Deborah Neilson

The applicant sought various statutory accident benefits following a motor vehicle accident, arguing that the respondent insurer failed to properly deny the treatment plans and was therefore liable to pay for them.

The Tribunal found that the respondent failed to provide proper medical reasons for denying the claims for chiropractic services, physiotherapy and massage therapy, and a chronic pain assessment, rendering it liable for expenses incurred under those plans during the periods of non-compliance.

The claims for attendant care benefits, assistive devices, a concussion assessment, and a neurological assessment were dismissed as the applicant failed to prove they were reasonable and necessary or the respondent had provided proper denials.

The applicant sought statutory accident benefits after suffering lower limb paraplegia following a car ride where the driver engaged in aggressive driving to avoid a group of motorcyclists.

The applicant argued the stress of the incident caused a blood pressure spike that ruptured a spinal aneurysm.

The Tribunal found that the applicant was not involved in an 'accident' under s. 3(1) of the Schedule.

Preferring the respondent's medical evidence, the Tribunal concluded that the applicant's congenital spinal arteriovenous malformation (AVM) likely ruptured spontaneously, making the AVM the dominant feature and 'but for' cause of the impairment, with the vehicle merely being the location of the injury.

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

The respondent denied the claims for physiotherapy and massage therapy on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's concussion diagnosis took him out of the MIG.

Furthermore, the Tribunal held that the respondent failed to provide proper medical reasons for denying the treatment plans under s. 38(8) of the Schedule.

As a result, the respondent was ordered to pay for the incurred expenses from the 11th business day after receiving the plans until a proper denial is provided, excluding a period of non-compliance with a s. 33 request.

The claims for the treatment plans being reasonable and necessary on their merits were dismissed, as was the claim for a special award.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits, treatment plans, and various assessments.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that she was barred from claiming non-earner benefits for failing to attend an insurer's examination.

The Tribunal found the respondent failed to prove the applicant missed the examination, allowing the non-earner benefits claim to proceed.

However, the Tribunal concluded the applicant's injuries were minor and resolved shortly after the accident, dismissing her claims for non-earner benefits, chronic pain, and catastrophic impairment assessments.

The Tribunal awarded a maximum of $400 for a psychological assessment under the MIG's supplementary goods and services provision.

The applicant, a Chinese tourist, was involved in a single-vehicle bus accident in Ontario and sought statutory accident benefits, claiming she sustained a catastrophic impairment including a traumatic brain injury and severe psychological impairments.

The respondent denied the benefits, arguing her ongoing impairments were related to pre-existing conditions and post-accident falls in China.

The Licence Appeal Tribunal found that the applicant failed to prove she sustained a traumatic brain injury in the accident, attributing her cognitive and physical decline to a probable cerebrovascular event and subsequent falls.

The Tribunal dismissed the claims for catastrophic impairment, non-earner benefits, and most medical and rehabilitation benefits.

However, the Tribunal awarded CN ¥159,705 yuan for incurred attendant care services and CN ¥612.32 yuan for specific prescription medications, finding the respondent had sufficient information to adjust those claims and the applicant had proven they were incurred.

The applicant requested a reconsideration of a decision that dismissed her claims for catastrophic impairment and other benefits following a motor vehicle accident.

She argued the adjudicator made errors of law and fact and violated procedural fairness by misapprehending medical evidence and disregarding witness testimony.

The adjudicator dismissed the request, finding that while one minor factual omission occurred regarding the cause of the applicant's mobility issues, it would not have changed the outcome.

The adjudicator concluded that the original findings regarding the applicant's pre-existing conditions, credibility, and lack of accident-related impairments were supported by the evidence.

The applicant was injured in a 2018 motor vehicle accident and sought ongoing income replacement benefits (IRBs) beyond the 104-week mark, along with medical benefits, an award, and costs.

The respondent denied the IRBs, arguing the applicant could work part-time in alternative roles.

