Brian Norris

The applicant sought payment for psychological treatment plans following a motor vehicle accident.

The respondent refused to pay the full invoiced amounts, arguing the services were provided by a psychotherapist (an unregulated professional) rather than a psychologist as proposed in the approved treatment plans.

The Tribunal found insufficient evidence that the psychotherapist was actively supervised by a psychologist and concluded the applicant was only entitled to the hourly rate for an unregulated professional.

The claims for the unpaid balance, interest, and an award were dismissed.

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

The insurer determined the injuries fell within the Minor Injury Guideline (MIG) and denied treatment plans for physiotherapy and a psychological assessment.

The Tribunal found the applicant failed to provide compelling evidence of psychological injuries, chronic pain, or pre-existing conditions that would warrant removal from the MIG.

The Tribunal concluded the applicant sustained predominantly minor injuries, is subject to the $3,500 funding limit, and is not entitled to the disputed treatment plans, interest, or an award.

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 several treatment and assessment plans.

The applicant applied to the Licence Appeal Tribunal, arguing that rotator cuff tendinopathy, psychological injuries, and chronic pain removed her from the MIG.

The Tribunal found that the rotator cuff injury met the definition of a minor injury and that there was insufficient evidence of psychological injuries or chronic pain, preferring the insurer's examination reports over the applicant's orthopaedic assessment.

The Tribunal concluded the applicant sustained predominantly minor injuries, making the disputed treatment plans and interest not payable as they exceeded the $3,500 funding limit.

The applicant, who suffered a catastrophic brain injury in a motor vehicle accident, sought attendant care benefits of $803.99 per month.

The Tribunal found the applicant was entitled to the benefits due to ongoing cognitive issues and fatigue.

However, the Tribunal held that the expenses claimed for services provided by a house helper and the applicant's wife were not 'incurred' under section 3(7)(e) of the Schedule, nor were they deemed incurred under section 3(8).

Consequently, no benefits or interest were payable.

The applicant requested a reconsideration of a decision finding her statute-barred from disputing entitlement to non-earner benefits due to failing to apply within the two-year limitation period.

The applicant argued the adjudicator erred in fact and law by not finding a bona fide intention to appeal and by failing to consider the respondent's delay in providing her accident benefit file.

The adjudicator dismissed the request, finding no error of law or fact, as the applicant failed to demonstrate a bona fide intention to appeal within the limitation period and the respondent's delay did not relieve the applicant of her obligation to file on time.

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

The respondent initially denied funding for physiotherapy and chiropractic treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

Prior to the hearing, the respondent conceded the injuries were not subject to the MIG.

The Tribunal found the applicant was entitled to a November 2016 physiotherapy plan as it was reasonable and necessary, but denied the October 2016 physiotherapy plan and May 2016 chiropractic plan.

Claims for an award and interest were also dismissed.

The applicant requested a reconsideration of a decision dismissing her application for failing to attend a section 44 insurer's examination.

The applicant argued the adjudicator erred in law and fact, violated procedural fairness by dismissing rather than adjourning the matter, and that new evidence warranted a different outcome.

The adjudicator dismissed the request, finding no errors of law or fact, that the dismissal was procedurally fair and statutorily permitted, and that the new evidence would not have altered the decision.

The applicant sought statutory accident benefits for two chiropractic treatment plans totaling $8,320, claiming she suffered post-concussion syndrome and a WAD 3 injury from a motor vehicle accident.

The insurer denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding the treatment plans were not reasonable and necessary.

The Tribunal preferred the insurer's medical examinations, which found no neurological signs or concussion related to the accident, over the applicant's medical reports, which lacked objective testing and were temporally removed from the treatment plans.

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

The respondent raised preliminary issues regarding whether the applicant was barred from proceeding due to non-compliance with requests for information and failure to attend insurer's examinations.

The Tribunal held that the applicant was barred from disputing entitlement to a chronic pain assessment because he failed to attend a properly scheduled insurer's examination without a reasonable explanation.

However, the applicant was not barred from disputing entitlement to income replacement benefits, as an Employer's Confirmation Form is not required to initiate a claim, and barring the entire application for missing an examination related to a discrete issue would be disproportionate.

The issue of repayment of income replacement benefits was deferred to the substantive hearing.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for various assessments and assistive devices.

The Licence Appeal Tribunal found that the applicant failed to prove the proposed neurological assessment, functional abilities evaluation, in-home ergonomic assessment, and assistive devices were reasonable and necessary.

The applicant's primary injury was a fractured forearm, which had largely resolved, and there was insufficient medical evidence to support the need for the disputed items.

The application was dismissed.

