Ian Maedel

The applicant sought medical benefits for psychotherapy and driving reintegration sessions, as well as transportation expenses, following a motor vehicle accident.

The respondent partially approved the medical benefits but denied the enhanced hourly rates and two-hour sessions requested, as well as the transportation expenses.

The Tribunal found the applicant failed to provide medical evidence justifying the enhanced rates or longer sessions.

The Tribunal also dismissed the claim for transportation expenses because the applicant failed to establish a causal link between his licence suspension and the accident, and failed to provide the required particulars.

The application was dismissed in its entirety.

The applicant sought to set aside a settlement agreement regarding statutory accident benefits, arguing he lacked mental capacity and was under duress when he signed it.

The Licence Appeal Tribunal found that the applicant failed to rescind the settlement within the two-day cooling period required by O. Reg. 664.

The Tribunal held that the applicant did not establish on a balance of probabilities that he lacked capacity or was under duress at the time of settlement.

The application was dismissed as statute-barred, and the respondent's request for costs was denied.

The applicant brought a motion in writing to add a claim for a special award under s. 10 of O. Reg. 664 to the issues in dispute and to issue a summons for the handling adjuster to testify at the upcoming hearing.

The Tribunal granted the motion, finding that the bar to add a special award is very low and the applicant established a potential basis for the claim.

The Tribunal also ordered the issuance of a summons for the adjuster, noting that her anticipated evidence regarding the continued assessment of the file was relevant to the newly added special award issue.

The applicant sought income replacement benefits (IRB) and medical benefits following a motor vehicle accident.

The Licence Appeal Tribunal found the applicant was not entitled to IRB as she failed to provide medical evidence demonstrating a substantial inability to perform the essential tasks of her employment.

The Tribunal also determined the applicant's injuries fell within the Minor Injury Guideline (MIG), as she provided no medical diagnosis of chronic pain or psychological impairment to remove her from the MIG cap.

Because the $3,500 MIG limit was already exhausted, the disputed treatment plans were not payable.

Finally, the Tribunal awarded $250 in costs to the respondent because the applicant and her counsel failed to attend the teleconference hearing without providing reasonable notice, which constituted bad faith.

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

The insurer determined the injuries fell within the Minor Injury Guideline (MIG) and denied a physiotherapy treatment plan and certain expenses.

The applicant applied to the Licence Appeal Tribunal, arguing her injuries fell outside the MIG due to pre-existing conditions and chronic pain, and sought an award for unreasonable delay.

The Tribunal found the application was not statute-barred but concluded the applicant's injuries were minor and subject to the MIG limit.

The Tribunal dismissed the claims for the treatment plan, expenses, and the section 10 award, finding the insurer did not act unreasonably.

The applicant sought interest on overdue income replacement benefits (IRBs), a rehabilitation benefit for an orthopedic mattress, and a special award following a motor vehicle accident.

The Tribunal found that the applicant was entitled to interest on the IRBs because the respondent conceded the benefits were payable, making them overdue under s. 51 of the Schedule.

The claim for the orthopedic mattress was dismissed as the applicant failed to prove it was reasonable and necessary, with both parties' physiatrists indicating it would not significantly assist with pain management.

The claims for costs and a special award were also dismissed as there was no evidence of bad faith or unreasonable delay by the respondent.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a physiotherapy treatment plan and an orthopaedic assessment.

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

The applicant argued that her injuries were not predominantly minor and that she had a pre-existing condition that would prevent her from achieving maximal recovery within the MIG limit.

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor soft tissue injuries.

The Tribunal also found no compelling evidence of a pre-existing medical condition that would take the applicant outside the MIG.

As funds remained within the MIG limit, the Tribunal dismissed the claims for the treatment plan, assessment, and interest.

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

Less than four weeks before the scheduled hearing, the respondent brought a motion for further productions pursuant to a prior order and for additional productions, including the applicant's employment file, income tax returns, and clinical notes.

The adjudicator dismissed the motion, noting that ordering further productions at this stage would complicate matters and delay the hearing, contrary to the goal of efficient and timely resolution under Rule 3.1(b) of the Licence Appeal Tribunal Rules of Practice and Procedure.

The applicant was injured in a motor vehicle accident and applied for income replacement benefits (IRB).

The parties agreed the applicant was entitled to IRB but disagreed on the quantum, specifically whether short term and long term disability benefits should be deducted from the IRB on a gross or net-of-tax basis.

