Dominique Setton

The applicant sought accident benefits following a motor vehicle accident, claiming removal from the Minor Injury Guideline (MIG) due to physical injuries, a psychological impairment, and chronic pain.

The adjudicator found insufficient evidence to support removal from the MIG, preferring the respondent's psychological assessment over the applicant's because it was based on clinical testing and medical records rather than solely self-reported data.

The applicant also failed to establish a functional impairment from chronic pain.

The application for a psychological assessment, interest, and a section 10 award was dismissed.

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

The respondent denied several treatment plans for physiotherapy and a psychological assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The Tribunal found that the applicant failed to provide objective medical evidence to prove his injuries fell outside the MIG or that a pre-existing condition precluded his recovery within the MIG.

As the MIG applied and the limits were exhausted, the treatment plans were not payable.

Claims for interest and a special award were also dismissed.

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 applicant argued she should be removed from the MIG due to psychological impairments and chronic pain with functional limitations.

The Tribunal found that the applicant's ongoing complaints were largely attributable to a prior 2015 accident and that she failed to establish a causal link between the current accident and her chronic pain or psychological issues.

The Tribunal concluded the applicant's injuries were predominantly minor, dismissing the claims for treatment plans, medical expenses, interest, and an award.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries warranted removal from the Minor Injury Guideline (MIG) due to a pre-existing condition, chronic pain, and a psychological condition.

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

Furthermore, the Tribunal gave little weight to the applicant's psychological assessment and found no evidence of chronic pain with functional impairment.

As the injuries were predominantly minor, the applicant was subject to the MIG limit, and the application for additional treatment plans and interest was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG due to chronic pain and a pre-existing temporomandibular joint (TMJ) disorder.

The Tribunal found that the applicant failed to provide compelling medical evidence that her TMJ precluded recovery within the MIG.

Furthermore, the Tribunal rejected the chronic pain argument, noting that the applicant's reported daily activities, such as gardening and painting her house, were inconsistent with chronic pain causing functional impairment.

As the MIG limit was already exhausted, the claim for a $850 physiotherapy treatment plan was dismissed, along with claims for interest and an award.

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 applicant claimed chronic pain and a psychological condition warranted removal from the MIG.

The Tribunal found the applicant's injuries were predominantly minor, noting his return to physically demanding work and lack of a chronic pain or psychological diagnosis.

The treatment plans for chronic pain and psychological assessments were denied as the applicant was held to the MIG funding limit.

The applicant sought entitlement to statutory accident benefits for various treatment plans, including chiropractic services, a biopsychosocial assessment, a driving evaluation, and a chronic pain assessment, following a motor vehicle accident.

The respondent denied the benefits on the basis that the applicant had reached maximum medical recovery and that her ongoing complaints were related to subsequent, non-accident incidents.

The Licence Appeal Tribunal found that the applicant failed to provide objective medical evidence to demonstrate that the proposed treatment plans were reasonable and necessary as a result of the accident.

The application was dismissed, and no interest was awarded.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit, a physiotherapy treatment plan, interest, and an award for unreasonable delay.

The adjudicator found that the applicant failed to demonstrate a complete inability to carry on a normal life, as medical assessments indicated he remained independent in his daily activities, including driving, working, and exercising.

Furthermore, the applicant did not prove the physiotherapy treatment plan was reasonable and necessary, as his own treating surgeon recommended exercise rather than physiotherapy.

The application was dismissed in its entirety.

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) and the $3,500 limit had been exhausted.

The applicant argued for removal from the MIG due to a concussion, pre-existing conditions, and psychological impairments.

The Tribunal found insufficient evidence of a concussion or pre-existing conditions precluding recovery.

Relying on the respondent's section 44 psychological assessment over the applicant's psychological report, the Tribunal concluded the applicant suffered only minor injuries.

The application for the disputed treatment plans, interest, and an award for unreasonable delay was dismissed.

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

The insurer partially approved treatment plans for psychological services but reduced the hourly rate for a psychotherapist from the psychologist rate to a lower rate.

The applicant also sought approval for a naturopath examination.

The Tribunal found that the insurer correctly applied the Professional Services Guideline in determining the hourly rate for the psychotherapist, as psychotherapists are not listed in the Guideline and the insurer's approved rate was reasonable.

The Tribunal also found the naturopath examination was not reasonable and necessary, preferring the insurer's examination report.

The application was dismissed.

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 applicant argued for removal from the MIG due to a pre-existing condition and a psychological impairment.

The Tribunal found that the applicant's injuries were predominantly minor soft tissue injuries and that she failed to provide compelling medical evidence of a pre-existing condition or psychological impairment warranting removal from the MIG.

Consequently, the disputed treatment plan for chiropractic services was deemed not reasonable and necessary, and claims for an award and interest were dismissed.

The applicant sought accident benefits following a motor vehicle accident, arguing his injuries warranted removal from the Minor Injury Guideline (MIG) due to a pre-existing torn meniscus, chronic pain, and psychological impairments.

The Licence Appeal Tribunal found the applicant failed to provide compelling medical evidence that his pre-existing knee injury was exacerbated by the accident or prevented his maximal medical recovery within the MIG.

The Tribunal also found insufficient evidence of chronic pain or psychological impairment.

As the MIG limits were exhausted, the claim for an orthopaedic assessment and an award for unreasonable delay were dismissed.