Brian Norris

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The respondent denied several treatment plans for chiropractic and psychological services.

The Tribunal found that the chiropractic treatment plans were reasonable and necessary to address the applicant's chronic pain, relying on the clinical notes of the applicant's family physician.

However, the Tribunal denied the psychological treatment plans because the applicant failed to provide evidence justifying the proposed hourly rates and the costs of the psychological materials.

The Tribunal also dismissed the applicant's claim for a special award, finding no evidence that the respondent unreasonably withheld or delayed benefits.

The applicant requested a reconsideration of a decision finding he materially misrepresented his involvement in a motor vehicle accident and ordering him to repay $6,012.65 in benefits to the respondent.

The applicant argued the adjudicator failed to consider medical evidence of his psychological issues, erred in admitting the repayment notice, and violated procedural fairness by relying on a witness who used undisclosed notes.

The Tribunal dismissed the request, finding no error of law or fact and no violation of procedural fairness, noting the applicant was attempting to relitigate issues already addressed at the hearing.

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

The insurer classified his injuries under the Minor Injury Guideline (MIG) and denied various treatment plans and income replacement benefits (IRBs).

The Licence Appeal Tribunal found that the applicant developed a chronic pain condition, removing him from the MIG.

The Tribunal approved a chronic pain assessment plan but denied a psychological assessment and a chronic pain treatment plan, finding them not reasonable and necessary.

The claim for IRBs was also dismissed as the applicant failed to prove a substantial inability to perform the essential tasks of his employment as a cabinet maker.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claims for non-earner benefits and various medical assessments, including plastic surgery, orthopaedic, and driving rehabilitation assessments.

The applicant argued the adjudicator made errors of law and fact and violated procedural fairness.

The Tribunal dismissed the request for reconsideration, finding no errors of law or fact that would have led to a different result, and noting that the applicant was attempting to relitigate issues and raise new arguments not presented at the initial hearing.

Aviva applied to the Licence Appeal Tribunal for the repayment of $18,935.40 in income replacement benefits paid to the respondent, alleging wilful misrepresentation of her pre-accident employment status.

The Tribunal found that the respondent provided inconsistent and unauthentic documents regarding her employment and income, establishing wilful misrepresentation.

Consequently, Aviva was not bound by the 12-month notice period for seeking repayment.

The Tribunal ordered the respondent to repay the full amount of the benefits, plus interest.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically the unapproved balance of a physiotherapy treatment plan.

The insurer had approved 60-minute sessions but denied funding for an additional 90 minutes per session and transportation expenses.

The Tribunal found that the applicant was not entitled to the benefits by operation of section 38(11) of the Schedule because no unapproved goods or services were incurred during the period of the insurer's non-compliance.

Furthermore, the applicant failed to demonstrate that the transportation expenses or the extended treatment sessions were reasonable and necessary.

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

The applicant sought entitlement to various medical benefits and assessments, including a chronic pain assessment and an orthopaedic 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 the proposed treatments were not reasonable and necessary.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to meet his burden of proof.

The Tribunal held that the initial treatment plan was properly denied under section 38(5) of the Schedule, transportation expenses were not payable as the applicant did not suffer a catastrophic impairment, and the medical evidence did not support a finding of chronic pain or the need for further facility-based treatment.

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

The respondent initially subjected the applicant to the Minor Injury Guideline (MIG) but later conceded the injuries were not predominantly minor.

Several treatment plans were resolved or withdrawn prior to the hearing.

The Tribunal found the applicant was entitled to the incurred costs of a physiatry assessment and a psychiatric assessment because the respondent failed to provide valid medical and other reasons for its denials under section 38(8) of the Schedule.

However, the Tribunal denied a chronic pain assessment, finding it was not reasonable and necessary, and declined to order an award under Regulation 664, as the respondent's defective notices did not amount to an unreasonable withholding of benefits.

The applicant sought reconsideration of a preliminary issue decision which found she was subject to the 2016 Schedule's catastrophic impairment definition and barred from disputing income replacement benefits.

The respondent argued the request was premature.

The adjudicator agreed and dismissed the request, noting that under Cura v. Aviva Insurance Canada, a request for reconsideration is only permitted on a decision that finally disposes of an appeal.

Since the applicant's appeal remained live with several issues pending for a substantive hearing, the reconsideration request was premature.

The applicant requested a reconsideration of a decision denying her non-earner benefits and physiotherapy treatment plans.

She argued the adjudicator erred in weighing surveillance evidence against her self-reports and failed to properly consider her treating practitioners' reports.

She also sought to introduce a new psychiatric report.

The adjudicator dismissed the request, finding no error of law or fact in the original weighing of evidence, and concluded the new medical report was not contemporaneous and would not have affected the outcome.

The applicant sought reconsideration of a Licence Appeal Tribunal decision denying entitlement to five treatment and assessment plans, including chiropractic treatment, attendant care, chronic pain, social work, and neurological assessments.

The applicant argued the adjudicator violated procedural fairness and erred in law, particularly regarding the sufficiency of the insurer's denial notices under section 38 of the Statutory Accident Benefits Schedule.

