Dina Mejalli-Willis

The applicant, a minor, sought accident benefits following a 2022 motor vehicle accident.

The respondent denied several treatment plans and requested an insurer's examination (IE) with a pediatric neurologist after receiving a report linking the applicant's symptoms to the accident.

The applicant failed to attend the scheduled IE, citing travel to India, and did not provide a reasonable explanation or cooperate in rescheduling.

The Tribunal found the IE request was reasonably necessary and timely.

Consequently, the applicant was barred from proceeding with the application under section 55(1)2 of the Schedule, and the application was dismissed.

The applicant sought entitlement to a physiotherapy treatment plan following a motor vehicle accident.

The respondent argued the applicant was statute-barred from proceeding to a hearing for failing to attend a scheduled insurer examination.

The Tribunal found the respondent's notices of examination were non-compliant with section 44(5)(a) of the Schedule, as they lacked specific medical reasons, meaning the applicant was not barred from proceeding.

However, on the substantive issue, the Tribunal dismissed the claim for the treatment plan, finding the applicant's reported injuries and limitations were inconsistent and uncorroborated by the clinical notes and records of his family physician.

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

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

The Tribunal found that the applicant's physical injuries were predominantly minor soft tissue injuries that had largely resolved.

The applicant failed to establish that she suffered from chronic pain with functional impairments or a psychological condition that would warrant removal from the MIG.

As the MIG limits were exhausted, the claims for additional treatment plans, interest, and an award were dismissed.

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

The respondent insurer denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to provide compelling medical evidence to warrant removal from the MIG, as her physical and psychological injuries were predominantly minor.

However, the Tribunal ordered the respondent to pay for four of the disputed treatment plans because the respondent's denial notices failed to comply with the requirements of s. 38(8) of the Schedule, lacking specific medical reasons or details about the applicant's condition.

The remaining treatment plans were denied, and interest was awarded on the overdue benefits.

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

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

The applicant argued that chronic pain and psychological impairments warranted removal from the MIG.

The Tribunal found that the applicant failed to provide compelling objective medical evidence to substantiate his claims, noting inconsistencies between the expert reports and the applicant's daily activities, including his return to full-time work.

The Tribunal concluded the applicant's injuries were predominantly minor, and because the $3,500 MIG limit was exhausted, the disputed treatment plans, award, and interest were denied.