Brian Norris

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

The respondent denied funding for chiropractic, physiotherapy, and psychological assessment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued he sustained psychological injuries and chronic pain outside the MIG.

The Licence Appeal Tribunal found insufficient evidence of a psychological injury or accident-related chronic pain, noting pre-existing conditions and relying on insurer's examinations.

The Tribunal concluded the applicant's injuries were minor, subject to the $3,500 MIG limit, and dismissed the claims for the disputed treatment plans, interest, and a section 10 award.

The applicant was struck by a vehicle as a pedestrian and sought statutory accident benefits, including non-earner benefits and various medical and rehabilitation treatment plans.

The Licence Appeal Tribunal dismissed the claim for non-earner benefits, finding that the applicant's functionality had improved and he did not suffer a complete inability to carry on a normal life, as evidenced by his return to post-secondary education and independence with self-care.

The Tribunal approved treatment plans for a chronic pain assessment and a functional abilities evaluation, finding them reasonable and necessary to investigate ongoing impairments.

The remaining claims for treatment plans and an award for unreasonable delay were dismissed.

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

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

The applicant argued that pre-existing back pain and an accident-related psychological condition (ADHD) precluded his recovery within the MIG.

The Licence Appeal Tribunal found insufficient evidence that the pre-existing disc bulge impaired recovery or that the ADHD was caused or exacerbated by the accident.

The Tribunal concluded the injuries were minor, subject to the MIG, and dismissed the application for the disputed treatment plans and interest.

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

The respondent denied several treatment and assessment plans.

The applicant applied to the Licence Appeal Tribunal to dispute the denials.

The Tribunal found that the applicant was statute-barred from disputing all but one of the plans because she failed to commence her application within the two-year limitation period under section 56 of the Schedule.

The Tribunal held that the limitation period was engaged by clear and unequivocal denial letters that included reference to the two-year limitation period.

For the remaining plan, the applicant failed to demonstrate that it was reasonable and necessary.

The application was dismissed.

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

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

The Tribunal found that the applicant sustained a fractured tooth, which is not a minor injury, and therefore he was not subject to the MIG.

However, the Tribunal dismissed the claims for physiotherapy and chiropractic treatment plans because they were submitted as standard plans rather than MIG treatment confirmation forms before evidence of the non-minor injury was provided.

The claims for psychological and occupational therapy assessments were also dismissed as the applicant failed to prove they were reasonable and necessary.

Claims for an award and interest were denied.

The applicant sought various statutory accident benefits, including attendant care, physiotherapy, and occupational therapy, following a 2018 motor vehicle accident.

The adjudicator dismissed the application in its entirety, finding the applicant was a poor historian and failed to meet his onus to prove the expenses were reasonable and necessary or incurred.

The adjudicator preferred the respondent's medical evidence, noting the applicant's significant pre-existing health issues, including severe osteoarthritis that necessitated a knee replacement.

The respondent's request for costs was also denied.

The applicant sought entitlement to several medical and rehabilitation assessment plans following a motor vehicle accident.

The applicant's submissions focused entirely on the insurer's alleged failure to comply with response obligations under section 38 of the Schedule, rather than the medical merits of the claims.

The adjudicator found that the applicant breached the Tribunal's page limit order by appending substantive submissions as an exhibit.

The adjudicator excluded the appended submissions and concluded that the insurer had provided compliant denials.

The application was dismissed as the applicant failed to meet her onus to demonstrate entitlement to the benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent under his aunt's insurance policy, claiming he was her financial dependent.

The respondent initially paid benefits but later denied coverage on the basis that the applicant was not a dependent.

The Tribunal applied the Market Basket Measure and the test from Allstate, finding that the applicant's income exceeded the financial support provided by his aunt.

As the applicant was not principally dependent on his aunt for financial support, he was not an 'insured person' under the Schedule and his application for benefits was dismissed.

The applicant, a pedestrian struck by a vehicle, sought a medical benefit for an occupational therapy treatment plan.

The respondent denied the plan but failed to provide medical reasons in its denial notices, violating section 38(8) of the Statutory Accident Benefits Schedule.

The Tribunal found the non-compliant denials engaged section 38(11), entitling the applicant to the incurred goods and services plus interest.

The applicant's claim for an award under section 10 of Regulation 664 was dismissed as the respondent's conduct was not excessive or imprudent.

The applicant was injured when a wall from a prefabricated modular building fell on her while being loaded onto a trailer by a mobile crane.

She sought statutory accident benefits from the respondent, who insured the mobile crane.

The respondent denied the claim, arguing the crane was excluded from coverage by an OPCF-30 endorsement and was covered under a separate commercial general liability policy.

