Bernard Trottier

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule, which the respondent insurer denied.

The applicant applied to the Licence Appeal Tribunal.

The Tribunal found that the applicant was not entitled to further passive physical therapies, a higher hourly rate for psychotherapy, or a new bed and mattress system, as these were not reasonable and necessary as a result of the accident, largely due to pre-existing degenerative conditions and sleep apnea.

However, the respondent unreasonably delayed approval of a concussion assessment and management program, which it approved shortly after the applicant's written submissions.

The Tribunal ordered the respondent to pay a 25% award under s. 10 of Reg. 664 on the concussion-related plans, along with interest.

The applicant's request for costs due to the respondent's late submissions was denied.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits for psychological services, a chronic pain management program, and physical therapy.

The respondent partially denied the psychological services and fully denied the other treatment plans.

The Tribunal found that the psychological services, to be provided by a registered psychotherapist, were reasonable and necessary, and that the respondent unreasonably withheld payment by applying the unregulated professional rate.

The Tribunal awarded the disputed amount for psychological services, plus a 25% award under s. 10 of Reg. 664 and interest.

The claims for the chronic pain management program and physical therapy were dismissed, as the Tribunal preferred the respondent's medical evidence that the applicant had reached maximum medical recovery and did not meet the criteria for chronic pain.

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

The adjudicator found the applicant was entitled to the disputed amount for a psychological services treatment plan, noting that psychotherapy is a regulated profession and the respondent failed to provide sufficient explanations for its partial denial.

The adjudicator dismissed the claims for a chronic pain management program and a physical therapy treatment plan, preferring the respondent's medical experts who opined the applicant had reached maximum medical recovery.

An award of 25% under s. 10 of Reg. 664 was granted for the respondent's unreasonable handling of the psychological services claim, along with interest.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries fell outside the Minor Injury Guideline (MIG) due to pre-existing chronic lower back pain and accident-related psychological impairments.

The Tribunal found the applicant failed to provide objective medical evidence of a pre-existing condition that would preclude recovery within the MIG, preferring the respondent's orthopedic assessment.

The Tribunal also accepted the respondent's psychological assessment, finding insufficient evidence of a diagnosable psychological condition.

As the injuries were deemed minor and the MIG limits were exhausted, the proposed treatment plans, an award for unreasonable delay, and interest were denied.

The applicant was injured in a motor vehicle accident and sought medical benefits for chiropractic treatment and massage therapy under the Statutory Accident Benefits Schedule.

The respondent denied the treatment plans based on insurer's examinations and surveillance evidence.

The applicant applied to the Licence Appeal Tribunal to dispute the denials and sought an award for unreasonable delay.

The Tribunal found that the applicant failed to prove the proposed treatment plans were reasonable and necessary, noting that the applicant had recovered much of his pre-accident functional abilities and that there were more effective alternatives for pain relief.

The Tribunal also found that the respondent provided sufficient medical reasons for its denials in compliance with section 38(8) of the Schedule.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her injuries fell outside the Minor Injury Guideline (MIG) due to pre-existing physical and psychological conditions.

She also sought a non-earner benefit and funding for various treatment plans.

The Tribunal found that the applicant failed to provide compelling medical evidence that her pre-existing conditions were exacerbated by the accident or prevented her from achieving maximum medical recovery within the MIG.

The Tribunal preferred the evidence of the respondent's assessors, finding the applicant's injuries were predominantly minor.

The claim for a non-earner benefit was dismissed as the applicant did not demonstrate a complete inability to carry on a normal life compared to her pre-accident activities.

Consequently, the proposed treatment plans outside the MIG were deemed not reasonable and necessary, and claims for an award and interest were dismissed.