The Licence Appeal Tribunal held that the definition of 'other income replacement assistance' under the Statutory Accident Benefits Schedule refers to the gross amount of disability benefits.

The Tribunal found that calculating deductions based on net income could lead to double recovery and was contrary to the legislative intent.

The applicant's claim for higher IRB amounts based on net deductions was dismissed.

The applicant, who sustained catastrophic injuries rendering him a tetraplegic in a motor vehicle accident, sought a rehabilitation benefit for the construction of a new home.

The parties agreed that building a new home was more reasonable than renovating the applicant's existing home.

The Tribunal considered section 16(4)(c) of the Statutory Accident Benefits Schedule, which limits the cost of a new home to the notional cost of renovating the existing home.

The Tribunal preferred the applicant's expert evidence regarding the estimated renovation costs and awarded $64,615.00 in addition to the previously approved amount.

The Tribunal also found that, as a status Indian residing on a reserve, the applicant was exempt from paying HST on the construction costs.

The applicant was injured in a motor vehicle accident and sought a medical benefit of $3,809.18 for a physiotherapy treatment plan.

The respondent denied the plan based on an orthopaedic surgeon's assessment concluding no further treatment was required.

The Tribunal admitted an addendum to the respondent's medical report on an unopposed motion.

The Tribunal found the respondent's comprehensive medical evidence more persuasive than the applicant's standalone treatment plan, concluding the applicant failed to prove the treatment was reasonable and necessary.

The application for benefits and interest was dismissed.

The applicant sought payment for several treatment plans and assessments following a motor vehicle accident, which the respondent insurer denied.

The Licence Appeal Tribunal found that the applicant failed to provide sufficient medical evidence to prove the treatment plans were reasonable and necessary.

The Tribunal preferred the evidence of the insurer's assessors, who concluded the physical injuries were minor and had largely resolved, and that there was no objective evidence linking the applicant's psychological issues to chronic physical pain.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits.

The insurer denied the claims on the basis that the injuries fell within the Minor Injury Guideline and requested the applicant attend several insurer examinations.

The applicant failed to attend the examinations, arguing the notices did not provide sufficient medical reasons.

The Tribunal found the notices were sufficient and that the applicant failed to comply with section 44 of the Statutory Accident Benefits Schedule.

Consequently, the application was dismissed pursuant to section 55.

The applicant, who sustained a catastrophic impairment in a motorcycle accident, sought payment for case management services provided by registered social workers at an hourly rate of $150.00.

The respondent insurer reduced the rate to $89.07 per hour, the maximum rate for unregulated providers under the Professional Services Guideline.

The Licence Appeal Tribunal held that the social workers fell within the definition of 'qualified case manager' under section 17(3) of the Statutory Accident Benefits Schedule and were therefore subject to the maximum hourly rate of $89.07 set out in the Guideline.

The applicant's claim for an award under section 10 of Regulation 664 was also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident but failed to participate in the dispute resolution process or attend a scheduled case conference.

The applicant's counsel brought a motion to be removed from the record due to a breakdown in the solicitor-client relationship, and the respondent brought a motion to dismiss the application as abandoned.

The Licence Appeal Tribunal granted both motions, removing counsel from the record and dismissing the application as abandoned pursuant to Rule 3.4 of the Licence Appeal Tribunal Rules of Practice and Procedure.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, which the insurer denied in 2012 and 2013.

The applicant filed an application with the Licence Appeal Tribunal in 2016, more than a year after the two-year limitation period had expired for all disputed benefits.

The Tribunal found that the insurer's denial letters were clear and unequivocal, triggering the limitation period.

The Tribunal declined to extend the limitation period under section 7 of the Licence Appeal Tribunal Act, finding no reasonable grounds to do so given the lengthy delay and lack of action by the applicant to preserve her rights.

The application was dismissed as statute-barred.

The respondent insurer brought a motion to prohibit the applicant from proceeding with an application for statutory accident benefits regarding three treatment plans.

The respondent argued the applicant failed to attend scheduled insurer's examinations under section 44 of the Statutory Accident Benefits Schedule.

The Tribunal found that the requested examinations were reasonably necessary and that the applicant failed to attend them without reasonable explanation.

Consequently, the applicant was found to be in non-compliance with section 44, and pursuant to section 55, was barred from proceeding with the application for the disputed treatment plans.

The respondent's request for costs was denied as there was insufficient evidence of unreasonable or bad faith conduct.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for rehabilitation services.

After the commencement of the hearing, the parties engaged in settlement discussions and resolved all issues in dispute.

The Tribunal closed the file.