The Tribunal found that although an executed OPCF-30 was not produced, the uncontested evidence demonstrated the parties agreed to amend the contract to exclude the mobile crane from coverage when used as a crane.

Consequently, the applicant was not involved in an 'accident' under the Schedule, and the application was dismissed.

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

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

The applicant argued she should be removed from the MIG due to pre-existing back, neck, and shoulder pain, as well as chronic pain caused by the accident.

The Tribunal found that the applicant's pre-existing conditions, which included prior workplace injuries, did not preclude her recovery within the MIG.

The Tribunal preferred the respondent's medical assessment over the applicant's expert, noting the latter failed to address the pre-existing conditions.

The application was dismissed, and the applicant was held to the $3,500 MIG funding limit.

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 a physiotherapy treatment plan and income replacement benefits (IRBs).

The Tribunal found the applicant's physical and psychological injuries were minor and did not warrant treatment outside the MIG, dismissing the claim for physiotherapy.

However, the Tribunal awarded IRBs for a closed period because the insurer failed to comply with the procedural requirements of section 36(4) of the Schedule when responding to the applicant's disability certificate, entitling the applicant to benefits until a clear and unequivocal denial was issued.

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

The Licence Appeal Tribunal found the applicant was entitled to a driving reintegration assessment because the insurer failed to provide a clear and unequivocal denial with sufficient medical reasons, rendering the plan payable once incurred.

However, a physiotherapy treatment plan was denied as not reasonable and necessary, with the adjudicator preferring the contemporaneous medical opinion that the applicant had reached maximal medical improvement.

Additional treatment plans for chiropractic care and assistive devices were dismissed because they were properly denied under section 38(5) of the Schedule while the applicant was subject to the Minor Injury Guideline, a refusal not subject to review.

Claims for an award and interest were also dismissed.

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

The Respondent denied the benefits, citing the Applicant's failure to comply with requests for information under section 33 of the Schedule.

The Tribunal found that the Applicant substantially complied with the requests and that the Respondent had agreed to pay the benefits subject to calculating quantum.

The Tribunal awarded IRBs at a rate of $30.29 per week for a limited period, based on self-employment income reported to the CRA, and denied further benefits as the Applicant had returned to work.

The Tribunal also ordered interest and a 20% award under section 10 of Regulation 664 due to the Respondent's unreasonable delay in calculating and paying the benefits.

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

The respondent insurer denied multiple treatment plans for chiropractic care, assistive devices including a tablet and mattress, and various medical assessments.

The Licence Appeal Tribunal dismissed the application, finding that the applicant's ongoing complaints were attributable to pre-existing degenerative changes rather than the accident.

The Tribunal preferred the evidence of the respondent's assessors, concluding that the proposed goods and services were not reasonable and necessary.

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

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

The Tribunal found that the applicant sustained a full thickness tear of her right shoulder as a result of the accident, which is not a minor injury, and therefore she was not subject to the MIG.

However, the Tribunal held that the applicant was barred from disputing a 2019 treatment plan due to the expiry of the two-year limitation period.

Furthermore, the applicant failed to meet her onus to prove that the proposed chronic pain and orthopaedic assessments were reasonable and necessary.

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

The respondent denied funding for physiotherapy and a psychological assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant failed to demonstrate a psychological injury or chronic pain condition caused by the accident.

The Tribunal concluded the applicant sustained a minor injury subject to the $3,500 funding limit, and dismissed the claims for the disputed treatment plans, interest, and an award.

The applicant was injured in a motor vehicle accident while a passenger in a rideshare vehicle.

She sought statutory accident benefits under her mother's auto insurance policy, claiming she was a dependent.

The insurer denied the claim on the basis that she was not an 'insured person' under the Schedule.

The Tribunal applied the Market Basket Measure to assess financial dependency over the 12-month period preceding the accident, including the applicant's receipt of CERB payments.

The Tribunal found that the applicant met more than 50% of her own financial needs and was therefore not principally dependent on her mother for financial support.

The application for benefits was dismissed.

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

She disputed the respondent's partial denial of a psychological treatment plan and the denial of a cognitive assessment plan.

The Tribunal found the applicant was not entitled to the unapproved balance of the psychological treatment plan because she failed to demonstrate that the unregistered psychotherapist provided services akin to a psychologist to justify the enhanced hourly rate.

The Tribunal also found the applicant was statute-barred from disputing the cognitive assessment plan because she filed her application more than two years after the denial and failed to attend a scheduled insurer's examination.

The application was dismissed.

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

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

The adjudicator found that the medical evidence, including hospital records and an insurer's examination, demonstrated only uncomplicated soft-tissue injuries.

As the applicant failed to prove his injuries fell outside the MIG, he was not entitled to the disputed treatment plans exceeding the $3,500 limit.