Anna Truong

The Applicant was catastrophically impaired in a motor vehicle accident and sought attendant care benefits of $6,000 per month for around-the-clock supervisory care due to severe psychiatric impairments.

The Tribunal found that the Applicant did require around-the-clock supervisory care.

However, because her care was provided by non-professional family members, the Tribunal had to determine whether the February 1, 2014 amendment to the Statutory Accident Benefits Schedule applied to limit her benefits to the economic loss sustained by the providers, given her accident occurred prior to the amendment.

Following appellate authority, the Tribunal held that the amendment applied immediately and the Applicant had no vested right to the pre-amendment calculation.

Consequently, her entitlement was limited to her mother's proven economic loss of $839.29 per month.

As the insurer had been paying a higher rate, no arrears or interest were owed.

The Applicant sought a determination that she sustained a catastrophic impairment following a motor vehicle accident, claiming her accident-related injuries necessitated cervical spinal fusion surgery.

The Respondent denied the claim, arguing the surgery resulted from pre-existing degenerative spinal conditions.

The Tribunal found that the Applicant's physical and psychological impairments combined to a 41% whole person impairment, falling short of the 55% threshold required for catastrophic impairment.

The Tribunal concluded that the Applicant's need for surgery was caused by the natural progression of her pre-existing congenital degenerative disc disease and spinal stenosis, and that an intervening chiropractic manipulation broke any chain of causation with the accident.

The claims for attendant care benefits and interest were consequently dismissed.

The Applicant, a self-employed truck driver, sought income replacement benefits (IRBs) following a motor vehicle accident.

The parties disputed the quantum of the IRB, specifically the base weekly rate, the treatment of post-accident income, and the deductibility of a collateral life insurance benefit.

The Tribunal preferred the Respondent's accounting expert, finding the Applicant's expert's treatment of capital cost allowance and rental expenses to be problematic and unreliable.

The Tribunal also determined that the Applicant's business profits should be deducted as post-accident income and that his Co-Operators disability benefit constituted an income continuation benefit plan, making it deductible from his IRB.

Consequently, the Tribunal found the Applicant was overpaid and ordered him to repay $6,535.62 to the Respondent.

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

The Tribunal found that the Minor Injury Guideline did not apply due to the insurer's failure to provide proper notice under subsection 38(8) of the Schedule.

However, the applicant's claims for attendant care benefits, physiotherapy, and chronic pain treatments were dismissed as the expenses were either not incurred or not reasonable and necessary.

The Tribunal ordered the insurer to pay for assistive devices and an attendant care assessment due to procedural breaches, and granted a 50% special award under O. Reg. 664 for unreasonably withholding payments.

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

The Tribunal found the Applicant was entitled to the balance of a 2015 treatment plan for documentation and an assessment, as the insurer had previously approved the documentation and failed to provide medical reasons for denying the assessment.

The Tribunal denied a 2016 physiotherapy treatment plan, finding the claimed shoulder and back impairments were not caused by the accident.

The Tribunal awarded interest on the overdue payments and granted a maximum 50% special award under section 10 of O. Reg. 664, finding the insurer's refusal to pay an explicitly approved expense and failure to update its denial notice to be unreasonable.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care, medical, and rehabilitation expenses.

The Licence Appeal Tribunal dismissed the claims.

The claim for attendant care benefits was denied because the applicant's mother, a non-professional provider, failed to prove she sustained an economic loss.

Claims for optometric services and eyewear were denied for lack of causation.

Transportation expenses for taxis to school were not authorized under the Schedule, and a claim for laser treatment was denied because no treatment plan had been submitted.

The applicant sought statutory accident benefits following a motor vehicle accident, including pre- and post-104 week income replacement benefits, chiropractic treatment plans, and the cost of a disability certificate.

The adjudicator found the applicant to be an unreliable witness due to inconsistencies in her testimony and self-reporting.

The adjudicator concluded the applicant did not suffer a substantial or complete inability to perform her employment tasks, noting her physical injuries were minor exacerbations of pre-existing conditions and there was no objective evidence of psychological impairment.

The claims for income replacement benefits, treatment plans, and the disability certificate were dismissed.

The respondent's request for costs of a motion was also 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 medical and rehabilitation benefits following a motor vehicle accident, which the respondent denied on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that his physical injuries, including a partial shoulder tear, and psychological impairments, diagnosed as an adjustment disorder, warranted removal from the MIG.

The Tribunal found that the physical injuries were predominantly minor and that the psychological diagnosis was not supported by the psychometric testing or DSM-5 criteria.

The application was dismissed, and no benefits or awards were granted.

The applicant was catastrophically impaired in a motor vehicle accident and sought attendant care benefits.

The respondent denied the benefits.

At a preliminary hearing, the Tribunal considered whether the applicant's mother, a trained and certified Personal Support Worker who had not yet obtained employment in her field at the time of the accident, qualified as a professional service provider under section 3(7)(e)(iii)(A) of the Statutory Accident Benefits Schedule.

