Christopher A. Ferguson

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits, attendant care benefits, and various medical benefits.

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

The Tribunal found that the applicant failed to establish entitlement to income replacement benefits, as he returned to work full-time and his business suffered no economic loss.

Furthermore, the Tribunal concluded that the applicant's physical injuries were predominantly minor and that he failed to prove on a balance of probabilities that he suffered from psychological impairments, chronic pain syndrome, or post-concussion syndrome that would remove him from the MIG.

Consequently, the application for benefits was denied.

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

The insurer denied the claims, and the applicant appealed to the Licence Appeal Tribunal.

The Tribunal found that the applicant failed to comply with the prescribed timelines for submitting her income replacement benefit claim and was therefore barred from appealing its denial.

However, the Tribunal ordered the insurer to pay the costs of two medical assessment plans because the insurer failed to provide the required notice of refusal within 10 business days under section 38(8) of the Schedule.

The applicant's request for an award for unreasonable delay was denied.

The applicant sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Licence Appeal Tribunal dismissed claims for amounts exceeding approved treatment plans and for services not covered by the Professional Service Guideline.

Claims for occupational therapy oversight of a fitness trainer and ongoing massage therapy were also dismissed as redundant or unnecessary, given the applicant had reached maximum medical improvement.

However, the Tribunal allowed the claim for a situational occupational therapy catastrophic impairment assessment, finding it distinct from an in-home assessment and necessary for a complete evaluation.

The applicant was injured in two motor vehicle accidents and sought non-earner benefits for both.

The insurer moved to bar the appeals, arguing they were filed beyond the two-year limitation period under s. 56 of the Statutory Accident Benefits Schedule.

The Tribunal found that the appeal for the first accident was statute-barred as the denial notice was clear and unequivocal.

However, the appeal for the second accident was allowed to proceed because the insurer issued multiple, confusing denial notices with changing reasons, which misled the applicant regarding the limitation period.

The applicant's request for costs was denied.

The applicant, an elderly pedestrian who was struck by a motor vehicle in a parking lot, applied for statutory accident benefits including non-earner benefits, attendant care benefits, and medical/rehabilitation benefits.

The adjudicator dismissed the application in its entirety.

The adjudicator found that the applicant failed to prove she suffered a complete inability to carry on a normal life, noting inconsistencies in her self-reporting and relying on insurer's examinations that found no objective impairment preventing her pre-accident activities.

Claims for attendant care and medical benefits were similarly dismissed due to a lack of persuasive medical evidence and inconsistencies in the applicant's submitted treatment plans.

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

The Licence Appeal Tribunal found that the applicant's injuries fell within the Minor Injury Guideline (MIG) and that she failed to prove any pre-existing conditions that would warrant removal from the MIG.

The Tribunal dismissed the applicant's claims for an in-home assessment, non-earner benefits, interest, and an award under Regulation 664, finding insufficient evidence to support her claims.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming $677.93 for the outstanding cost of a psychological assessment plan.

The respondent had partially approved the plan but disputed the remaining cost.

The applicant argued the respondent was statute-barred from denying the claim due to late notice under s. 38(8) of the Schedule.

The Tribunal found the applicant incurred the cost after receiving the denial notice, meaning s. 38(11)2 did not apply.

On the merits, the Tribunal preferred the evidence of the respondent's expert and found the applicant failed to prove the additional cost was reasonable and necessary.

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

The applicant sought statutory accident benefits, including non-earner benefits, medical benefits for psychological services, chronic pain treatment, physiotherapy, and assessments, following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove her entitlement to the benefits.

The Tribunal gave substantial weight to the respondent's insurer's examination reports, noting that the applicant's self-reporting to her own experts was inconsistent with her statements to the respondent's assessors, undermining her claims of complete inability to carry on a normal life, psychological impairment, and chronic pain syndrome.

The applicant's requests for interest and a special award were also denied.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically a medical benefit of $4,652.42 for physiotherapy.

The respondent denied the claim on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 limit.

The Licence Appeal Tribunal found that the applicant's physical injuries were predominantly minor strains and sprains.

The Tribunal also found no compelling evidence of a pre-existing condition that would remove the applicant from the MIG.

Consequently, the claim for the physiotherapy treatment plan was dismissed, and no interest was payable.

The applicant sought to enforce an alleged oral settlement of $12,500 for statutory accident benefits.

The respondent denied making the offer and argued that no binding settlement was concluded because no Settlement Disclosure Notice (SDN) was provided.

The Licence Appeal Tribunal found that under section 9.1 of Regulation 664, an SDN is a mandatory prerequisite to forming a binding settlement agreement.

Since no SDN was provided, no binding settlement was reached.

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

The applicant sought statutory accident benefits following a motor vehicle accident, including costs for a physiatry assessment, an occupational therapy assessment, acupuncture, and pharmacotherapy.

