Avril A. Farlam

The applicant sought statutory accident benefits after being assaulted while attempting to park his vehicle.

The respondent denied the benefits, arguing the incident was not an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal found that while the incident met the purpose test, it failed the causation test because the assault was an intervening act that directly caused the impairment.

The application was dismissed.

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

The respondent determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied income replacement benefits (IRB) and certain treatment plans.

The Tribunal found that the applicant's injuries were predominantly minor and that he failed to prove a pre-existing condition, psychological injury, or chronic pain that would remove him from the MIG.

The Tribunal also found the applicant was not entitled to an IRB as he did not suffer a substantial inability to perform the essential tasks of his pre-accident employment.

However, the Tribunal found the disputed physiotherapy treatment plans were reasonable and necessary, and ordered them payable up to the $3,500 MIG limit, less amounts already paid.

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

The respondent denied certain psychological treatment and assessment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant contended that pre-existing back pain and accident-related psychological impairments and chronic pain removed her from the MIG.

The Tribunal found insufficient medical evidence to support the applicant's claims, noting her family physician's records did not substantiate a pre-existing condition or a psychological diagnosis.

The Tribunal preferred the respondent's psychological expert over the applicant's, concluding the injuries were predominantly minor and the disputed treatment plans were not reasonable and necessary.

The application was dismissed.

The applicant sought entitlement to statutory accident benefits for a chronic pain assessment and a neurological assessment following a 2015 motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the assessments were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's medical examiners, which indicated the applicant's injuries were manageable with soft tissue interventions and that his neurological symptoms were likely unrelated to the accident.

The Tribunal also found the respondent's denial notices complied with the requirements of the Schedule.

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

The respondent denied certain treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been reached.

The applicant argued that pre-existing back pain, chronic pain, and psychological impairment removed him from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence of a pre-existing condition that would prevent maximal recovery within the MIG limits.

Furthermore, the Tribunal concluded that the applicant did not prove on a balance of probabilities that he suffered from chronic pain or a psychological impairment as a result of the accident.

Consequently, the applicant's injuries were deemed minor, and his claims for additional medical benefits and interest were dismissed.

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

The insurer stopped paying the benefits, determining her ineligible.

The applicant applied to the Licence Appeal Tribunal.

The Tribunal found that the applicant failed to prove she suffered a complete inability to carry on a normal life under section 12 of the Statutory Accident Benefits Schedule.

The medical evidence did not support her claims of physical and psychological injuries preventing her from engaging in substantially all of her pre-accident activities.

The application was dismissed.

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

The insurer denied certain medical benefits and requested a preliminary issue hearing to determine if the applicant was barred from proceeding with her application because she failed to attend section 44 insurer's examinations.

The Tribunal found that the applicant failed to attend multiple scheduled examinations without a reasonable explanation.

Consequently, the applicant was barred from proceeding with her application under section 55 of the Schedule.

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

The insurer denied the benefits, arguing the applicant did not suffer a complete inability to carry on a normal life.

The Tribunal found that the applicant's pre-accident medical records documented severe pain, limitation of function, and substance abuse, contradicting her claims of pre-accident independence and well-managed symptoms.

Surveillance evidence and medical reports also indicated she was able to perform various activities post-accident.

The Tribunal concluded the applicant failed to prove she suffered a complete inability to carry on a normal life as a result of the accident and dismissed the application.

The applicant requested a reconsideration of a decision finding his injuries fell within the Minor Injury Guideline (MIG) and denying his claim for income replacement benefits.

The applicant argued the adjudicator failed to properly consider medical evidence and pre-existing conditions.

The Vice Chair dismissed the request, finding no errors of law or fact in the original decision.

The adjudicator had properly weighed the evidence and the applicant was attempting to reargue his case, which is not permitted on reconsideration.

The applicant sought entitlement to several treatment plans for physiotherapy and a chronic pain assessment following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the treatment plans were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's medical assessor, who concluded the applicant suffered uncomplicated soft-tissue injuries that would not benefit from further facility-based therapy, over the applicant's treating physician and assessor.

