, which would have prevented the insurer from terminating benefits it had mistakenly paid for several months.

The Executive Chair dismissed the request, holding that the Tribunal must resolve disputes in accordance with the Statutory Accident Benefits Schedule and cannot use equity to override the statutory requirement that expenses be 'incurred.' Furthermore, the test for estoppel by convention was not met, as the parties did not share a mutual assumption and the applicant suffered no detriment.

The applicant sought reconsideration of a preliminary issue decision that barred her application to the Tribunal under s. 55(1)2 of the Statutory Accident Benefits Schedule for failing to attend an insurer examination.

The Executive Chair granted the reconsideration, finding that the Tribunal erred in refusing to consider the sufficiency of the insurer's notice.

The Executive Chair held that the insurer's notice failed to provide sufficient medical reasons for the examination as required by s. 44(5)(a), and therefore the applicant was not barred from proceeding with her application.