Dawn J. Kershaw

The applicant requested a reconsideration of a case conference order that mandated a four-day in-person hearing, limited each party to four witnesses, and set a surveillance disclosure date.

The applicant argued these orders violated natural justice and procedural fairness, citing cost concerns and the need to call additional expert witnesses.

The Tribunal dismissed the request, finding no evidence that the hearing format was cost-prohibitive or that the witness limit denied procedural fairness.

The surveillance issue was moot as the respondent had no surveillance to disclose.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, as well as post-104 week income replacement benefits (IRB), which the respondent insurer denied.

The Licence Appeal Tribunal found that the applicant likely suffered a concussion and continued to experience dizziness, cognitive impairments, and psychological difficulties.

The Tribunal determined that the proposed treatment plans for occupational therapy, physiotherapy, and speech language therapy were reasonable and necessary, with the exception of a weighted vest.

Furthermore, the Tribunal concluded that the applicant met the test for post-104 week IRB, as her ongoing impairments rendered her completely unable to engage in any employment for which she was reasonably suited.

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

The respondent, a self-employed dump truck driver, was injured in a motor vehicle accident and received income replacement benefits (IRB) from the applicant insurer.

The insurer sought repayment of an alleged overpayment, arguing that collateral disability benefits received by the respondent should have been deducted.

The respondent disputed the deductibility of the collateral benefits and sought ongoing IRB up to the 104-week mark.

The Tribunal found that the collateral benefits were income continuation benefits and therefore deductible, entitling the insurer to repayment subject to the 12-month notice period.

However, the Tribunal also found that the respondent remained substantially unable to perform the essential tasks of his employment and was entitled to ongoing IRB up to the 104-week mark.

The applicant sought payment for a psychological assessment following a motor vehicle accident.

The insurer denied the treatment plan and required an insurer's examination (IE).

The applicant attended the IE but it did not proceed because she wished to record the session.

The insurer refused to pay for the assessment, alleging non-attendance, and brought a preliminary motion to preclude the applicant from proceeding with her Tribunal application.

The Tribunal dismissed the insurer's motion, finding that the insurer's notice of the IE was deficient because it failed to provide sufficient medical and other reasons for the examination as required by the Statutory Accident Benefits Schedule.

The applicant was struck by a reversing car while walking in a parking lot and sought statutory accident benefits.

The respondent denied funding for a psychological assessment and chiropractic services on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) limit of $3,500.

The applicant argued that pre-existing conditions, including shoulder issues and Bell's palsy, prevented maximal recovery within the MIG.

The Tribunal found that the applicant's injuries were minor and that the pre-existing conditions did not prevent maximal recovery.

As the MIG limit was already exhausted, the claims for additional treatment, interest, and a special award were dismissed.

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

The adjudicator found that the applicant's physical and psychological injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 funding limit, as the applicant failed to prove pre-existing conditions or psychological injuries that would exempt him.

Consequently, the disputed treatment plans were denied.

The adjudicator also dismissed the claim for IRB, finding the applicant did not provide sufficient medical evidence to prove a substantial inability to perform the essential tasks of his employment as a taxi driver.

The applicant insurer sought repayment of income replacement benefits paid to the respondent, alleging wilful misrepresentation.

The respondent admitted to submitting a fraudulent fire department accident report because she did not have a legitimate one.

The adjudicator found that the fraudulent report constituted wilful misrepresentation, as the insurer had no proof an accident occurred.

The insurer was entitled to repayment of the benefits under section 52 of the Statutory Accident Benefits Schedule.

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

The disputed benefits included a treatment plan for assistive devices, a treatment plan for physiotherapy and massage, a non-earner benefit, and a special award.

The Tribunal found that the applicant was entitled to the non-earner benefit, as she demonstrated a complete inability to carry on a normal life, having gone from an active, independent lifestyle to being dependent on her grandson and church community.

The Tribunal also approved the assistive devices, except for blind spot mirrors, but denied the treatment plan for physiotherapy and massage, finding it was not reasonable and necessary given the lack of improvement and the recommendation for alternative treatment.

The claim for a special award was dismissed, but interest was awarded on the overdue payments.

The applicant was injured in a motor vehicle accident and sought payment of $3,225.80 for a chiropractic treatment plan.

The insurer denied the claim based on an insurer's examination.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment was reasonable and necessary, noting that neither the insurer's orthopaedic surgeon nor the applicant's own orthopaedic assessor supported the recommended manipulation and exercise.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought payment for an orthopaedic assessment under the Statutory Accident Benefits Schedule.

The respondent denied the treatment plan based on an insurer's examination which concluded the injuries were mild and temporary.

The Tribunal found the assessment was reasonable and necessary given the chronic nature of the applicant's pain and the need to rule out orthopaedic causes.

The respondent was ordered to pay for the assessment.

The applicant sought statutory accident benefits five and a half years after a motor vehicle accident.

The insurer denied the claims and argued the application was time-barred.

The Tribunal held the applicant was not barred from proceeding because the insurer failed to advise her that she could be permanently disentitled if she did not provide a reasonable explanation for the delay.

The Tribunal also found the insurer failed to provide notice within 10 days that it was relying on the Minor Injury Guideline (MIG), meaning it could not rely on the MIG limit and had to pay for physiotherapy incurred during the default period.

However, the Tribunal dismissed the claims for psychological services and prescription medication, finding the applicant failed to prove they were reasonable and necessary or temporally connected to the accident.