Harouna Saley Sidibé

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

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

The applicant argued for removal from the MIG due to chronic pain, a pre-existing rotoscoliosis condition, concussion symptoms, and psychological impairment.

The Tribunal found that the applicant failed to provide compelling medical evidence to establish any of these conditions warranted removal from the MIG.

As the applicant remained within the MIG, the disputed treatment plans were not assessed, and the application was dismissed.

The applicant sought entitlement to various treatment and assessment plans following a motor vehicle accident, as well as an award for unreasonable delay.

The Tribunal found the applicant entitled to psychological services, a neurological assessment, a biopsychosocial assessment, an ENT assessment, and a sleep quality assessment, largely due to the insurer's failure to provide compliant medical reasons for denial under s. 38(8) of the Schedule.

However, the Tribunal denied the claims for chiropractic services, finding them not reasonable and necessary based on the medical evidence and the insurer's orthopaedic assessment.

The request for a special award under s. 10 of Regulation 664 was dismissed, as the insurer's conduct did not rise to the level of unreasonable behaviour.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries fell outside the Minor Injury Guideline (MIG) due to a pre-existing back condition and accident-related chronic pain.

The Tribunal found the applicant established a pre-existing condition but failed to provide compelling medical evidence that it precluded his recovery within the MIG.

The Tribunal also found the applicant failed to establish on a balance of probabilities that his chronic pain was caused by the accident, noting inconsistencies in the clinical records and a lack of clear medical attribution.

As the applicant's injuries were deemed predominantly minor, the disputed treatment plans were not assessed, and claims for an award and interest were dismissed.

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

The Tribunal found the applicant entitled to outstanding amounts for psychological and psychotherapy services, accepting that a registered psychotherapist could reasonably bill at a rate comparable to a psychologist when providing structured cognitive behavioural therapy under clinical supervision.

The Tribunal also approved a chiropractic treatment plan and assessments for neurology and chronic pain, finding them reasonable and necessary based on ongoing symptoms.

However, a comprehensive chronic pain program was denied due to insufficient evidence of severity and functional decline.

The applicant's claim for a special award was dismissed.

The applicant sought statutory accident benefits following a May 2020 motor vehicle accident.

The respondent denied treatment plans for chiropractic, psychological, and psychiatric services on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to establish that she suffered from accident-related chronic pain with functional impairment or a psychological condition that would warrant removal from the MIG, noting a subsequent accident in June 2024 complicated causation.

The Tribunal also found the respondent's denial letters complied with section 38(8) of the Schedule.

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 based on a pre-existing chronic back condition and a psychological impairment.

The Tribunal found that the applicant failed to provide compelling medical evidence that his pre-existing back condition would prevent maximal recovery under the MIG.

Furthermore, the psychological evidence was insufficient to establish an impairment warranting removal.

As the applicant remained subject to the MIG, the disputed treatment plans and claim for interest were dismissed.

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

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

The Tribunal found that the applicant's soft-tissue injuries were predominantly minor and that he failed to establish that pre-existing conditions or accident-related chronic pain warranted removal from the MIG.

The Tribunal also dismissed the claim for a non-earner benefit, finding the applicant had resumed substantially all of his pre-accident activities.

As the MIG limits were exhausted, the disputed treatment plans and claims for interest were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing her placement in the Minor Injury Guideline (MIG) and claiming entitlement to income replacement benefits (IRBs), attendant care benefits (ACBs), and specific treatment plans.

The Tribunal found that the applicant's injuries were predominantly minor, rejecting claims of an accident-related concussion and chronic pain syndrome due to a lack of contemporaneous and consistent medical evidence.

The Tribunal also dismissed the claims for IRBs and ACBs, finding the applicant did not demonstrate a substantial inability to perform her pre-accident employment tasks or a functional need for attendant care.

The application was dismissed in its entirety.

The applicant requested reconsideration of a Licence Appeal Tribunal decision that denied certain physiotherapy and chiropractic treatment plans following a motor vehicle accident.

The applicant argued that his post-hearing decision to undergo shoulder surgery constituted new evidence that would have affected the outcome.

The Tribunal found that while the decision to have surgery was new evidence, it would not have changed the original decision.

The original denial was based on the lack of clinical justification for extended passive treatment and a factual finding that the applicant did not sustain a concussion, neither of which were altered by the subsequent surgery.

The request for reconsideration was dismissed.

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

The respondent denied benefits 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 sustained predominantly soft-tissue injuries and failed to establish chronic pain with functional impairment or a psychological condition sufficient to remove him from the MIG.

