Billeh Hamud

The applicant insurer sought repayment of $2,193.57 in non-earner benefits paid to the respondent, arguing it had mistakenly applied a 4-week waiting period instead of the applicable 26-week waiting period.

The respondent argued the insurer's notice of repayment was out of time under s. 52(3) of the Statutory Accident Benefits Schedule, as it was sent more than 12 months after the first erroneous payment.

The Tribunal agreed with the respondent, finding that the 12-month limitation period commences from the first payment made in error, rejecting the insurer's argument for a 'rolling limitation period.' The application for repayment was dismissed, and the respondent's request for costs was also denied.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and a chronic pain assessment.

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

The Licence Appeal Tribunal found that the applicant suffered from chronic pain syndrome, which removed him from the MIG.

The Tribunal ordered the respondent to pay for the disputed physiotherapy treatment plans and the chronic pain assessment, finding them reasonable and necessary, along with interest on the overdue payments.

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

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

The applicant argued that a pre-existing condition of lower back pain should remove him from the MIG.

The Tribunal found that while the applicant had a pre-existing condition, he failed to provide compelling evidence that it would prevent him from achieving maximal recovery within the MIG limits.

The application was dismissed.

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

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

The Tribunal found that the applicant's self-reports to his medical assessors were unreliable due to significant credibility issues raised by video surveillance and social media evidence, which showed him engaging in activities inconsistent with his reported limitations.

Consequently, the Tribunal placed minimal weight on the applicant's medical reports and concluded that he failed to prove his injuries fell outside the MIG.

The application was dismissed.

The applicant sought dispute resolution for various denied statutory accident benefits following a motor vehicle accident, including attendant care, medical benefits, and out-of-pocket expenses.

The Licence Appeal Tribunal found the applicant was entitled to $297.00 for attendant care provided by a qualified personal support worker.

The Tribunal also awarded $200.00 for the completion of an OCF-18 and $360.00 for a psychological progress report, finding the respondent's denials unreasonable.

The remaining claims for treatment plans, assistive devices, and transportation expenses were dismissed for lack of evidence or failure to meet statutory requirements.

Interest was awarded on the overdue amounts.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and attendant care benefits from the respondent insurer.

The Tribunal found that the applicant, who was self-employed in a physically demanding construction job, suffered a substantial inability to perform the essential tasks of his employment, relying on the respondent's own physiotherapist's assessment.

The Tribunal awarded IRBs at $400.00 per week and attendant care benefits based on the Form 1 hourly rate, along with interest on overdue payments.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits, an orthopaedic assessment, assistive devices, and occupational therapy services.

The adjudicator dismissed the application, finding that the applicant was independent with his activities of daily living and failed to establish any economic loss for attendant care.

The adjudicator also found that the requested medical benefits and assistive devices were not reasonable and necessary, preferring the respondent's medical evidence over the applicant's contradictory and incomplete reports.

The applicant sought statutory accident benefits following a 2013 motor vehicle accident.

The Tribunal found that the applicant's claim for a $2,850 chiropractic treatment plan was statute-barred by the two-year limitation period.

However, the Tribunal determined that the applicant's injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain syndrome and a pre-existing condition from a 2011 accident.

The Tribunal ordered the respondent to pay for the remaining chiropractic treatment plans, a psychological assessment, and a chronic pain assessment, finding them reasonable and necessary, along with interest on the assessments.

The applicant sought dispute resolution at the Licence Appeal Tribunal after the respondent insurer denied four treatment plans following a motor vehicle accident.

The adjudicator denied the request for an orthopaedic assessment, finding it was based solely on self-reported injuries without objective medical evidence.

Two chiropractic treatment plans were approved as reasonable and necessary because they included appropriate active and passive modalities consistent with the applicant's injuries.

A third chiropractic plan was denied due to a lack of substantive benefit and failure to address other barriers to recovery.

The applicant's claim for a special award under s. 10 of Regulation 664 was dismissed, but interest was awarded on the approved benefits.

The applicant sought income replacement benefits (IRBs) and a medical benefit following a motor vehicle accident.

The Tribunal found the applicant was entitled to IRBs for the period where income documentation was provided, though the insurer had already paid the outstanding amount based on an accountant's calculation.

The claim for IRBs for the subsequent period was dismissed because the applicant failed to provide required income documentation.

The Tribunal awarded the medical benefit because the insurer failed to provide medical reasons for its denial as required by section 38(8) of the Schedule.

Interest was awarded on the overdue medical benefit.