Brian Norris

The applicants sought statutory accident benefits for psychological injuries sustained after their family member witnessed a fatal motor vehicle accident.

In a previous preliminary issue decision, the Tribunal found the applicants were not 'insured persons' under the Schedule because the family member did not sustain a physical injury.

The applicants brought a new application raising a constitutional challenge to the Schedule and tendering new medical reports.

The Tribunal dismissed the application, holding it was barred by res judicata.

The Tribunal found the constitutional issue could have been raised previously, and the new medical reports did not conclusively impeach the original finding that no physical injury was sustained.

The applicant sought reconsideration of a decision denying his entitlement to income replacement benefits (IRBs).

He argued the adjudicator erred in fact and law by relying on insurer's examination (IE) reports that were allegedly procured through deficient notices.

The Tribunal dismissed the request, finding that even without the IE reports, the applicant had failed to meet his onus to prove entitlement to IRBs because he provided no contemporaneous medical evidence.

The Tribunal also noted that the applicant could not attend an IE and later claim the report was void due to improper notice.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs), attendant care benefits (ACBs), and medical benefits.

The Tribunal found the applicant met the post-104 week test for IRBs due to chronic pain and psychological impairments preventing him from returning to his restaurant business, though quantum was deferred.

The applicant was found entitled to ACBs but no amount was payable as the expenses were not incurred.

The Tribunal approved the occupational therapy and physiotherapy treatment plans but denied the social rehabilitation counselling plans.

Claims for an award and costs were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a catastrophic impairment due to psychological and neurological injuries.

The Licence Appeal Tribunal found that the applicant did not meet the criteria for a catastrophic impairment, as her mental and behavioural impairments did not reach the marked level in three or more spheres of function.

The Tribunal preferred the respondent's expert evidence, noting the applicant's self-reported independence in activities of daily living.

Claims for attendant care benefits, a neurological assessment, unapproved assessment costs, and an award for unreasonable withholding of benefits were all dismissed.

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

The insurer denied the claim because the application for benefits (OCF-1) was submitted beyond the 30-day prescribed time limit.

The applicant's counsel had inadvertently faxed the application to the wrong number.

The Tribunal found that the insurer failed in its positive obligation to assist the applicant with his claim after receiving treatment plans indicating an intention to claim benefits.

The Tribunal held that the applicant had a reasonable explanation for the delay and permitted the application to proceed.

The applicant, who was a minor at the time of the motor vehicle accident, sought accident benefits which were denied by the insurer.

The insurer raised a preliminary issue that the application was statute-barred under the two-year limitation period in section 56 of the Statutory Accident Benefits Schedule.

The Tribunal held that the term 'court' in section 2 of the Limitations Act, 2002 includes the Licence Appeal Tribunal, meaning the limitation period was suspended under section 6 of the Limitations Act while the applicant was a minor without a litigation guardian.

As the applicant was not represented by a litigation guardian for the accident benefits claim, the application was not statute-barred.

The respondent insurer requested a reconsideration of a decision granting the applicant ongoing income replacement benefits (IRBs).

The adjudicator found that he had made errors of fact regarding the timeline of the applicant's medical restrictions and post-accident employment, and had violated procedural fairness by admitting late evidence in reply submissions without allowing the respondent to address it.

Upon correcting these errors, the adjudicator concluded that the applicant was able to perform the essential tasks of his post-accident employment as a shift supervisor and was not entitled to ongoing IRBs.

The adjudicator also corrected an error of law regarding the repayment of benefits, finding that the insurer was not required to prove material misrepresentation to claim repayment within the one-year statutory period.

The initial decision was varied to deny ongoing IRBs and order the applicant to repay $1,200.00 in overpaid benefits.

The applicant was involved in a motor vehicle accident and subsequently developed a severe neurocognitive disorder, rendering her incapable of caring for herself.

She sought statutory accident benefits, including a determination of catastrophic impairment, income replacement benefits, and attendant care benefits.

The respondent denied the benefits, arguing the applicant's dementia pre-dated the accident and was not caused by it.

The Licence Appeal Tribunal found that the accident materially contributed to the onset and rapid acceleration of the applicant's neurocognitive disorder.

The Tribunal held that the applicant sustained a catastrophic impairment under criterion 8 (mental and behavioural impairment) and awarded income replacement benefits, attendant care benefits up to $6,000 per month, and specific medical treatment plans, along with interest.

Claims for an award under section 10 and costs were dismissed.

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

The respondent denied non-earner benefits and various medical and rehabilitation benefits, arguing the applicant's injuries fell within the Minor Injury Guideline.

The applicant argued that the respondent's denial notices were defective and that the insurer's examination reports should be struck.

The Tribunal found that the applicant did not suffer a complete inability to carry on a normal life and dismissed the claim for non-earner benefits.

However, the Tribunal granted a cannabis treatment plan, preferring the treating physician's recommendation over the insurer's assessor.

The Tribunal also granted a psychological treatment plan because the respondent failed to provide a proper medical reason for its denial, applying the Suarez principle.

The remaining claims for medical benefits and a special award were dismissed.

The applicant sought medical benefits for occupational therapy (a SPECT scan) and optometric services following a motor vehicle accident, along with interest and a special award.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the treatment plans were reasonable and necessary.

