Amar Mohammed

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain with functional impairment.

The respondent denied the benefits, relying on a section 44 medical report concluding the injuries were minor.

The Licence Appeal Tribunal found the applicant failed to provide sufficient medical evidence of a chronic pain diagnosis or functional impairment beyond the sequelae of a minor injury.

As the applicant remained subject to the MIG, her claims for chiropractic and physiotherapy treatment plans exceeding the $3,500 limit were dismissed.

The applicant sought payment for an occupational therapy assessment under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent denied the benefit, arguing it was duplicative of two comprehensive occupational therapy assessments the applicant had already undergone in 2021.

The Tribunal found that the applicant failed to demonstrate that a further assessment was reasonable and necessary, as she did not provide evidence showing how the disputed assessment would gather new information or investigate a new condition.

The application was dismissed, and no interest was awarded.

The applicant sought medical and rehabilitation 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's chronic pain and left elbow arthrofibrosis warranted removal from the MIG.

However, the Tribunal denied the applicant's claim for a $7,520.00 elbow flexion and extension unit because the applicant failed to submit the required OCF-18 treatment plan.

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

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a catastrophic impairment due to mental and behavioural disorders.

The Tribunal found the applicant met the catastrophic impairment threshold under Criterion 8, demonstrating marked impairments in activities of daily living, social functioning, and adaptation.

The Tribunal preferred the evidence of the applicant's assessors, noting the respondent's assessors failed to adequately consider the applicant's reliance on her partner and conducted flawed situational assessments.

The Tribunal awarded the cost of an in-home assessment but denied the claim for attendant care benefits, finding the proposed hours were overestimated and included tasks the applicant could perform independently.

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).

The Tribunal found that the respondent's denial of a $2,803.60 chiropractic treatment plan was non-compliant with s. 38(8) of the Schedule because it applied the MIG after the applicant had already been removed from it due to a psychological condition.

Consequently, the applicant was entitled to payment under s. 38(11).

The Tribunal also awarded a 25% penalty under s. 10 of Reg. 664 for the respondent's unreasonable delay of nearly two years in approving other treatment plans after removing the applicant from the MIG.

The applicant sought statutory accident benefits for physical therapy services following a 2016 motor vehicle accident.

The respondent denied the treatment plan and brought a preliminary motion to exclude late-filed medical evidence and an affidavit from the applicant, while also seeking costs.

The Tribunal admitted the medical evidence, finding no prejudice to the respondent, and partially admitted the affidavit.

On the substantive issue, the Tribunal applied the 'but for' test for causation and found the applicant suffered from accident-related chronic pain syndrome.

The Tribunal concluded the proposed physical therapy plan was reasonable and necessary, ordering the respondent to pay $4,620.73 plus interest.

The respondent's request for costs was denied.

The applicant was injured in a motor vehicle accident and sought payment for three treatment plans (physiotherapy and chiropractic services) under the Statutory Accident Benefits Schedule.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the first two treatment plans were reasonable and necessary based on documented improvements in range of motion.

However, the third plan was denied as it was duplicative of a previously submitted plan.

The applicant was also awarded interest on overdue benefits.

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 argued for removal from the MIG based on chronic pain and psychological impairments, including PTSD.

The Tribunal found insufficient evidence of chronic pain with functional impairment.

Regarding the psychological claims, the Tribunal gave little weight to the applicant's psychological assessment because it was conducted in English without an interpreter, despite the applicant's language difficulties.

The Tribunal preferred the respondent's section 44 assessment, which utilized an interpreter and found no psychological basis for removal from the MIG.

The Tribunal concluded the applicant's injuries were predominantly minor and subject to the MIG limit, dismissing the claims for disputed treatment plans and an award for unreasonable delay.

The applicant sought various statutory accident benefits following a 2014 motor vehicle accident.

The Tribunal found that the doctrine of res judicata applied to a previous 2020 decision, which determined the applicant suffered only uncomplicated soft tissue injuries and that his shoulder condition was due to natural degeneration and prior trauma.

The applicant failed to establish that his chronic pain and other physical complaints were caused by the accident.

The Tribunal dismissed the claims for attendant care benefits above the agreed amount, as well as claims for physiotherapy, housing assessments, dental services, and assistive devices.

However, because both parties' assessors agreed the applicant met the catastrophic impairment threshold under Criterion 8 (mental/behavioural), the Tribunal awarded $4,400 for the assessments related to that determination.

The claim for a special award for unreasonable delay was dismissed.

The applicant sought a non-earner benefit following a motor vehicle accident.

The dispute centered on two conflicting disability certificates (OCF-3s) submitted by the same physiotherapist.

