Brian Norris

The applicant, who sustained a catastrophic impairment in a motor vehicle accident, sought $14,900 for housekeeping and home maintenance expenses incurred prior to the catastrophic impairment determination.

The services were provided by her adult son.

The Tribunal found that the expenses were not 'incurred' under section 3(7)(e)(iii) of the Schedule because the son did not provide the services in the course of his ordinary employment or sustain an economic loss.

The Tribunal also declined to deem the expenses incurred under section 3(8), finding that the insurer did not unreasonably withhold or delay payment.

The application was dismissed.

The Applicant sought income replacement benefits (IRBs) and medical benefits following a low-speed motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the Applicant failed to provide contemporaneous medical evidence demonstrating a substantial inability to perform the essential tasks of his employment as a cleaning company manager.

The Tribunal relied on insurer's examination reports which found no functional impairments or severe emotional symptomology.

Claims for physiotherapy, psychological services, and an occupational therapy assessment were also dismissed as not reasonable and necessary.

The applicant sought various medical and rehabilitation benefits, including assessments and chiropractic treatment, following a motor vehicle accident.

The respondent denied the benefits, relying on insurer's examinations and social media surveillance showing the applicant travelling internationally and engaging in physical activities.

The Tribunal found that only one chiropractic treatment plan was reasonable and necessary, supported by the family physician's recommendations.

The remaining assessment and treatment plans were denied, as the evidence demonstrated the applicant had returned to her pre-accident functional level and did not exhibit symptoms warranting further investigation.

The Tribunal also denied the applicant's claim for an award under Regulation 664, finding no unreasonable delay by the respondent.

The applicant, who sustained catastrophic impairments after being struck by a vehicle as a pedestrian, sought various statutory accident benefits including transportation, food, taxi expenses, nursing services, assistive devices, and internet services.

The Licence Appeal Tribunal found that the applicant was entitled to $588.00 for internet services, as she required it to connect with community supports following the accident.

However, the Tribunal dismissed the remaining claims, finding that the applicant failed to meet her onus to demonstrate that the other expenses were reasonable and necessary medical or rehabilitation expenses.

The Applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming that chronic pain syndrome prevented him from working full-time.

The Applicant had returned to his pre-accident role but at reduced hours.

The Respondent denied the IRBs, arguing the Applicant did not meet the post-104 test of suffering a complete inability to engage in suitable employment.

The Tribunal dismissed the application, finding that while the Applicant suffered from chronic pain, he had successfully returned to work at two-thirds capacity and maintained his status and reward.

The Tribunal preferred the Respondent's medical evidence that the Applicant was not medically restricted from working and would benefit from workplace accommodations and exercise.

The applicant sought statutory accident benefits for physiotherapy and psychological services following a motor vehicle accident.

The respondent denied the physiotherapy treatment plans on the basis that the applicant had reached maximum medical recovery, and disputed the hourly rate claimed for psychological services rendered by a social worker.

The adjudicator found that the applicant had recovered from uncomplicated soft-tissue injuries and had no residual impairments, making further physiotherapy not reasonable and necessary.

The adjudicator also held that the social worker was not entitled to the enhanced hourly rate reserved for psychologists under the Professional Services Guideline.

Claims for an award and interest were dismissed as no benefits were unreasonably withheld or overdue.

The applicant witnessed a severe motor vehicle collision from his aunt's front porch, which resulted in two fatalities.

He subsequently developed psychological injuries and sought statutory accident benefits from the respondent insurer.

The respondent denied the claims on the basis that the applicant was not 'involved in an accident' as defined by the Statutory Accident Benefits Schedule.

The Tribunal agreed, finding that witnessing an accident or its aftermath does not constitute being involved in it.

Furthermore, the applicant could not claim benefits for nervous shock because he was not related to any of the accident victims.

The application was dismissed.

The applicant sought income replacement benefits and a physiotherapy treatment plan following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant's medical evidence unpersuasive and contradictory.

The Tribunal preferred the respondent's insurer's examination reports, which concluded the applicant did not suffer a substantial inability to perform his essential tasks as a chef and had achieved maximal medical recovery.

Consequently, the claims for benefits and interest were denied.

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

The respondent insurer determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied further treatment plans, non-earner benefits, and attendant care benefits.

The Licence Appeal Tribunal found that the applicant failed to prove he sustained psychological injuries that would remove him from the MIG.

As the applicant had exhausted the $3,500 MIG limit, the disputed treatment plans were not payable.

The Tribunal also dismissed the claims for non-earner and attendant care benefits, finding insufficient evidence of a complete inability to carry on a normal life.

The application was dismissed.

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

The insurer raised a preliminary issue, arguing the applicant was statute-barred from proceeding with the application under section 55(1)2 of the Schedule because he failed to attend scheduled section 44 insurer's examinations.

The Tribunal found that the insurer's notices for the examinations were not compliant with section 44(5) of the Schedule, as they failed to provide the medical and other reasons for assessing the applicant's entitlement to medical benefits, focusing instead only on non-earner benefits which were no longer at issue.

