Christopher A. Ferguson

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

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

The applicant argued the insurer was precluded from relying on the MIG due to prior approvals, and alternatively, that her pre-existing obesity and alleged post-concussion syndrome removed her from the MIG.

The Tribunal held the insurer provided proper notice and was not precluded from applying the MIG.

The Tribunal further found the applicant failed to provide compelling evidence that her obesity was a documented pre-existing condition that prevented recovery within the MIG cap, or that she suffered a concussion caused by the accident.

The appeal was dismissed.

The applicant was struck by a motor vehicle as a pedestrian and sought statutory accident benefits, including income replacement benefits (IRBs), a functional abilities evaluation, and physiotherapy.

The insurer denied the claims.

The Licence Appeal Tribunal dismissed the appeal, finding the applicant was barred from claiming IRBs due to her failure to provide reasonably requested financial information under section 33 of the Schedule.

The Tribunal also found the applicant failed to prove the requested medical benefits and assessments were reasonable and necessary, preferring the insurer's medical evidence that the applicant had suffered uncomplicated soft tissue injuries that did not require further treatment.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a psychological assessment, chiropractic services, and an occupational therapy in-home assessment.

The insurer denied the benefits, arguing the physical injuries were pre-existing and the psychological assessment costs were unreasonable.

The Licence Appeal Tribunal dismissed the appeal, finding the applicant failed to prove the claimed psychological assessment costs were reasonable compared to the insurer's examination.

The Tribunal also found the applicant failed to establish causation for the physical injuries, noting extensive pre-existing conditions and a lack of evidence connecting the requested chiropractic and occupational therapy treatments to the accident.

The applicant, a pedestrian struck by a motor vehicle, sought statutory accident benefits for two physiotherapy treatment plans that were partially denied by the respondent insurer.

The Tribunal found that the applicant failed to meet the onus of proving the disputed treatments were reasonable and necessary.

The Tribunal accepted the uncontradicted evidence of the insurer's medical expert, who opined that the applicant was near maximum medical recovery and required home-based exercise rather than further facility-based passive physiotherapy.

The appeal was dismissed.

The applicant sought income replacement benefits following a motor vehicle accident.

The insurer denied the claim and the applicant filed an appeal with the Licence Appeal Tribunal more than two years after the denial.

The insurer raised a preliminary issue that the appeal was statute-barred.

The applicant argued the limitation period did not begin because the insurer's notice of denial referenced the former dispute resolution process.

The Tribunal found the notice was clear and compliant at the time it was issued, and the applicant failed to meet the criteria for an extension of time under section 7 of the Licence Appeal Tribunal Act.

The appeal was dismissed as statute-barred.

The applicant sought medical benefits for psychological and chiropractic services following a motor vehicle accident.

The insurer denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to meet the onus of proving the treatments were reasonable and necessary.

The Tribunal preferred the evidence of the insurer's medical assessors, who found no ongoing psychological or orthopedic impairments and concluded the applicant had reached maximum medical recovery.

The claims for benefits, interest, and a special award were dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) from the respondent insurer.

The insurer discontinued the IRBs and requested that the applicant's appeal be barred because he failed to attend five scheduled insurer's examinations (IEs).

The applicant argued that the transport provider was sent to the wrong address for two of the appointments, but provided no explanation for missing the others or failing to reschedule.

The Tribunal found that the applicant did not provide a reasonable explanation for his non-compliance with section 44(9) of the Schedule.

Consequently, pursuant to section 55(1)2., the applicant was barred from proceeding with his appeal regarding the disputed IRBs.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits for acupuncture and physiotherapy services.

The respondent insurer denied the treatment plans.

The adjudicator found that the applicant failed to meet the onus of proving the treatments were reasonable and necessary, as she did not submit the disputed treatment plans in evidence and her own family doctor's notes indicated significant physical improvement.

The respondent's medical assessor also concluded there were no ongoing musculoskeletal impairments.

The application was dismissed and no interest was awarded.

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

The respondent insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG), subjecting her to a $3,500 treatment limit.

The applicant argued she should be exempted from the MIG due to pre-existing conditions and a psychological impairment.

The Tribunal found that the applicant failed to provide compelling evidence of a pre-existing condition that would prevent maximal medical recovery within the MIG.

Furthermore, the Tribunal rejected the claim of psychological impairment due to unexplained discrepancies in the applicant's self-reporting to different medical experts.

The Tribunal concluded the injuries were predominantly minor, the $3,500 cap applied, and no further benefits or interest were payable.

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

The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG), capping benefits at $3,500.

The applicant argued that he sustained psychological injuries that removed him from the MIG.

The Tribunal preferred the respondent's psychological assessment, which included validity testing indicating symptom magnification, over the applicant's evidence.