The respondent denied the claims based on insurer's examinations concluding the applicant suffered only from minor physical injuries.

The Tribunal found the applicant's medical evidence, which diagnosed concussion, post-concussive disorder, and chronic pain, outweighed the respondent's evidence.

The Tribunal ordered the respondent to pay the disputed benefits and interest.

However, the Tribunal dismissed the applicant's claim for a special award, finding the respondent had reasonable grounds to doubt the claims based on its own specialist reports.

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

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

The Tribunal found that the applicant's physical injuries were predominantly minor and that he failed to provide compelling evidence of a pre-existing condition that would preclude maximal recovery within the MIG limits.

The Tribunal also preferred the evidence of the respondent's psychological expert, finding that the applicant did not suffer from a psychological impairment that would remove him from the MIG.

As the applicant's injuries were confined to the MIG, the disputed benefits exceeding the $3,500 cap were denied.

The applicant sought payment for a $2,000 chronic pain assessment following a motor vehicle accident.

The respondent denied the claim, arguing the applicant's injuries fell within the Minor Injury Guideline.

The applicant challenged the sufficiency of the respondent's denial notices under s. 38 of the Statutory Accident Benefits Schedule.

The Tribunal found that the respondent's explanations of benefits complied with s. 38.

On the merits, the Tribunal held that the applicant failed to prove the chronic pain assessment was reasonable and necessary, noting evidence of steady improvement, return to pre-accident activities, and failure to pursue approved treatments.

The application was dismissed, with no interest or costs awarded.

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

The central issue was whether the applicant's injuries fell within the Minor Injury Guideline (MIG), which caps treatment at $3,500.

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

The Tribunal found that the applicant failed to provide compelling medical evidence from appropriately qualified practitioners to substantiate these claims, preferring the respondent's psychiatric and physiatry evidence.

The Tribunal also excluded the applicant's late challenge to the respondent's expert reports due to non-compliance with the Tribunal's rules on notice.

The application was dismissed, and the claimed medical benefits and assessment costs were denied.

The applicant sought statutory accident benefits for psychological and physiotherapy services following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application.

The Tribunal found the applicant's evidence for psychological services unreliable due to unexplained contradictions in his self-reporting between his own expert and the insurer's examiner.

The claim for physiotherapy services was dismissed because the applicant failed to submit the disputed treatment plan.

The applicant's request for costs was also denied as it lacked supporting evidence or argument.

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

The insurer argued the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered a concussion and post-concussion syndrome, removing the claims from the MIG.

However, the Tribunal dismissed the applicant's claims for a chronic pain assessment and an in-home assessment, finding the applicant failed to prove they were reasonable and necessary.

Claims for interest and a special award were also dismissed.

The applicant sought a medical benefit of $2,000 for psychological services following a motor vehicle accident.

The Tribunal dismissed the claim, finding that the applicant's self-reporting to her own experts was inconsistent with her statements during the insurer's examination.

The Tribunal preferred the evidence of the insurer's expert, who concluded that the applicant did not suffer from a psychological impairment requiring formal services.

The applicant's request for costs was also denied as it was unsupported by evidence or argument.

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

The central issue was whether the applicant's injuries fell within the Minor Injury Guideline (MIG), which caps benefits at $3,500.

The applicant argued that psychological impairments and chronic pain syndrome removed him from the MIG.

The Tribunal found that the applicant failed to prove a psychological injury, preferring the insurer's psychological assessment over the applicant's due to inconsistencies in the applicant's self-reporting.

While the Tribunal accepted that the applicant suffered from chronic pain syndrome, it concluded that the chronic pain symptoms were clinically associated sequelae to his minor soft-tissue injuries, and therefore fell within the MIG definition.

Consequently, the applicant's claims for various treatment and assessment plans were denied as the $3,500 limit applied.

The applicant, who was 9 years old at the time of the motor vehicle accident, sought statutory accident benefits for social worker support, an in-home occupational therapy assessment, and travel costs for a service provider.

The Licence Appeal Tribunal dismissed the claims, finding that the social worker support duplicated an already approved psychological treatment plan, and the in-home assessment was not reasonable and necessary given the applicant's functional independence.

The Tribunal also held that the Statutory Accident Benefits Schedule does not mandate insurers to pay for the travel expenses of service providers.

The applicant, who was injured in a motor vehicle accident, sought statutory accident benefits for social worker support, an in-home occupational therapy assessment, and travel costs for a service provider.

The Licence Appeal Tribunal found that the social worker support duplicated an already approved psychological treatment plan and was therefore not reasonable and necessary.

The Tribunal also found the in-home assessment was not reasonable and necessary based on independent medical examinations.

Finally, the Tribunal held that the Statutory Accident Benefits Schedule does not require insurers to pay travel costs for service providers.

The application was dismissed.