The adjudicator dismissed the request, finding the applicant was attempting to relitigate the weighing of evidence and correctly applied the law that an insured must incur the expenses to trigger the mandatory payment provisions under section 38(11).

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 adjudicator found that the applicant failed to prove he suffered from a pre-existing condition, psychological injury, or chronic pain condition that would remove him from the MIG.

Relying on insurer's examinations and the lack of consistent medical complaints, the adjudicator concluded the injuries were predominantly minor.

The application for disputed benefits and interest was dismissed.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, as well as assessments, from the respondent insurer.

The respondent denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) or that further treatment was not reasonable and necessary.

The adjudicator found that the applicant was no longer subject to the MIG and approved two chiropractic treatment plans, noting they were reasonable and necessary given the applicant's ongoing pain.

However, claims for a yoga plan, further chiropractic care, and unapproved balances for psychological services were dismissed for lack of evidence.

The adjudicator also denied the requested chronic pain, functional, and attendant care assessments, finding it unlikely the applicant suffered from chronic pain syndrome.

The respondent's claim for repayment of income replacement benefits was dismissed due to a lack of evidence.

The Applicant sought statutory accident benefits following a motor vehicle accident, claiming psychological injuries that would remove him from the Minor Injury Guideline (MIG).

The Tribunal found the psychological report submitted by the Applicant unpersuasive because it relied solely on self-reporting without reviewing medical records that indicated pre-existing psychiatric issues.

Preferring the comprehensive report of the respondent's psychologist, the Tribunal concluded the Applicant sustained only minor injuries.

Consequently, the Applicant remained subject to the $3,500 MIG funding limit and was not entitled to the disputed treatment plans, assessments, or interest.

The applicant sought statutory accident benefits following an alleged motor vehicle accident.

The respondent denied benefits and sought repayment, arguing the applicant was not involved in the accident and wilfully misrepresented his involvement.

The Tribunal found the applicant lacked credibility, noting significant inconsistencies in his accounts and his failure to produce the driver of the vehicle as a witness.

Relying on the testimony of the other driver involved in the collision, the Tribunal concluded the applicant was not a passenger in the vehicle.

The application for benefits was dismissed, and the respondent was granted a repayment of $6,012.65 with interest due to the applicant's wilful misrepresentation.

The applicants were injured in a motorcycle accident and inadvertently applied for statutory accident benefits from their standard policy insurer rather than their enhanced policy insurer.

The enhanced policy insurer denied their subsequent claim, arguing the initial election was binding.

The Licence Appeal Tribunal found it had jurisdiction under section 129 of the Insurance Act to grant equitable relief.

Applying the test for relief from forfeiture, the Tribunal allowed the applicants to rescind their initial application and apply for the enhanced benefits, noting the innocent nature of the error and the consumer protection mandate of the Schedule.

The applicants were involved in a motorcycle accident and inadvertently applied for statutory accident benefits from their standard policy insurer (Economical) instead of their enhanced policy insurer (Heartland).

Heartland denied their subsequent claim, arguing the initial application to Economical was irrevocable.

The applicants sought relief from forfeiture to rescind their initial application and apply to Heartland.

The Tribunal found it had jurisdiction under section 129 of the Insurance Act to grant equitable relief.

Applying the test for relief from forfeiture, the Tribunal found the applicants made an innocent mistake, the gravity of the breach was minimal, and the disparity between the forfeited enhanced benefits and the damage caused was significant.

The Tribunal granted relief from forfeiture, allowing the applicants to rescind their application with Economical and apply to Heartland.

The applicant was involved in a rear-end motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs) and various medical and rehabilitation benefits.

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

The Tribunal found that the applicant sustained predominantly minor injuries (soft tissue sprains/strains) and failed to prove that pre-existing conditions, neurological issues, psychological injuries, or chronic pain warranted removal from the MIG.

The Tribunal also found the applicant failed to demonstrate a substantial inability to perform the essential tasks of his pre-accident employment, denying the claim for IRBs.

The application was dismissed in its entirety.

The applicant sought a medical benefit of $1,023.40 for a treadmill following a motor vehicle accident.

The insurer initially denied the benefit under the Minor Injury Guideline but later conceded the applicant was not subject to the guideline.

However, the insurer maintained its denial of the treadmill because the applicant purchased it before submitting a treatment plan.

The Tribunal agreed, finding that under section 38(2) of the Statutory Accident Benefits Schedule, the insurer is not liable for expenses incurred prior to the submission of a treatment plan, and none of the exceptions applied.

The application for the benefit, an award, and interest was dismissed.

The applicant insurer sought repayment of $60,984.73 in income replacement benefits (IRBs) paid to the respondent following a motor vehicle accident.

The insurer alleged the respondent wilfully misrepresented his employment status by claiming he was unable to work while his tax documents showed he earned full-time income.

The respondent did not participate in the hearing.

The Tribunal found the respondent committed wilful misrepresentation and ordered him to repay the full amount of IRBs, plus interest.