Suhasha Hewagama

The applicant was injured in a motor vehicle accident and sought payment for two chiropractic and physiotherapy treatment plans totaling approximately $4,000.

The insurer denied the plans based on an insurer's examination concluding the applicant had reached maximum medical recovery.

The Tribunal found the treatment plans were reasonable and necessary, preferring the evidence of the applicant's treating practitioners who diagnosed chronic pain and noted ongoing functional impairments.

The Tribunal ordered payment of the treatment plans with interest, but declined to order a special award, finding the insurer's reliance on its medical assessment was not unreasonable.

Aviva sought reconsideration of a Licence Appeal Tribunal decision that found M.R. was entitled to payment for a chronic pain assessment and a neurological assessment under the Statutory Accident Benefits Schedule.

The adjudicator dismissed the request regarding the chronic pain assessment, finding no significant error of law or fact in the original decision's reliance on the medical records and the assessor's recommendations.

However, the adjudicator granted the request regarding the neurological assessment, acknowledging an error in focusing on headaches rather than the cervicalgia noted in the treatment plan.

The original decision was varied to deny entitlement to the neurological assessment.

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

The insurer denied treatment plans for a psychological assessment, psychological treatment, physical therapy services, and a chronic pain assessment.

The Licence Appeal Tribunal found the psychological assessment and chronic pain assessment to be reasonable and necessary, noting ongoing complaints of driving anxiety and persistent pain.

The Tribunal partially approved the physical therapy plan for massage therapy and a functional exercise program based on the applicant's self-reports of pain relief.

However, the claim for psychological treatment was denied because the supporting psychological report was given no weight due to contradictory statements and lack of clarity regarding the author's diagnosis.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a chronic pain assessment and a neurological assessment, which the respondent insurer denied.

The Licence Appeal Tribunal found that both assessments were reasonable and necessary given the applicant's ongoing complaints of pain and headaches, preferring the recommendations of the applicant's assessors over the insurer's medical examiner.

The Tribunal ordered the respondent to pay for the assessments and interest on overdue benefits, but declined to order an award under O. Reg. 664, finding the insurer had properly considered the claims.

The respondent requested a reconsideration of a motion order that permitted the applicant to file a late affidavit regarding an orthopaedic assessment.

The respondent argued the Tribunal made significant errors of fact and law and breached procedural fairness by denying cross-examination.

The Vice-Chair dismissed the request, finding no significant errors and noting that the respondent was given an opportunity to respond to the affidavit, which minimized any prejudice and satisfied procedural fairness.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a physiatry assessment, assistive devices, and physiotherapy.

The respondent insurer denied the benefits, relying on insurer's examinations which concluded the applicant had reached maximum medical recovery from minor soft tissue injuries.

The adjudicator found that the applicant failed to prove the claimed benefits were reasonable and necessary, preferring the detailed analysis of the insurer's experts over the applicant's medical evidence.

The appeal was dismissed and no benefits or interest were awarded.

The applicant sought statutory accident benefits for chiropractic treatment and an orthopedic assessment following a 2015 motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the chiropractic treatment plan was not reasonable and necessary due to a lack of supportive medical evidence, the applicant's failure to disclose a subsequent accident to the insurer's assessors, and her failure to utilize previously approved treatment.

The cost of the orthopedic assessment was also denied because the treatment plan lacked detail and the assessor's conclusions were unsupported by his physical examination findings.

Claims for interest and a special award were consequently dismissed.

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

The adjudicator found that the applicant's right hip injury was caused by a subsequent fall from a truck, not the accident.

Relying on the insurer's examination report, the adjudicator concluded that the applicant had already received adequate soft tissue rehabilitation and did not exhibit signs of chronic pain requiring further assessment.

The application was dismissed, and no benefits or interest were awarded.

The applicant was injured in a motor vehicle accident and sought medical benefits beyond the $3,500 limit prescribed by the Minor Injury Guideline (MIG).

The applicant argued that his injuries fell outside the MIG due to psychological impairments, chronic pain, and a pre-existing condition.

The adjudicator found the applicant's medical evidence inconsistent, particularly noting the lack of psychological complaints or referrals in his family physician's clinical notes.

The adjudicator concluded that the applicant sustained predominantly minor injuries and was subject to the MIG limit.

The application for further benefits was dismissed, and neither party was awarded costs.

The applicant sought statutory accident benefits following a 2010 motor vehicle accident, claiming catastrophic impairment, attendant care, housekeeping, and non-earner benefits.

The insurer argued the applicant's impairments were solely due to pre-existing rheumatoid arthritis.

The arbitrator found the accident was a material contributing factor to the applicant's catastrophic impairment, relying on expert medical and psychological evidence.

However, the claims for attendant care and housekeeping benefits were dismissed because the applicant failed to provide documentary evidence that her service providers suffered an economic loss.

The claim for non-earner benefits was also dismissed due to insufficient evidence comparing pre- and post-accident activities.

The applicant was awarded $3,100 for the cost of examinations.