Brian Norris

The respondent insurer sought reconsideration of a decision finding the applicant sustained a catastrophic impairment and was entitled to income replacement benefits.

The insurer argued the adjudicator made errors of fact regarding the applicant's activity levels and errors of law by failing to cite case law or address section 57 of the Schedule.

The Tribunal dismissed the request, finding the initial conclusions were supported by medical and surveillance evidence, and that the insurer had failed to provide the requisite notice under section 57(4) to terminate benefits for non-compliance with treatment.

The applicant was involved in a motor vehicle accident and initially declined to claim accident benefits, but later changed his mind and notified the insurer.

The insurer delayed sending the application package and failed to provide information assisting the applicant or warning him of the consequences of a late application.

The Tribunal held that the insurer's failure to fully comply with its obligations under section 32(2) of the Schedule meant the 30-day time limit for the applicant to submit the application was never triggered.

The applicant was permitted to proceed with his claim.

The applicant was injured in a motor vehicle accident and submitted her application for accident benefits nearly two years late.

The insurer argued she was barred from proceeding with her claim.

The Tribunal found that the applicant had a reasonable explanation for the delay due to her struggles with substance abuse, homelessness, poverty, and incarceration following the accident.

However, the Tribunal held that the applicant was barred from claiming non-earner benefits because she failed to submit a disability certificate within the 104-week eligibility period.

The applicant sought to rescind a settlement agreement reached with the respondent insurer regarding statutory accident benefits arising from two 1996 motor vehicle accidents.

The applicant argued the settlement was invalid because the Settlement Disclosure Notice failed to include the commuted value of attendant care benefits, as required by s. 9.1 of Regulation 664.

The Tribunal found that res judicata did not apply from prior proceedings.

However, the Tribunal held the settlement was valid because the applicant had not claimed attendant care benefits at the time of settlement, making it impossible and unnecessary for the insurer to provide a commuted value for a benefit with a quantum of zero.

The application was dismissed.

The applicant, a pedestrian struck by a vehicle, sought non-earner benefits and a medical benefit for physiotherapy from her insurer.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to demonstrate a complete inability to carry on a normal life as required for non-earner benefits.

The Tribunal also found the physiotherapy treatment plan was not reasonable and necessary, noting a lack of contemporaneous medical evidence supporting the need for treatment.

Claims for interest and a special award were consequently dismissed.

The applicant sought accident benefits following a motor vehicle collision.

The insurer denied a chiropractic treatment plan on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she suffered from psychological injuries, chronic pain, and neurological issues that removed her from the MIG.

The Tribunal found insufficient evidence of a psychological injury or chronic pain condition, noting the applicant did not meet the AMA Guides criteria for chronic pain.

The Tribunal concluded the applicant sustained a minor injury, making her subject to the $3,500 funding limit, and dismissed the claims for the treatment plan and interest.

The applicant sought attendant care benefits following a motor vehicle accident.

The insurer agreed to pay the benefits subject to proof that the expenses were incurred, but the applicant failed to provide any expense claim forms or invoices.

The applicant argued the expenses should be deemed incurred due to the insurer's delayed response to a Form 1.

The Tribunal found that the delayed response did not automatically entitle the applicant to benefits and declined to deem the expenses incurred.

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

The applicant sought an award under section 10 of Regulation 664, arguing the respondent unreasonably withheld benefits by subjecting her to the Minor Injury Guideline (MIG) despite her sustaining a concussion.

The Tribunal found that the applicant's initial medical records did not clearly diagnose a concussion and that the respondent acted reasonably in requesting an insurer's examination.

Once the neurologist recommended removing the applicant from the MIG due to pre-existing conditions, the respondent complied.

The Tribunal concluded the respondent did not unreasonably withhold or delay benefits and dismissed the application for an award and interest.

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

The respondent insurer denied various treatment plans and income replacement benefits (IRBs), arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant's injuries were minor, rejecting reports of psychological impairment and chronic pain due to inconsistencies and suspected malingering.

The Tribunal preferred the insurer's medical examinations, concluding the applicant was subject to the $3,500 MIG limit and not entitled to the disputed medical benefits.

The claim for IRBs was also dismissed as the applicant failed to prove an inability to perform essential tasks and did not disclose post-accident income.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, including physiotherapy, psychological treatment, and chronic pain programs, which the respondent insurer denied.

The Licence Appeal Tribunal found that the first two physiotherapy plans were reasonable and necessary based on contemporaneous clinical notes and records showing ongoing physical impairment.

However, the Tribunal dismissed the claims for the remaining physiotherapy plans and all other treatment and assessment plans, finding the applicant failed to meet his evidentiary burden and relying on unpersuasive or unsupported expert reports.