The Tribunal found that the applicant met the post-104 week test for IRBs because the alternative employment proposed by the respondent offered significantly less income and status than her pre-accident work, and her psychological impairments limited her to working only 6 to 10 hours per week.

However, the Tribunal dismissed the claims for metabolic testing, neuromonitoring, and physiotherapy due to insufficient evidence regarding their necessity and reasonable costs.

The claims for a special award and costs were also dismissed.

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

The respondent raised a preliminary issue that the applicant was barred from proceeding with his claims for non-earner benefits and a chronic pain assessment because he failed to attend multiple insurer's examinations (IEs).

The Tribunal found that the applicant failed to attend the scheduled IEs without a reasonable excuse and that the respondent was prejudiced by the non-attendance.

The Tribunal declined to exercise its discretion to allow the hearing to proceed.

The applicant's claims were barred, and he withdrew the remaining issues, resulting in the closure of the file.

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), subject to a $3,500 limit.

The applicant argued she should be removed from the MIG due to pre-existing conditions, psychological impairments, and chronic pain.

The Tribunal found the applicant failed to provide compelling evidence that her pre-existing conditions prevented maximal recovery within the MIG.

Furthermore, the Tribunal gave little weight to the applicant's expert reports regarding psychological impairments and chronic pain, finding them inconsistent with other medical evidence and lacking in establishing causation.

As the $3,500 MIG limit was exhausted, all claims for treatment, assessments, and an award were dismissed.

The minor applicant, who suffered a catastrophic impairment in a motor vehicle accident, sought non-earner benefits (NEBs).

The insurer denied the claim, arguing NEBs are not payable until the applicant turns 18, and since he would not turn 18 within 104 weeks of the accident, he would never be entitled.

The insurer also argued the Tribunal lacked jurisdiction to order future payments.

The Tribunal held it had jurisdiction to determine entitlement because the insurer had issued a denial.

Interpreting the Schedule harmoniously, the Tribunal found the applicant was entitled to NEBs for the 104-week period following the accident, with payment deferred until he reaches 18 years of age.

An order was also granted to anonymize the minor applicant's identity.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to non-earner benefits, physiotherapy, and psychological and chronic pain assessments.

The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit was exhausted.

The Tribunal found that the applicant failed to prove she sustained a concussion, psychological impairment, or chronic pain caused by the accident that would remove her from the MIG, noting significant reliability issues with her self-reporting to medical experts.

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 application was dismissed in its entirety.

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

The respondent denied medical and rehabilitation benefits, arguing the injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant sustained a psychological impairment (Adjustment Disorder) that removed him from the MIG.

The Tribunal awarded the costs of a psychological assessment, psychological treatment, and physiotherapy.

The applicant was also awarded income replacement benefits for a limited period, the cost of an accountant's report to calculate self-employment income, and interest.

The claim for a special award under s. 10 of Regulation 664 was dismissed as the insurer's conduct was not unreasonable.

The applicant sought payment for several treatment plans and a special award under Reg. 664, alleging the respondent unreasonably delayed determining her catastrophic impairment status and failed to accommodate her disabilities under the Human Rights Code during the insurer's examination (IE) process.

The Tribunal found that the respondent did not unreasonably delay the payment of benefits, noting that the delays in scheduling IEs were largely attributable to the applicant and her counsel's refusal to attend and objections to the assessment process.

The Tribunal also found no violation of the Human Rights Code, as the respondent attempted to accommodate the applicant by reducing the number of required IEs.

The claims were dismissed in their entirety.

The applicant was injured in a pedestrian knockdown accident and sought statutory accident benefits.

The respondent paid income replacement benefits (IRBs) initially but later terminated them after the applicant failed to attend multiple insurer's examinations (IEs).

The applicant eventually attended a psychiatric IE, after which the respondent reinstated IRBs and accepted she was catastrophically impaired, but refused to pay IRBs for the period of non-attendance.

The applicant sought payment of the withheld IRBs and a special award under s. 10 of Reg. 664, alleging the respondent unreasonably delayed payment, failed to accommodate her disabilities under the Human Rights Code, and improperly scheduled the IEs.