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

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

The Licence Appeal Tribunal found that the applicant's psychological complaints and spondylolysis did not warrant removal from the MIG, preferring the respondent's insurer examination reports over the applicant's psychological assessment.

The Tribunal dismissed the claims for additional medical benefits and interest.

Furthermore, the Tribunal awarded $200 in costs to the respondent due to the applicant's unreasonable behaviour, including late filings, adding unpleaded issues, and falsely certifying service of materials.

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

The respondent denied certain benefits, and the applicant applied to the Licence Appeal Tribunal.

The respondent raised a preliminary issue, arguing the application was statute-barred as it was filed outside the two-year limitation period.

The Tribunal found that the applicant had properly filed the application by fax within the limitation period, but it was not processed due to an administrative error by the Tribunal.

Consequently, the applicant was not statute-barred from proceeding.

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

The applicant argued the adjudicator erred in law by failing to assess whether the disputed treatment plans were reasonable and necessary, and by failing to consider evidence of chronic pain and psychological impairments.

The adjudicator denied the request, finding no error of law or fact.

Because the applicant had already exhausted the $3,500 MIG limit, a reasonable and necessary analysis was not required.

Furthermore, the original decision explicitly considered and weighed the medical evidence regarding the applicant's psychological and chronic pain claims.

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

The respondent approved a portion of the treatment plan but denied the balance.

The Tribunal found that the unapproved balance was not reasonable and necessary because the treatment plan proposed a per-session rate that exceeded the maximum hourly rate prescribed by the Professional Services Guideline.

However, because the respondent failed to provide a compliant notice of refusal within the required 10 business days under section 38 of the Schedule, the respondent was liable to pay for any goods and services incurred during the period of non-compliance, plus interest.

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

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

The applicant argued that pre-existing conditions and accident-related psychological injuries precluded recovery within the MIG limits.

The Licence Appeal Tribunal found insufficient evidence of pre-existing conditions or accident-related psychological injuries that would warrant removing the applicant from the MIG.

The Tribunal concluded the applicant sustained predominantly minor injuries, is subject to the $3,500 funding limit, and is not entitled to the disputed benefits or interest.

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

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

The Tribunal found that the applicant was statute-barred from disputing two of the treatment plans because the insurer had provided clear and unequivocal denials more than two years prior to the application.

On the merits, the Tribunal concluded that the applicant failed to establish that her injuries, including alleged chronic pain and psychological issues, fell outside the MIG.

Consequently, the applicant was bound by the $3,500 funding limit, and the remaining treatment plan was denied.

Claims for an award and interest were also dismissed.

The applicant was injured in a motor vehicle accident as a pedestrian and sought non-earner benefits.

The respondent requested the applicant attend insurer's examinations, which the applicant failed to attend, arguing it was unreasonable to schedule them close to a case conference.

The Tribunal found the applicant failed to attend properly scheduled insurer's examinations without a valid exemption.

Consequently, the applicant is barred from disputing her entitlement to non-earner benefits, and the issue was struck from the application, though she may proceed with her claim for medical benefits.

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

The respondent determined the injuries fell within the Minor Injury Guideline (MIG) and refused to fund a $2,594.00 chiropractic treatment plan.

The applicant argued that pre-existing chronic back pain and ongoing pain precluded recovery within the MIG.

The Tribunal found insufficient evidence that the pre-existing condition or chronic pain warranted removal from the MIG.

As the applicant had already reached the $3,500 funding limit under section 18 of the Schedule, the disputed treatment plan and claim for interest were dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a chiropractic treatment plan, a psychological assessment, and a psychological treatment plan.

The respondent partially denied funding for these plans.

The Tribunal found that the chiropractic treatment plan was not reasonable and necessary, but the applicant was entitled to some incurred expenses because the respondent failed to provide a valid medical reason for the denial within the required timeframe.

The Tribunal also found the applicant was entitled to the unpaid balance of the psychological assessment because the respondent's denial was not clear and unequivocal.

The balance of the psychological treatment plan was denied as it was not reasonable and necessary, and the psychotherapist was not entitled to the same hourly rate as a psychologist.

Interest was awarded on the overdue payments.

The applicant was injured in a motor vehicle accident and sought funding for a catastrophic impairment assessment.

The respondent initially denied the $12,400.00 assessment on the basis that the applicant had exhausted the non-catastrophic funding limit, but later approved $10,400.00.

The applicant sought the $2,000.00 balance, which was for a clinic file review, as well as an award for unreasonable delay.

The Tribunal dismissed the claim for the balance, finding that file review is captured within the $2,000.00 per-assessment limit under section 25(5)(a) of the Schedule.

However, the Tribunal granted an award of $2,080.00 under section 10 of O. Reg. 664, finding that the respondent's initial denial unreasonably disregarded established caselaw.