The application for disputed treatment plans and interest was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit, various treatment plans, and removal from the Minor Injury Guideline (MIG) due to chronic pain and pre-existing conditions.

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor and that he failed to establish chronic pain with functional impairment or a pre-existing condition that would preclude recovery within the MIG.

The Tribunal also dismissed the claim for a non-earner benefit, finding the applicant did not suffer a complete inability to carry on a normal life.

Claims for an award and interest were dismissed as the insurer's handling of the file was reasonable.

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

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

As a preliminary issue, the Tribunal exercised its discretion under s. 55(2) of the Schedule to allow the applicant to proceed with a claim for a psychological assessment despite her failure to attend scheduled insurer's examinations.

On the substantive issues, the Tribunal found that the applicant failed to establish chronic pain with functional impairment or a psychological condition sufficient to remove her from the MIG.

Consequently, the applicant was not entitled to the disputed treatment plans, interest, or an award under s. 10 of Reg. 664.

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 her injuries fell outside the MIG due to chronic pain and psychological impairments.

The Tribunal found that the applicant failed to establish chronic pain with functional impairment or a diagnosed psychological impairment that would warrant removal from the MIG.

The Tribunal preferred the respondent's medical evidence over the applicant's chiropractor's disability certificate.

As the applicant remained within the MIG, the disputed treatment plans beyond the $3,500 limit were not payable.

Claims for an award and interest were also dismissed.

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

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal found the applicant did not meet the test for a complete inability to carry on a normal life, preferring the respondent's section 44 assessments which attributed her functional decline to pre-existing conditions and age rather than the accident.

Furthermore, the Tribunal held that the applicant's claims for attendant care and treatment plans were barred because the non-catastrophic policy limit of $65,000 had been fully exhausted and there was no catastrophic impairment designation.

Claims for interest and a special award were also dismissed.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that found the applicant's injuries fell outside the Minor Injury Guideline and awarded treatment plans.

The respondent argued the Tribunal made a material error of fact by failing to consider its written submissions, which were uploaded but lost due to a technical portal error.

The adjudicator granted the reconsideration request, acknowledging the factual error.

However, upon reviewing the respondent's submissions, the adjudicator found they did not provide sufficient medical evidence to contradict the applicant's diagnoses of PTSD and depression.

The original decision was confirmed.

The applicant was injured in a motor vehicle accident and sought payment for various treatment and assessment plans, including psychological services, chiropractic services, assistive devices, an EMG assessment, and a dietary assessment.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the plans were reasonable and necessary.

The Tribunal noted issues with duplicative treatments, lack of medical evidence supporting the necessity of the plans, and non-compliance with the Professional Services Guideline.

Claims for interest and a section 10 award were also dismissed.

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

The insurer raised a preliminary issue that the applicant was barred from proceeding because he failed to notify the insurer of the accident within seven days and failed to submit the application for benefits (OCF-1) within 30 days, as required by section 32 of the Schedule.

The Tribunal found that the applicant delayed notifying the insurer for approximately 9.5 months and failed to provide a credible or reasonable explanation for the delay under section 34.

The applicant's explanation of mild symptoms and language barriers was not supported by medical records or other objective evidence.

The application was dismissed.

The insurer applied for repayment of $10,571.43 in income replacement benefits (IRBs) paid to the insured person, while the insured person sought entitlement to various treatment plans and an award for unreasonable delay.

The Tribunal found that the insurer provided a valid and timely repayment notice and was entitled to the full repayment amount, as the insured person had returned to work earning her pre-accident wages and failed to comply with section 33 requests for income information.

The Tribunal denied the insured person's claims for physiotherapy and medication, finding insufficient evidence of reasonableness and necessity, but approved a neurology assessment plan based on persistent post-concussion symptoms.

Claims for an award and costs were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit, disputed treatment plans, and removal from the Minor Injury Guideline (MIG) due to pre-existing conditions and psychological impairments.

The Licence Appeal Tribunal found that the applicant failed to provide compelling medical evidence that her pre-existing conditions or psychological symptoms precluded recovery within the MIG.

The Tribunal also dismissed the claim for a non-earner benefit, finding the evidence insufficient to establish a complete inability to carry on a normal life compared to her pre-accident baseline.

Claims for an award and interest were also dismissed.

The applicant sought a special award and interest after withdrawing substantive claims for statutory accident benefits following a motor vehicle accident.

The Tribunal found that because the substantive claims for attendant care benefits were withdrawn and the applicant failed to prove the expenses were incurred, there was no basis to conclude the insurer unreasonably withheld or delayed payment.

The application for an award and interest was dismissed.