The Tribunal found the applicant's injuries were predominantly minor and subject to the MIG cap.

A preliminary motion by the respondent to strike the applicant's Reply submissions for case splitting was dismissed.

The applicant sought a medical and rehabilitation benefit of $2,661.57 for physiotherapy following a motor vehicle accident, along with interest and an award for unreasonable delay.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide any medical evidence or argument to prove the treatment was reasonable and necessary.

The insurer's examination concluded the treatment was not required, and the applicant's criticisms of the insurer's claims adjustment process did not substitute for positive medical evidence.

Consequently, the claims for interest and an award were also dismissed.

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

The insurer denied the benefits and the parties subsequently reached a partial settlement for IRBs up to the 104-week mark.

Years later, the applicant sought post-104 week IRBs, which the insurer denied based on the original limitation period.

The Tribunal found that the appeal was filed beyond the limitation period, but granted an extension under s. 7 of the Licence Appeal Tribunal Act.

The Tribunal reasoned that the language of the settlement agreement induced a bona fide belief that the applicant could still claim post-104 week benefits, and the balance of prejudice favoured allowing the appeal to proceed.

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

The insurer brought a motion to bar the application on the basis that the applicant failed to attend nine scheduled insurer's examinations.

The Tribunal found that the applicant failed to attend the examinations without a reasonable explanation and that the insurer provided adequate notice.

The Tribunal declined to exercise its discretion to permit the application to proceed.

The insurer's request for reimbursement of cancellation fees was dismissed for lack of jurisdiction, and its request for costs was denied.

The applicant sought statutory accident benefits for a Functional Abilities Evaluation (FAE), vocational assessments, and a Chronic Pain Assessment (CPA) following a motor vehicle accident.

The adjudicator found the FAE and vocational assessments were reasonable and necessary to determine the applicant's capacity to work as a drywaller and painter, awarding the prescribed maximum of $4,400.00 plus interest.

However, the claim for a CPA was denied because the applicant already had a comprehensive chronic pain diagnosis and the proposed assessment would not provide new medical guidance.

The respondent's request for costs was dismissed.

The applicant sought non-earner benefits and a medical benefit for physiotherapy following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove she suffered a complete inability to carry on a normal life.

The Tribunal relied on insurer's examination reports and the applicant's own self-reporting to medical practitioners, which contradicted her claims of disability and indicated she had returned to a substantially normal, active life.

The claim for physiotherapy was also dismissed as the applicant failed to provide medical evidence to support it, and the insurer's medical examination concluded she had reached maximum medical recovery.

Claims for interest and a special award were consequently dismissed, and the insurer's request for costs was denied.

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

The respondent insurer denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 limit.

The applicant argued for removal from the MIG based on a pre-existing knee condition, chronic pain, and psychological impairments.

The Tribunal found insufficient evidence that the pre-existing condition would prevent maximal recovery.

Relying on the respondent's independent medical examinations, the Tribunal concluded the applicant did not suffer from chronic pain or a psychological impairment caused by the accident.

The injuries were deemed predominantly minor, and the claims for chiropractic services were denied.

The respondent insurer brought a motion for the production of the appellant's medical records and information regarding a subsequent insurance policy.

The appellant opposed the motion, arguing that the only issue in the appeal was whether he had a reasonable explanation for submitting his claim late, making medical records irrelevant.

The Tribunal granted the motion, finding that there was a medical issue in the appeal regarding the cost of a Disability Certificate, and that the requested documents were relevant to assessing the appellant's credibility and his explanation for the delay.

The applicant sought various statutory accident benefits, including prescription medications, medical and rehabilitation treatment plans, and a worksite assessment, following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the appeal in its entirety, finding that the applicant failed to meet the onus of proving the expenses were reasonable and necessary.

The Tribunal accepted the insurer's uncontested medical evidence that the applicant had reached maximal medical recovery and that the ongoing pain was largely related to a pre-accident condition.

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

The respondent insurer denied a $2,200 treatment plan for a psychological assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit was exhausted.

The applicant argued for removal from the MIG based on pre-existing conditions, chronic pain, and psychological impairment.

The Tribunal found insufficient evidence of a pre-existing condition preventing maximal recovery, no diagnosis of chronic pain, and rejected the psychological impairment claim due to inconsistencies in the applicant's self-reporting.

The application was dismissed as the injuries were deemed predominantly minor.

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

The respondent insurer denied a treatment plan for $1,252.55, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit was exhausted.

The applicant claimed to suffer from chronic pain, which would remove him from the MIG.

The Tribunal found the applicant failed to prove a chronic pain condition, noting a lack of medical evidence linking his complaints to the accident and accepting the insurer's medical examination finding no chronic pain.

The application was dismissed.