The applicant sought entitlement to various medical and rehabilitation benefits, including assistive devices, chiropractic treatment, physiotherapy, Botox treatment, a diagnostic nuclear imaging assessment, and pilates expenses, following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove on a balance of probabilities that the disputed treatment plans and expenses were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's assessors, who opined that the applicant did not require assistive devices, had reached maximum medical recovery, and did not require further facility-based treatment.

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

A videoconference hearing was scheduled, but the applicant failed to attend, file documents, or respond to communications.

The Tribunal issued a Notice of Intent to Dismiss, to which the applicant did not respond.

Consequently, the Tribunal found the applicant had abandoned the appeal and dismissed the application without a hearing.

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

The respondent denied certain treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit was exhausted.

The applicant argued his injuries were outside the MIG due to a concussion and chronic pain syndrome.

The Tribunal found the medical evidence did not support a diagnosis of concussion or chronic pain syndrome, preferring the evidence of neurologists over the family physician.

The Tribunal concluded the applicant sustained predominantly minor injuries, and since the MIG limit was exhausted, the disputed treatment plans were not payable.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that their injuries fell within the Minor Injury Guideline.

The applicant failed to file any written submissions or evidence for the hearing.

Consequently, the Tribunal dismissed the application, finding no evidence to support the claim that the injuries fell outside the guideline or that the disputed treatment plan was reasonable and necessary.

The respondent's request for costs was denied, as the applicant's failure to file submissions did not amount to bad faith or vexatious conduct.

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

The respondent determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied several treatment plans.

The applicant argued his injuries were not minor and that a pre-existing condition from a 2016 accident removed him from the MIG.

The Tribunal found insufficient medical evidence to support a pre-existing condition that would prevent maximal recovery within the MIG limit.

The Tribunal concluded the applicant's injuries were predominantly minor and that the disputed treatment plans for physiotherapy, medical services, and assessments were not reasonable and necessary.

Claims for a special award and interest were also dismissed.

The applicant, a pedestrian injured in a motor vehicle accident, sought statutory accident benefits for vision impairments.

The respondent insurer denied treatment plans for visual training and therapeutic glasses, arguing the vision issues were pre-existing and not caused by the accident.

The Tribunal found that the applicant's vision impairments were caused or exacerbated by the accident, preferring the evidence of her treating practitioners over the respondent's neurological assessor.

The Tribunal concluded that the disputed treatment plans were reasonable and necessary, and ordered the respondent to pay for them with interest.

The applicant sought medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The disputed benefits included treatment plans for psychometric testing, a neuro-psychological examination, and a neuro-psychological intake interview recommended by her psychologist.

The adjudicator found that the applicant failed to prove the treatment plans were reasonable and necessary.

The adjudicator preferred the evidence of the respondent's multidisciplinary assessors, who concluded there was no ongoing accident-related brain injury or cognitive impairment.

The application was dismissed and no interest was payable.

The applicant requested a reconsideration of a decision finding that his injuries fell within the Minor Injury Guideline (MIG) and denying disputed treatment plans.

The applicant argued the adjudicator violated procedural fairness by admitting the respondent's medical reports and excluding his affidavit, and made errors of law and fact regarding the MIG.

The Vice Chair dismissed the request, finding no jurisdictional error or procedural unfairness, as the affidavit was excluded based on a prior consent order.

The Vice Chair also found no error in the MIG analysis, noting the applicant failed to provide persuasive evidence of a psychological injury or chronic pain condition to warrant removal from the MIG.

The respondent's request for costs was denied.

The applicant sought non-earner benefits after slipping on black ice and fracturing her ankle while exiting her parked vehicle.

The respondent denied the benefits on the basis that the incident was not an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal applied the two-part purpose and causation test and found that while the purpose test was met, the causation test was not.

The Tribunal concluded that the ice was an independent intervening event that directly caused the injuries, breaking the chain of causation from the use or operation of the automobile.

The application was dismissed.

The applicant sought income replacement benefits following a motor vehicle accident.

The respondent insurer stopped paying the benefits and issued a clear and unequivocal denial letter.

The applicant filed an application with the Licence Appeal Tribunal more than two years after the denial.

The Tribunal found the application was statute-barred under s. 56 of the Statutory Accident Benefits Schedule and declined to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act, 1999, noting the applicant's failure to file evidence or establish reasonable grounds for an extension.