Brian Norris

The applicant sought statutory accident benefits following a motor vehicle accident but failed to submit her application within the 30-day timeline prescribed by section 32 of the Statutory Accident Benefits Schedule, submitting it over a year and a half late.

The respondent denied the claim due to the delay.

The Licence Appeal Tribunal found that the applicant failed to provide a reasonable explanation for the delay under section 34, as her claim of latent injuries was contradicted by her examination under oath where she admitted to experiencing extreme back pain months before applying.

Consequently, the applicant was barred from proceeding with her claim pursuant to section 55(1)1 of the Schedule.

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

The insurer determined her injuries fell within the Minor Injury Guideline (MIG) and denied certain medical and non-earner benefits.

The Tribunal found that the applicant sustained a psychological injury (Adjustment Disorder) that removed her from the MIG, entitling her to funding for a psychological assessment.

However, the applicant failed to prove entitlement to further physiotherapy, non-earner benefits, or an award for unreasonable delay.

The applicant requested a reconsideration of a decision finding that her accident-related injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 funding limit.

She argued the adjudicator erred in assessing her pre-existing medical conditions, ongoing pain, and psychological injuries.

The Tribunal found no error of law or fact, noting insufficient evidence that her pre-existing conditions prolonged her recovery or that she suffered from chronic pain removing her from the MIG.

The request for reconsideration was dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought accident benefits.

The respondent insurer determined the injuries fell within the Minor Injury Guideline (MIG) and denied funding for several treatment plans.

The applicant argued that pre-existing back pain and chronic pain removed her from the MIG.

The Tribunal found insufficient evidence that the pre-existing condition would preclude recovery within the MIG, noting the injuries were predominantly soft-tissue strains.

As the applicant had already exhausted the $3,500 MIG funding limit, the disputed treatment plans were denied.

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

The insurer determined the injuries fell within the Minor Injury Guideline (MIG) and denied several treatment plans.

The applicant argued the insurer failed to comply with notice provisions under section 38 of the Schedule.

The Tribunal found the applicant sustained minor injuries, failed to prove entitlement due to defective notices, and had exhausted the $3,500 MIG funding limit.

The application was dismissed.

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

The insurer denied the treatment 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 predominantly minor soft-tissue injuries and failed to provide compelling evidence of a psychological injury or functional impairment that would warrant removal from the MIG.

The Tribunal also found that the insurer complied with the notice requirements under section 38(8) of the Schedule.

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

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

The respondent insurer determined the injuries fell within the Minor Injury Guideline (MIG) and refused to fund certain treatment plans.

The applicant argued that pre-existing back pain and sciatica from prior accidents precluded her recovery within the MIG.

The Tribunal found no compelling evidence that the pre-existing conditions prevented recovery, noting objective medical evidence and inconsistencies in the applicant's self-reporting to assessors.

The Tribunal concluded the applicant sustained minor injuries, was subject to the $3,500 funding limit, and dismissed the claims for additional treatment and assessments as the limit was exhausted.

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) and denied several treatment plans for psychological and chiropractic care.

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor soft-tissue injuries and that there was insufficient evidence of chronic pain or psychological impairment to warrant removal from the MIG.

As the disputed treatment plans proposed treatment outside the MIG limits, they were denied.

The claim for interest was also dismissed.

The applicants claimed statutory accident benefits for psychological injuries sustained after witnessing a vehicle strike their relative.

They did not have their own auto insurance policy and claimed under the policy of the driver who struck their relative.

The Licence Appeal Tribunal found that the applicants were not 'involved' in the accident as defined by section 3 of the Statutory Accident Benefits Schedule, as they were merely bystanders who witnessed the accident and its aftermath.

Furthermore, they were not entitled to make a 'nervous shock' claim under the driver's policy because they were not named insureds or relatives of the named insured.

The applications were dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits beyond the $3,500 Minor Injury Guideline (MIG) limit.

The respondent denied the treatment plans, arguing the injuries were minor.

The Tribunal found insufficient evidence of psychological injuries or chronic pain that would warrant removal from the MIG.

The application was dismissed, and the applicant was found not entitled to the disputed treatment plans or interest.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and chiropractic treatment plans.

The respondent insurer denied the treatment plans.

The Licence Appeal Tribunal found that the applicant failed to provide compelling contemporaneous medical evidence to support the ongoing treatment.

The applicant's medical records and the insurer's examination report indicated she had reached maximal medical recovery for her physical injuries and had successfully reintegrated into her community.

The application was dismissed, and no interest was payable.