The Tribunal dismissed the application, finding the respondent provided proper notice, scheduled reasonably necessary IEs, and did not violate the Human Rights Code.

The Tribunal concluded the applicant failed to attend the IEs without a reasonable excuse, and the respondent did not unreasonably delay or withhold benefits.

The applicant, who sustained a catastrophic impairment in a motor vehicle accident, sought attendant care benefits (ACB) of $4,339.71 per month and assistive devices.

The respondent insurer had reduced her ACB to $1,040.10 per month.

The Tribunal found that the applicant's claim was not statute-barred because the insurer failed to provide proper medical reasons for its refusal, meaning the limitation period had not commenced.

On the merits, the Tribunal accepted the applicant's need for daytime cueing and mobility assistance but rejected the need for nighttime supervisory care, awarding ACB at $1,630.72 per month.

The Tribunal declined to deem the expenses incurred, as the insurer had paid all submitted invoices and did not unreasonably delay payment.

Claims for assistive baby devices and a special award under Regulation 664 were dismissed.

The applicant sought statutory accident benefits following a 2013 motor vehicle accident, claiming she sustained a catastrophic impairment due to chronic pain syndrome and psychological impairments.

The respondent denied further non-earner benefits, massage therapy, and the catastrophic impairment designation.

The Tribunal found the applicant to be an unreliable historian whose evidence was riddled with inconsistencies regarding her pre-accident health and post-accident functioning.

The Tribunal preferred the respondent's expert evidence, concluding that the applicant's current physical and psychological impairments were caused by pre-existing conditions and other life stressors, not the accident.

Consequently, the applicant failed to prove she sustained a catastrophic impairment or was entitled to the claimed benefits, special award, or interest.

The application was dismissed.

The applicant sought reconsideration of a decision finding he did not sustain a catastrophic impairment from a 2006 automobile accident.

The applicant argued the Tribunal erred in law by mischaracterizing evidence, failing to give sufficient weight to his testimony, and violating procedural fairness by relying on hearsay medical records over live testimony.

The adjudicator dismissed the request, finding the Tribunal properly weighed contemporaneous documentary evidence over unreliable testimony and that the applicant's procedural fairness rights were not violated as he had the opportunity to test the hearsay evidence but chose not to.

The applicant sought reconsideration of a Licence Appeal Tribunal decision that dismissed her claims for income replacement benefits (IRBs) and other benefits following a motor vehicle accident.

The applicant argued the Tribunal erred in its IRB calculations, improperly allowed the deduction of Employment Insurance benefits, failed to dismiss the respondent's repayment claim, and exhibited racial bias during the hearing.

The adjudicator dismissed the reconsideration request, finding no errors of law or fact that would change the outcome.

The adjudicator held that the applicant failed to meet her burden of proving entitlement to a higher IRB quantum, the Tribunal correctly applied binding precedent regarding EI deductions, and there was no reasonable apprehension of bias.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to treatment plans for chiropractic services, a psychological assessment, and a chronic pain assessment.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the policy limits were exhausted.

The Tribunal found that the applicant failed to prove her chronic pain and psychological impairments were accident-related or severe enough to warrant removal from the MIG.

As the MIG limits were exhausted, the claims for treatment plans, a section 10 award, and interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including chiropractic treatment, a psychological assessment, a chronic pain assessment, a special award, and interest.

The adjudicator found no jurisdiction over the chiropractic treatment plans as they had already been approved by the respondent and the dispute arose from improper invoicing.

The claim for the remaining cost of a psychological assessment was dismissed because the applicant failed to prove that fees exceeding the guideline rate were reasonable.

However, the adjudicator granted the cost of a chronic pain assessment, finding it necessary to explore the applicant's pain complaints and rejecting the respondent's medical examination report.

The claim for a special award for unreasonable delay was dismissed, but interest was awarded on the approved chronic pain assessment.