The Tribunal found that the mother was actively seeking employment as a PSW prior to the accident and therefore qualified as a professional service provider.

Consequently, she was not required to prove an economic loss to be compensated for providing attendant care services to her son.

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

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

The applicant applied to the Licence Appeal Tribunal, arguing for removal from the MIG due to psychological impairments.

The Tribunal found that the applicant failed to meet the onus of proving his injuries were not predominantly minor, as his medical evidence lacked corroboration and was contradicted by the insurer's examination.

The application for assessment costs was dismissed, and the applicant's request for costs was denied due to a lack of evidence of unreasonable conduct by the insurer.

The applicant sought medical benefits and the cost of a psychological assessment following a motor vehicle accident.

The Licence Appeal Tribunal found that one treatment plan was statute-barred as the application was brought more than two years after the denial.

Other treatment plans were denied because the applicant failed to prove they were reasonable and necessary, lacking contemporaneous medical evidence.

Two treatment plans that the respondent conceded were approved were found payable.

The claim for the psychological assessment was dismissed as the applicant made no submissions on it.

Interest was awarded on any overdue payments for the approved plans.

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

The Licence Appeal Tribunal found the applicant suffered a complete inability to engage in any employment for which he was reasonably suited, entitling him to a post-104 week income replacement benefit.

The Tribunal also determined the applicant sustained a catastrophic impairment, as his combined physical, neurocognitive, and mental/behavioural impairments met the 55% whole person impairment threshold under the AMA Guides.

However, the applicant's claims for specific medical and rehabilitation benefits were dismissed for lack of evidence proving they were reasonable and necessary.

The applicant sought entitlement to a treatment plan for physiotherapy and massage therapy in the amount of $1,849.55 following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to provide contemporaneous medical evidence to support the necessity of the treatment plan.

Relying on the respondent's physiatry examination report, which concluded the applicant had reached maximum therapeutic benefit, the Tribunal held that the treatment plan was not reasonable and necessary.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, which were initially denied by the respondent.

After the applicant filed an application with the Licence Appeal Tribunal, the parties resolved the substantive issues following a case conference.

The applicant sought costs, arguing the respondent acted unreasonably by failing to consider medical evidence and respond to correspondence prior to the case conference.

The Tribunal dismissed the request for costs, finding that conduct prior to the proceeding cannot attract costs under Rule 19.1, and the respondent's conduct during the proceeding did not meet the high bar for unreasonableness, as the respondent appropriately changed its position upon receiving additional documents at the case conference.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit, medical and rehabilitation benefits, and assessment costs outside the Minor Injury Guideline (MIG).

The Tribunal found the applicant's subjective reports of impairment inconsistent with surveillance footage and objective medical evidence.

Preferring the respondent's expert assessments, the Tribunal concluded the applicant did not suffer a complete inability to carry on a normal life and that her injuries were predominantly minor.

Consequently, the claims for a non-earner benefit, treatment plans outside the MIG, interest, and a special award were dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, which were denied by the respondent.

The applicant filed an application with the Licence Appeal Tribunal but withdrew it at a Case Conference after the respondent raised her failure to attend an Insurer's Examination.

Hours later, the applicant filed a second application for the same issue.

She subsequently failed to attend a rescheduled Insurer's Examination and withdrew the second application at another Case Conference.

The respondent sought costs.

The Tribunal found the applicant's conduct in filing the second application to be frivolous, vexatious, and unreasonable, constituting an abuse of process.

The respondent was awarded $500 in costs.

The applicant insurer sought repayment of income replacement benefits and accountant fees from the respondent, alleging wilful misrepresentation.

The respondent did not participate in the hearing.

The Tribunal dismissed the application, finding that the applicant failed to provide evidence that it had given the respondent notice of the repayment amount, which is a mandatory requirement under section 52 of the Statutory Accident Benefits Schedule.

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

The respondent insurer denied the treatment plans on the basis that the injuries fell within the Minor Injury Guideline and required the applicant to attend insurer's examinations (IEs).

The applicant failed to attend multiple scheduled IEs over a nine-month period, later claiming the notices were non-compliant with the Schedule.

The Tribunal found that the respondent's notices were sufficient and compliant, as they clearly stated the medical and other reasons for the IEs.

Consequently, the applicant was found to be in non-compliance with section 44 of the Schedule.

Pursuant to section 55, the application was dismissed and the Tribunal file closed.

The respondent's request for costs was denied.

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

The respondent insurer denied treatment plans for chiropractic care and a physiatry assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained predominantly soft tissue injuries and failed to establish any underlying neurological disorder that would warrant removal from the MIG.

As the injuries were minor, the applicant was limited to the $3,500 funding cap, and the Tribunal did not need to assess the reasonableness or necessity of the disputed treatment plans.