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

The respondent initially placed the applicant in the Minor Injury Guideline (MIG) but later removed him due to psychological injuries.

The applicant sought funding for a chiropractic treatment plan, which the respondent denied.

The Tribunal found the treatment plan was not reasonable and necessary, as there was no compelling contemporaneous evidence supporting it, and preferred the insurer's examination report over the applicant's family physician's records.

Claims for interest and an award for unreasonable delay were also dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and chiropractic services.

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

The applicant argued her pre-existing back and shoulder conditions were exacerbated, precluding recovery within the MIG.

The Tribunal found no compelling evidence that the pre-existing conditions were exacerbated by the accident or prevented recovery.

The Tribunal preferred the insurer's medical examination report over the applicant's orthopaedic assessment, which was historically inaccurate.

The Tribunal concluded the applicant sustained a minor injury, had exhausted her MIG funding, and was not entitled to the disputed benefits or interest.

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

The respondent insurer determined the injuries fell within the Minor Injury Guideline (MIG) and denied funding for proposed chiropractic and physiotherapy treatment plans beyond the $3,500 limit.

The applicant argued the MIG should not apply due to chronic pain, psychological injuries, and the respondent's failure to provide proper notice under section 38(8) of the Schedule.

The Tribunal found no compelling medical evidence of chronic pain or psychological injury to remove the applicant from the MIG.

The Tribunal also found the respondent's notice deficiency was cured and did not entitle the applicant to the disputed plans.

The application was dismissed.

The applicant sought various medical and rehabilitation benefits following a motor vehicle accident.

The Licence Appeal Tribunal found that only the physiotherapy treatment plan was reasonable and necessary, relying on the recommendation of the applicant's family physician.

The remaining claims for massage therapy, chiropractic treatment, occupational therapy, a qEEG assessment, and various other expenses were denied due to insufficient medical evidence or because they were incurred prior to the submission of a treatment plan.

The Tribunal also awarded the applicant 10% of the amounts withheld for two psychological treatment plans, finding that the respondent unreasonably delayed funding despite having sufficient evidence to approve them.

The applicant sought statutory accident benefits for five chiropractic treatment plans following a 2015 motor vehicle accident.

The respondent denied the plans, arguing the applicant's symptoms were a continuation of pre-existing injuries from a 2011 accident.

The adjudicator found that the applicant had returned to her pre-accident health status shortly after the 2015 accident and that her ongoing difficulties at work were primarily cognitive, not related to the subject accident.

The adjudicator concluded the proposed treatment plans were not reasonable and necessary, and dismissed the claims for benefits, interest, and an award.

The applicant sought statutory accident benefits after allegedly being struck by an unidentified vehicle while crossing a street.

The respondent denied the claim on the basis that there was no evidence a vehicle was involved.

The Licence Appeal Tribunal found that the applicant failed to meet the burden of proving that a vehicle caused his injuries, as there were no witnesses, no police report confirming a collision, and medical records were equivocal about the cause of his injuries.

The application was dismissed.

The applicant requested a reconsideration of a decision denying entitlement to a physiotherapy treatment plan.

The applicant argued the adjudicator erred in law by interpreting section 38(11) of the Statutory Accident Benefits Schedule to require that goods and services be incurred before an insurer is obligated to pay for them following a failure to provide timely notice under section 38(8).

The adjudicator dismissed the request, finding no error of law.

The adjudicator confirmed that section 38(11)(2) serves to compel timely responses from insurers but still requires the insured to actually incur the goods and services described in the treatment plan.

The applicant sought non-earner benefits and funding for a psychological assessment following a motor vehicle accident.

The respondent denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that he did not suffer a complete inability to carry on a normal life.

The Tribunal found that the applicant, who continued to work multiple jobs post-accident, failed to demonstrate a complete inability to carry on a normal life, disqualifying him from non-earner benefits.

Furthermore, the Tribunal determined that the applicant's physical and psychological injuries were minor and subject to the MIG's $3,500 funding limit.

The request for a psychological assessment was denied as it fell outside the MIG methodologies, and no interest was awarded.

The applicant sought reconsideration of a decision finding he sustained a minor injury and was not entitled to non-earner benefits.

He argued the adjudicator erred in law by allowing the respondent to file insurer's examination reports and violated procedural fairness by failing to impartially assess his evidence.

The adjudicator dismissed the request, finding no error in law or breach of procedural fairness, as the applicant failed to properly identify the evidence he sought to exclude and failed to meet his burden of proof regarding his entitlement to benefits.