Amanda Marshall

The applicant requested a reconsideration of a decision dismissing his application for abandonment after he and his counsel failed to attend a rescheduled case conference.

The applicant argued that the Tribunal scheduled the resumption without his input while his counsel was on vacation.

The adjudicator found that while the Tribunal provided reasonable notice of the date, it violated procedural fairness by failing to inform the parties of their right to make submissions before dismissing the application, as required by Rule 3.5 of the Common Rules.

The request for reconsideration was granted and the application reinstated.

The applicant, who was catastrophically impaired following a 2014 motor vehicle accident, sought payment for massage therapy, chiropractic services, physiotherapy, and occupational therapy.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to meet the burden of proving the treatments were reasonable and necessary.

The Tribunal accepted the respondent's section 44 physiatry report, which concluded that further facility-based treatment was not warranted six years post-accident without evidence of improvement.

Claims for an award, interest, and costs were also dismissed.

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

The respondent denied treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that pre-existing physical and psychological conditions, as well as chronic pain, warranted removal from the MIG.

The Tribunal found that the applicant's physical injuries were soft tissue in nature and that he failed to prove his pre-existing conditions prevented maximal medical recovery.

The Tribunal also found insufficient evidence of an accident-related psychological impairment or chronic pain syndrome.

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

The applicant sought various statutory accident benefits following a motor vehicle accident, including attendant care benefits, medical benefits, and an award for unreasonable delay.

The adjudicator found that the applicant was not entitled to attendant care benefits, orthotics, an orthopaedic assessment, or a Functional Abilities Evaluation, as they were not proven to be reasonable and necessary.

However, the applicant was awarded the balance of a psychological assessment and medication expenses.

Additionally, the adjudicator found that the respondent failed to provide proper notice under s. 38(8) of the Schedule for a chiropractic treatment plan, making the respondent liable for incurred costs during the period of non-compliance.

The claim for an award under Regulation 664 was dismissed.

The applicant was injured in a motor vehicle accident and sought approval for a physiotherapy treatment plan costing $3,927.98, which the respondent insurer denied.

The respondent relied on an insurer's examination report suggesting the applicant had not responded to facility-based treatment.

The Tribunal found the treatment plan reasonable and necessary, preferring the recommendations of the applicant's treating practitioners and independent assessor who supported ongoing physical treatment.

The Tribunal ordered the respondent to pay for the treatment plan along with applicable interest.

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

The respondent denied the claims, asserting the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG) limit.

The applicant argued for removal from the MIG based on chronic pain and psychological impairments.

The Tribunal found that the applicant did not meet the criteria for chronic pain syndrome under the AMA Guides, noting his ability to work full-time and manage daily activities.

The Tribunal also found insufficient evidence of an accident-related psychological impairment.

As the applicant failed to demonstrate his injuries warranted removal from the MIG, and the MIG limits were exhausted, the claims for treatment plans and assessments were dismissed.

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

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that the ambulance fee had not been submitted to the applicant's extended health care provider.

The Tribunal found that the applicant failed to demonstrate the physiotherapy treatments were reasonable and necessary, accepting the respondent's physiatrist report that the injuries were minor.

The Tribunal also denied the ambulance fee because the applicant did not prove it was submitted to his collateral benefits provider.

The application was dismissed.

The applicant sought various medical and rehabilitation benefits following a motor vehicle accident, including chiropractic treatments, psychological services, a social work assessment, and a chronic pain assessment.

The Tribunal found that the applicant's physical injuries fell within the Minor Injury Guideline and denied the chiropractic treatments.

The Tribunal also denied the social work and chronic pain assessments, finding the applicant did not meet the criteria for chronic pain syndrome.

However, the Tribunal partially approved one psychological treatment plan, reducing the hourly rate as the services were provided by a social worker rather than a psychologist.

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

The respondent denied certain medical and assessment benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that a pre-existing knee condition, a concussion, and psychological impairments warranted removal from the MIG.

The Tribunal found insufficient evidence of a pre-existing condition precluding recovery, no medical diagnosis of a concussion, and preferred the respondent's psychological assessment which found no DSM-5 diagnosis.

The application was dismissed as the MIG limits were exhausted.

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

The respondent denied treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG due to a pre-existing brain aneurysm, chronic pain, and a psychological impairment.

The Tribunal found insufficient medical evidence to support removal from the MIG, noting that the physical injuries were minor soft tissue injuries, the pre-existing condition did not preclude recovery, and the psychological evidence was unpersuasive.

The application was dismissed.

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

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

The Tribunal found that the applicant failed to provide evidence demonstrating his injuries warranted removal from the MIG.

However, the Tribunal determined that the insurer's initial denial notice was defective under section 38(8) of the Schedule for failing to provide medical reasons.

A subsequent denial notice was found to be compliant.

As a result, the insurer was ordered to pay for any treatment incurred between the 11th business day after receiving the plan and the date of the compliant denial.

The claim for a section 10 award was dismissed.