The applicant was awarded the first two physiotherapy plans with interest, and the remainder of the application was dismissed.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming she was substantially unable to perform her pre-accident employment tasks.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to provide contemporaneous medical evidence of disability during the claim period.

The Tribunal relied on insurer's examinations and the applicant's successful enrollment in a computerized accounting program to conclude she was not disabled from her sedentary administrative duties.

Claims for an award and interest were consequently dismissed.

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

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

The Tribunal found that the applicant sustained soft tissue injuries and did not suffer from chronic pain or a psychological injury caused by the accident.

Consequently, the applicant was subject to the MIG and its funding limits, precluding entitlement to the disputed medical and attendant care benefits.

The Tribunal also dismissed the claim for non-earner benefits, finding the applicant did not suffer a complete inability to carry on a normal life.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to medical benefits for chiropractic and psychological treatment, as well as income replacement benefits.

The insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and that she was not substantially unable to perform her employment tasks.

The Licence Appeal Tribunal found that the applicant did not suffer from an accident-related psychological injury or chronic pain condition, preferring the insurer's medical examinations over the applicant's expert.

The Tribunal concluded the applicant sustained a minor injury subject to the $3,500 funding limit and dismissed the claims for additional medical benefits, income replacement benefits, and interest.

The Applicant sought a determination that he sustained a catastrophic impairment and was entitled to ongoing income replacement benefits following a 2017 motor vehicle accident.

The Respondent brought a preliminary motion to strike the Applicant's catastrophic impairment report, arguing it was not conducted by a physician as required by section 45(2)1 of the Schedule.

The Tribunal dismissed the motion, finding the report was directed by a physician and compliant with the Schedule.

On the merits, the Tribunal preferred the Applicant's expert evidence, concluding he suffered a marked impairment in all four areas of functioning due to somatic symptom disorder and major depressive disorder.

The Tribunal found the Applicant catastrophically impaired and completely unable to engage in suitable employment, granting entitlement to income replacement benefits and interest.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including attendant care benefits and various treatment plans.

The respondent denied the benefits, arguing the applicant was bound by the Minor Injury Guideline (MIG).

The Tribunal found the applicant was not bound by the MIG due to psychological injuries, relying on an insurer's examination report.

The Tribunal granted entitlement to the physical treatment plans (physiotherapy and chiropractic) as reasonable and necessary, but denied the attendant care benefits and the unapproved balances of the psychological treatment plans for lack of evidence.

The applicant sought income replacement benefits and funding for a chiropractic treatment plan following a motor vehicle accident.

The adjudicator found that the applicant failed to meet her burden of proving a substantial inability to perform the essential tasks of her pre-accident employment, relying on insurer's examination reports that found no physical or psychological disability.

The adjudicator also denied the treatment plan, finding it was not reasonable and necessary as the applicant had fully recovered from her soft tissue injuries.

The application was dismissed in its entirety.

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

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

The applicant claimed to suffer from psychological injuries and chronic pain outside the MIG.

The Tribunal found no compelling evidence of an accident-related psychological injury or chronic pain condition, noting the applicant's failure to produce transcribed clinical notes from his family physician.

The Tribunal concluded the applicant sustained a minor injury, remains subject to the MIG's $3,500 funding limit, and is not entitled to the disputed treatment plans or interest.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits, attendant care benefits, and various medical and rehabilitation benefits.

The Licence Appeal Tribunal dismissed the application in its entirety.

The adjudicator found the applicant to be a poor historian whose self-reported limitations were inconsistent with contemporaneous medical records.

The tribunal preferred the evidence of the respondent's assessors, concluding that the applicant did not suffer a complete inability to carry on a normal life, did not incur attendant care expenses, and failed to prove the claimed medical benefits were reasonable and necessary.

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

The respondent classified the applicant's injuries as minor and subject to the Minor Injury Guideline (MIG) and its $3,500 funding limit, denying several treatment and assessment plans.

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

The Tribunal found the applicant's physical injuries were minor and her ongoing pain was related to a pre-existing condition (polymyalgia rheumatica), not the accident.

The Tribunal preferred the respondent's medical experts over the applicant's assessor, concluding the applicant did not sustain accident-related chronic pain or psychological impairments.

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

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for various treatment and assessment plans.

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

The applicant argued he suffered from pre-existing impairments, psychological injuries, and chronic pain that removed him from the MIG.

The Tribunal found no evidence that pre-existing conditions precluded recovery, rejected the applicant's psychological expert evidence as contradicted by the applicant's own self-reports, and found insufficient evidence of chronic pain.

The Tribunal concluded the applicant sustained a minor injury and dismissed the application for the disputed benefits and interest.