12 total
Application for accident benefits dismissed; applicant failed to prove injuries warranted removal from the Minor Injury Guideline.
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 that the applicant failed to provide sufficient objective medical evidence to prove that his psychological injuries or chronic pain warranted removal from the MIG.
The Tribunal also dismissed the claim for a non-earner benefit, as the applicant failed to provide evidence of his pre-accident activities to satisfy the Heath test.
Claims for disputed treatment plans, an award, and interest were also dismissed.
Application for accident benefits dismissed; applicant failed to establish injuries warranted removal from the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident, arguing her injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain and psychological impairment.
The Licence Appeal Tribunal found the applicant's medical evidence, including illegible clinical notes and a psychological pre-screen by a social worker, insufficient to establish chronic pain or a psychological condition.
The Tribunal also rejected the applicant's argument that the insurer failed to comply with the notice requirements under section 38(8) of the Schedule.
The application was dismissed, and the applicant was held to the $3,500 MIG limit.
Application for statutory accident benefits dismissed due to lack of contemporaneous medical evidence and submissions.
The applicant sought statutory accident benefits following a 2019 motor vehicle accident, including non-earner benefits, medical benefits for chiropractic and psychological treatment, and a special award.
The Licence Appeal Tribunal dismissed the application in its entirety.
The adjudicator found the applicant failed to establish a complete inability to carry on a normal life, noting a lack of contemporaneous medical evidence and details regarding pre-accident activities.
The claims for medical benefits and assessments were also dismissed as the applicant failed to prove they were reasonable and necessary, with several claims lacking any supporting submissions or evidence.
Reconsideration granted; Tribunal breached procedural fairness by unilaterally dismissing 26 issues at case conference.
The applicant requested reconsideration of a case conference report and order that unilaterally dismissed 26 issues in dispute.
The adjudicator had dismissed the issues on the mistaken belief that they were duplicative of issues in a prior application.
The Tribunal found that it committed a material breach of procedural fairness by dismissing the issues without providing the parties an opportunity to make written submissions, contrary to Rules 3.4 and 3.5 of the Licence Appeal Tribunal Rules.
The request for reconsideration was granted, and the 26 issues were reinstated for case management.
Tribunal partially approves occupational therapy and assistive devices but denies special award for accident benefits.
The applicant sought statutory accident benefits following a motor vehicle accident, disputing the denial of treatment plans for a bio-feedback assessment, occupational therapy assessments and services, and assistive devices.
The Tribunal found the occupational therapy assessment and portions of the occupational therapy services and assistive devices to be reasonable and necessary, noting that some devices were duplicative of those already provided to the applicant's spouse.
The claim for the bio-feedback assessment was dismissed as the applicant failed to establish entitlement to the denied portion.
The Tribunal also denied the applicant's request for a special award, finding the insurer's conduct was not unreasonable.
Application for statutory accident benefits dismissed as applicant failed to prove treatment plans were reasonable and necessary.
The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's denial of several treatment plans for chiropractic and psychological services, as well as a chronic pain assessment.
The Tribunal found that the applicant failed to prove the chiropractic treatment plans were reasonable and necessary, preferring the insurer's physiatrist's evidence that there was no ongoing physical impairment.
The Tribunal also dismissed the claim for further psychological services, noting the insurer had already approved a partially reasonable treatment plan and the applicant provided no evidence of ongoing need.
Finally, the Tribunal denied the chronic pain assessment due to a lack of objective evidence establishing that the accident was a necessary cause of the applicant's pain.
The application was dismissed in its entirety.
Application for accident benefits dismissed; injuries remained within the Minor Injury Guideline.
The respondent determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied further treatment plans and income replacement benefits (IRB) after the $3,500 limit was exhausted.
The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain or psychological injuries caused by the accident that would remove him from the MIG, noting he withheld information about a subsequent shooting incident from his assessors.
The Tribunal also found the applicant did not suffer a substantial inability to perform the essential tasks of his employment.
The application was dismissed.
Accident benefits claims dismissed as injuries were minor and required treatment plans were not submitted.
The applicant sought medical and rehabilitation benefits following a motor vehicle accident.
The adjudicator found that the applicant sustained predominantly minor injuries, as defined by the Schedule, and that there was no evidence of a pre-existing condition that would warrant extending the $3,500 limit.
The applicant's claims for various medical expenses and assistive devices were dismissed because she failed to submit the required treatment plans, claimed items not permitted under the Schedule, and failed to prove the expenses were reasonable and necessary.
Income replacement benefit denied due to return to work; applicant removed from Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to an income replacement benefit (IRB) and a medical benefit for acupuncture.
The adjudicator dismissed the IRB claim, finding the applicant failed to prove a substantial inability to perform the essential tasks of his employment, noting he had returned to work and collected employment insurance during the claimed period.
However, the adjudicator found the applicant's injuries were not predominantly minor injuries under the Minor Injury Guideline due to continuous and severe pain symptoms.
Consequently, the applicant was awarded the outstanding balance for the acupuncture treatment plan and interest.
Application for accident benefits dismissed due to applicant's failure to attend a properly scheduled insurer's examination.
The respondent insurer requested the applicant attend an insurer's examination (IE) to determine if the injuries fell outside the Minor Injury Guideline.
The applicant refused to attend, arguing the proposed assessor's professional designation did not match the practitioner who recommended the benefits.
The Tribunal held that an insured cannot dictate the identity of the IE assessor, provided they are a regulated health professional.
Because the applicant failed to attend a properly scheduled IE, section 55(1)(2) of the Schedule precluded the applicant from proceeding with the application.
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline.
The respondent denied the claims on the basis that the applicant's injuries were predominantly minor and the $3,500 funding limit under the Minor Injury Guideline (MIG) had been exhausted.
The Tribunal found that the applicant failed to prove his physical or psychological injuries fell outside the MIG, and that his chronic pain symptoms were clinically associated sequelae to his minor injuries.
Applications for income replacement benefits dismissed as statute-barred due to expiry of two-year limitation period.
The applicant sought Income Replacement Benefits (IRBs) following two separate motor vehicle accidents.
The insurer denied the benefits and the applicant applied to the Licence Appeal Tribunal for dispute resolution.
The insurer brought a preliminary issue hearing arguing the applications were barred by the two-year limitation period.
The Tribunal found that the insurer had provided clear and unequivocal denials of the IRBs, along with the required dispute resolution options, more than two years before the applications were filed.
The Tribunal declined to extend the limitation period, finding no reasonable grounds to do so, and dismissed the applications as statute-barred.