The medical evidence, including normal MRI results and a lack of referrals, did not support the need for a SPECT scan or functional assessment.

The claims for interest and a special award were consequently dismissed.

The applicant sought various statutory accident benefits following a 2008 motor vehicle accident.

The respondent raised a preliminary issue that the applicant was barred from proceeding with her claims for attendant care and housekeeping benefits due to her failure to attend insurer's examinations.

The adjudicator found the applicant failed to comply with her obligation to attend the examinations but exercised discretion to permit the application to proceed, subject to the condition that the claims be restricted to the period ending on the date of the decision.

On the substantive issues, the adjudicator dismissed the applicant's claims for attendant care, housekeeping, and other medical and rehabilitation benefits, finding she had not demonstrated the expenses were incurred or reasonable and necessary.

The respondent's claim for repayment of non-earner benefits was also dismissed.

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

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the chiropractic treatment was reasonable and necessary, noting a lack of supporting clinical notes and a subsequent unrelated ankle injury.

The Tribunal also denied the claim for an enhanced hourly rate for psychological services, as the applicant did not demonstrate the psychotherapist had training or experience akin to a psychologist to justify the higher rate.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision.

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

The Tribunal found that the applicant failed to prove his injuries fell outside the MIG, rejecting claims of pre-existing conditions, psychological injury, and chronic pain.

The Tribunal gave no weight to the applicant's psychological assessment report as it relied solely on self-reporting and contradicted clinical notes.

Consequently, the disputed medical benefits were denied as they exceeded the $3,500 MIG limit.

The claim for income replacement benefits was also dismissed because the applicant had returned to work in a physical role shortly after the accident.

Claims for interest and a section 10 award were dismissed.

The applicant sought payment for the unapproved balance of a multidisciplinary catastrophic impairment assessment following a motor vehicle accident.

The respondent had approved the assessments up to the $2,000 per modality limit but denied additional fees for file reviews and transportation.

The Tribunal found that file review fees are an essential component of an assessment and are captured within the $2,000 funding limit.

The Tribunal also found that the applicant was not entitled to transportation expenses because she lived within the 50 km deductible radius and had withdrawn her claim for a catastrophic impairment determination.

The application was dismissed.

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

The respondent insurer split the determination of her injuries, subjecting her physical injuries to the Minor Injury Guideline (MIG) limits while accepting her psychological injuries were non-minor.

The applicant applied to the Licence Appeal Tribunal.

At the case conference, the respondent agreed to pay the disputed benefits.

The Tribunal held a written hearing to determine if the applicant was entitled to an award under section 10 of Regulation 664.

The Tribunal found the respondent's position to split the determination was contrary to settled law and constituted unreasonable withholding of benefits.

The applicant was awarded $3,194.41, representing 50% of the amounts withheld based on the split determination.

The applicant sought a determination of catastrophic impairment following a motor vehicle accident, claiming a class 5 extreme mental and behavioural impairment.

The applicant moved to exclude the respondent's insurer's examination report by a psychologist, which the Tribunal denied, finding that the restrictions in section 45(2) of the Schedule apply to insured persons, not insurers.

On the merits, the Tribunal found the applicant did not sustain a catastrophic impairment, giving no weight to her psychiatric expert's report due to methodological deficiencies, lack of an occupational therapy assessment, and over-reliance on the applicant's inconsistent self-reporting.

The application for benefits and an award was dismissed.

The applicant sought reconsideration of a decision denying his claim for statutory accident benefits.

The Tribunal had previously found that the applicant was not principally dependent on his aunt, through whose policy he claimed benefits, because he could not prove she provided more than 50% of his financial needs.

The applicant argued the Tribunal erred in its mathematical application of the dependency test and failed to consider his transitional circumstances.

The Tribunal dismissed the reconsideration request, finding no error of law or fact in its application of the dependency test or its assessment of the evidence regarding household expenses.

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

The respondent insurer denied the claims.

The applicant applied to the Licence Appeal Tribunal for resolution.

The Tribunal found that the applicant failed to demonstrate that the proposed treatment plans were reasonable and necessary as a result of the accident, noting that the medical evidence provided was not contemporaneous with the plans and primarily related to pre-existing or unrelated conditions.

The application was dismissed, and no interest or award was payable.

The applicant sought Income Replacement Benefits (IRBs), a special award, and interest following a motor vehicle accident.

The respondent had previously paid IRBs but stopped after the applicant failed to attend insurer's examinations.

The Tribunal found that the applicant failed to provide contemporaneous medical evidence demonstrating a complete inability to engage in reasonably suited employment.

The Tribunal preferred the respondent's medical assessments, which found no physical or psychological impairments caused by the accident that would prevent the applicant from working.

The application for ongoing IRBs, a special award, and interest was dismissed.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including treatment plans for psychological, physiotherapy, chiropractic, occupational therapy, dental services, and medication expenses.

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

The adjudicator found that the applicant was entitled to some of the treatment plans, including chiropractic and dental services, as well as certain medication expenses, as they were reasonable and necessary as a result of the accident.

However, other plans, including psychological services and attendant care assessments, were denied for lack of evidence or because they were duplicative.

The adjudicator also awarded interest on overdue payments but declined to order an award for unreasonable delay, finding the respondent's denials were based on medical assessments.