Consequently, the applicant was permitted to proceed with his application, and the insurer's request for costs was denied.

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

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

The applicant argued he sustained a psychological injury that removed him from the MIG.

The Tribunal found no compelling evidence of a psychological injury, preferring the respondent's psychological assessment over the applicant's, as it was more consistent with the clinical notes and the applicant's return to work.

The application for disputed treatment plans, an award, and interest was dismissed.

The applicant sought statutory accident benefits for psychological treatment following a motor vehicle accident.

The core dispute was whether the applicant's psychotherapist should be paid at an enhanced hourly rate of $149.61, akin to a psychologist, rather than the $100.00 rate approved by the respondent.

The adjudicator found that the psychotherapist was not listed in the Professional Services Guideline and the applicant failed to demonstrate entitlement to the enhanced rate, noting the absence of evidence that specialized cognitive behavioural therapy was provided.

Claims for ancillary documentation fees and workbooks were also denied for lack of evidence.

The application was dismissed.

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

The respondent insurer denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG) and its $3,500 funding limit.

The applicant argued she suffered from chronic pain and psychological injuries warranting removal from the MIG.

The Tribunal found insufficient evidence of chronic pain or psychological impairment, noting the lack of diagnosis in the family physician's records and the unpersuasive nature of the psychological pre-screen report.

The Tribunal concluded the applicant's injuries were minor and subject to the MIG.

As the applicant had exhausted the $3,500 limit, the disputed treatment and assessment plans were denied, and no interest was payable.

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

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

The Licence Appeal Tribunal found that the applicant sustained an Adjustment Disorder with Mixed Anxiety and Depressed Mood as a result of the accident, removing her from the MIG.

Consequently, the 2020 psychological assessment and treatment plans were deemed reasonable and necessary.

However, the tribunal denied the physical and chronic pain treatment plans, finding that the applicant's ongoing physical complaints were related to pre-existing degenerative issues rather than the accident.

The tribunal also awarded the applicant $1,612.79 under section 10 of O. Reg. 664, finding the insurer unreasonably delayed payment by refusing to accept the uncontested psychological assessment report.

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

The insurer determined the injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that his pre-existing mild scoliosis warranted removal from the MIG.

The Tribunal found insufficient medical evidence to establish that the pre-existing condition precluded his recovery within the MIG framework.

As the applicant had exhausted the $3,500 funding limit, the disputed treatment plan was denied and the application was dismissed.

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

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

The applicant applied to the Licence Appeal Tribunal, arguing that pre-existing knee pain, chronic pain, and psychological injuries warranted removal from the MIG.

The Tribunal found no compelling evidence that the pre-existing condition precluded recovery, and preferred the respondent's medical assessors over the applicant's assessors regarding chronic pain and psychological injuries.

The Tribunal concluded the applicant sustained predominantly minor injuries, was subject to the MIG, and was not entitled to the disputed treatment plans as the funding limit was exhausted.

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

The respondent denied the benefits, arguing the applicant's inability to work was due to injuries from a prior 2017 accident and a 2018 ankle injury.

The Tribunal found that the applicant was not working at the time of the subject accident and that her disability pre-dated it.

Medical evidence, including clinical notes and insurer's examinations, did not support that the subject accident caused a substantial inability to perform the essential tasks of her employment.

The application for IRBs, an award, and interest was dismissed.

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

The Respondent denied certain benefits, arguing the Applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the Applicant's injuries, which included an exacerbation of pre-existing psychological issues and ongoing pain, fell outside the MIG.

The Tribunal ordered the Respondent to pay for chiropractic and psychological treatment plans, but denied a chronic pain assessment plan.

The Applicant was also awarded income replacement benefits for specific periods when she was substantially unable to perform the essential tasks of her employment as an esthetician.

Claims for an award under Regulation 664 were dismissed.

The applicant sought statutory accident benefits following two motor vehicle accidents that resulted in a traumatic brain injury and post-concussion syndrome.

The respondent insurer denied funding for optometry, speech-language pathology, and physiotherapy treatment plans.

The Tribunal found the optometry and physiotherapy plans reasonable and necessary, preferring the evidence of the applicant's treating practitioners over the insurer's examiners, noting the applicant's measurable improvement with treatment and deterioration when treatment ceased.

However, the Tribunal denied the speech-language pathology assessment, finding insufficient contemporaneous medical evidence of communication impairments.

The applicant was injured in a motor vehicle accident and sought a medical benefit of $10,204.92 for a chronic pain treatment plan.

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

In a prior hearing, the Tribunal determined the applicant's injuries were predominantly minor.

The respondent argued the current application was barred by res judicata.

The Tribunal found that the characterization of the applicant's injuries was decided in the first hearing and that new evidence submitted by the applicant did not conclusively impeach those findings.

The applicant also failed to prove the respondent breached statutory notice requirements under section 38 of the Schedule.

The application was dismissed.