The first OCF-3 endorsed a complete inability to carry on a normal life but not a substantial inability to perform essential employment tasks.

After the insurer contacted the clinic for clarification, an amended OCF-3 was submitted stating the applicant did not suffer a complete inability to carry on a normal life.

The applicant argued the insurer improperly contacted the provider and that the denial notice was non-compliant.

The Tribunal found the insurer's inquiry was reasonably required under s. 46.2(1) of the Schedule to determine eligibility.

The applicant failed to provide medical evidence establishing a complete inability to carry on a normal life or a copy of the denial notice to prove non-compliance.

The application for the non-earner benefit, interest, and an award was dismissed.

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

The respondent moved to dismiss the application because the applicant failed to attend a scheduled psychological insurer's examination under s. 44 of the Schedule.

The Tribunal found the applicant had a reasonable explanation for the non-attendance and had substantially complied with other examination requests.

Exercising its discretion under s. 55(2), the Tribunal stayed the hearing and ordered the respondent to reschedule the examination, permitting the application to proceed once the applicant attends.

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

The respondent denied several benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that she failed to attend scheduled insurer's examinations (IEs).

The Tribunal found the applicant was barred from disputing certain assessments because she failed to attend the IEs without a reasonable explanation.

However, the Tribunal determined the applicant was not subject to the MIG due to a concussion diagnosis.

The applicant was awarded payment for a neuropsychological assessment and psychological services under the shall-pay provisions of s. 38(11) due to defective denial notices, payable once incurred.

Claims for a non-earner benefit and an award were dismissed as the applicant failed to provide submissions on those issues.

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).

The Tribunal found that the applicant's documented pre-existing chronic pain condition and accident-related psychological impairments warranted removal from the MIG.

The Tribunal ordered the respondent to pay for the disputed attendant care, chiropractic, and psychological treatment plans, along with interest, but denied the claim for assistive devices and a special award for unreasonable delay.

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

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

The applicant contended that he developed chronic pain with functional impairment warranting removal from the MIG.

The Tribunal found that the applicant failed to provide sufficient medical evidence, such as a formal diagnosis or particulars of functional impairment, to establish chronic pain.

The Tribunal concluded the injuries were predominantly minor, and therefore the disputed treatment plans for a chronic pain assessment and physiotherapy were not payable.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs), non-earner benefits (NEBs), medical and rehabilitation benefits, and attendant care benefits.

The adjudicator dismissed the claim for IRBs because the applicant had been on long-term disability for 20 years and was not employed at the time of the accident.

The claim for NEBs was dismissed as the applicant failed to establish a complete inability to carry on a normal life, with self-reported evidence showing he could still perform most pre-accident activities.

The adjudicator partially approved a treatment plan, awarding funds for physiotherapy and massage therapy to address exacerbated pre-existing conditions, but denied chiropractic and pharmacotherapy services.

The claim for attendant care benefits was deemed premature as the required Form-1 had not been properly submitted to the insurer.

The request for a special award was also dismissed.

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 statutory accident benefits following a motor vehicle accident.

The respondent denied a treatment plan for chiropractic services and argued the applicant was subject to the Minor Injury Guideline (MIG).

The Tribunal found the applicant was no longer subject to the MIG.

The Tribunal also held that the respondent's denial notice for the chiropractic treatment plan was defective because it lacked specific medical reasons, triggering the 'shall pay' provision under s. 38(11) of the Schedule.

The applicant was awarded the treatment plan costs once incurred, plus interest, but the claim for a special award was dismissed.

The applicant sought various medical and rehabilitation benefits following a 2020 motor vehicle accident.

The adjudicator found the applicant was not subject to the Minor Injury Guideline, as the insurer had previously removed her from it.

The applicant was awarded a chronic pain assessment based on her family doctor's records, and the balance of a mental health assessment due to a non-compliant denial notice by the insurer.

Claims for psychological, physiatry, and neurological assessments were dismissed, as was the claim for a special award under s. 10 of Regulation 664.

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 argued for removal from the MIG based on chronic pain and a psychological condition.

The Tribunal found insufficient contemporaneous medical evidence to support a diagnosis of chronic pain with functional impairment or a psychological condition beyond normal psycho-social sequelae.

The Tribunal concluded the applicant's injuries were subject to the MIG limit, making it unnecessary to assess the disputed treatment plans, and denied the claim for interest.

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) and that she did not meet the test for a non-earner benefit.

The Tribunal found the applicant failed to discharge her evidentiary burden to prove her injuries warranted removal from the MIG.

The Tribunal also upheld the respondent's denial notices as compliant with the Schedule and dismissed the claims for treatment plans, non-earner benefits, and an award for unreasonable delay.