Janet Rowsell

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

The respondent insurer denied the benefits, arguing the applicant's impairments were pre-existing and not caused or exacerbated by the accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to meet the "but for" test for causation.

The Tribunal relied on extensive pre-accident medical records and independent medical examinations demonstrating the applicant had a significant history of chronic pain, substance abuse, and psychological impairments that were unaffected by the accident.

Claims for an award for unreasonable delay and interest were also dismissed.

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) and the funding limits had been exhausted.

The applicant argued that pre-existing psychological and physical conditions, as well as chronic pain, warranted removal from the MIG.

The Tribunal found insufficient evidence that the pre-existing conditions prevented maximal medical recovery within the MIG limits, noting the applicant's functionality improved post-accident and diagnostic tests showed no significant injuries.

The application was dismissed, and claims for treatment plans, interest, and a special award were denied.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident.

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

The applicant argued she suffered from pre-existing conditions and chronic pain syndrome that warranted removal from the MIG.

The Tribunal found insufficient evidence of pre-existing physical or psychological conditions preventing maximal recovery, and no evidence satisfying the AMA Guides criteria for chronic pain.

As the remaining MIG funding was insufficient to cover the disputed treatment plans, the claims were dismissed.

Claims for an award and interest were also dismissed.

The applicant sought various statutory accident benefits following a 2017 motor vehicle accident, including treatment plans for physiotherapy, occupational therapy, a chronic pain assessment, and catastrophic impairment assessments.

The respondent denied the benefits.

The Tribunal found that the respondent's notices of denial were compliant with the Statutory Accident Benefits Schedule.

On the merits, the Tribunal held that the applicant failed to prove the treatment plans were reasonable and necessary, noting that the applicant's cognitive impairments were pre-existing and that she had reached maximal medical recovery for her accident-related physical injuries.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her injuries fell outside the Minor Injury Guideline (MIG) due to pre-existing conditions including chronic back pain, depression, and a potential concussion.

The Licence Appeal Tribunal found insufficient medical evidence to demonstrate that any pre-existing condition prevented the applicant from achieving maximal medical recovery within the MIG limits.

Relying on an insurer's examination which concluded the applicant's soft tissue injuries had resolved, the Tribunal held the injuries were predominantly minor.

As the $3,500 MIG funding limit was exhausted, the claim for an occupational therapy treatment plan, along with claims for a section 10 award and interest, were dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a chronic pain assessment in the amount of $2,460.00.

The respondent insurer denied the treatment plan based on an insurer's examination report which concluded the applicant suffered only minor soft tissue injuries.

The Licence Appeal Tribunal found the insurer's medical report failed to adequately consider the clinical notes and records of the applicant's family physicians, which included a chronic pain diagnosis.

Relying on the applicant's psychological assessments and the AMA Guides criteria for chronic pain, the Tribunal concluded the chronic pain assessment was reasonable and necessary.

The Tribunal ordered the respondent to pay for the assessment and interest on the overdue payment, but dismissed the applicant's claim for a special award under section 10 of O. Reg. 664, finding the insurer's conduct did not meet the threshold of being excessive or imprudent.

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

The Tribunal found that the applicant failed to provide compelling evidence of a pre-existing psychological condition or chronic pain syndrome that would prevent maximal medical recovery within the MIG.

Relying on clinical notes, prescription records, and independent medical examinations, the Tribunal concluded the injuries were minor.

As the MIG limits were exhausted, the disputed treatment plans and interest were denied.

The applicant sought statutory accident benefits following a motor vehicle accident, including funding for physiotherapy and medical services.

The matter proceeded to a written hearing.

The applicant's legal representative was removed from the record prior to the hearing, and the applicant failed to retain new counsel or file an adjournment request.

The applicant subsequently failed to file any written submissions or documentary evidence in support of her claims.

The Tribunal dismissed the application, finding that the applicant failed to meet her evidentiary burden to establish entitlement to the disputed benefits.

The applicant sought various medical and rehabilitation benefits following a motor vehicle accident, including natural supplements, medical marijuana, Platelet Rich Plasma (PRP) therapy, physiotherapy, psychological services, and a visual assessment.

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal found that medical marijuana was contraindicated due to the applicant's pre-existing conditions, and that PRP therapy was experimental and thus excluded under s. 15(2)(a) of the Schedule.

Relying on independent medical examinations, the Tribunal concluded that the remaining physical and psychological treatment plans were not reasonable and necessary.

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 injuries were predominantly minor and that he failed to provide compelling medical evidence of a pre-existing condition, psychological impairment, or chronic pain syndrome that would warrant removal from the MIG.

As the remaining MIG limit was insufficient to cover the proposed chronic pain assessment, and the assessment was not reasonable and necessary, the claim was dismissed.

No interest was awarded as no benefits were overdue.

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

The insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the funding limits had been exhausted.

The applicant argued she should be removed from the MIG due to pre-existing carpal tunnel syndrome, chronic pain, and psychological injuries.

The Tribunal found the applicant failed to provide compelling medical evidence that her pre-existing condition prevented maximal recovery within the MIG, or that her physical and psychological injuries were more than minor sequelae.

As the MIG limits were exhausted, the disputed treatment plans and claim for interest were 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 Tribunal found that the applicant failed to provide compelling medical evidence of a pre-existing condition, chronic pain, or psychological impairment that would warrant removal from the MIG.

As the $3,500 MIG limit was already exhausted, the disputed treatment plans were denied.

Claims for an award for unreasonable delay and interest were also dismissed.

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

The applicant argued her pre-existing conditions, chronic pain syndrome, and psychological impairments warranted removal from the MIG.

The Tribunal found insufficient objective medical evidence to support removal from the MIG, noting the applicant's self-reports were inconsistent with medical records and she returned to work immediately after the accident.

The application was dismissed.

The applicant sought interest and a special award under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent argued that the underlying treatment plans had been settled prior to the application and no invoices had been submitted, meaning no benefits were overdue.

The Tribunal dismissed the application, finding it lacked jurisdiction to address stand-alone claims for interest and an award when there were no substantive benefits in dispute.

The respondent's request for costs was also dismissed, as the applicant's conduct was not found to be unreasonable, frivolous, or vexatious.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of treatment plans for chiropractic services, a chronic pain assessment, and a psychological assessment.

The Tribunal found the applicant failed to prove the chiropractic and chronic pain treatment plans were reasonable and necessary, noting her failure to produce pre-accident and post-accident clinical notes from her family physician and the lack of objective evidence of impairment in the insurer's orthopaedic examination.

However, the Tribunal approved the psychological assessment, as the respondent conceded it was reasonable and necessary based on its own psychological examination.

The Tribunal also ordered the respondent to pay interest and a special award under section 10 of O. Reg. 664 solely in relation to the delayed payment for the psychological assessment.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

The insurer denied the benefits 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 she suffered from chronic pain syndrome and had pre-existing conditions that prevented maximal recovery within the MIG.

The Tribunal found insufficient medical evidence to support the applicant's claims, noting a three-year gap in reporting accident-related pain to her family physician.

The Tribunal concluded the injuries were predominantly minor and dismissed the application for further treatment plans, assessments, and interest.

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

The matter was scheduled for a written hearing, but the applicant failed to file submissions and filed his evidence brief late without explanation or consent.

The respondent brought a motion to dismiss the application.

The adjudicator found that the applicant failed to meet his evidentiary burden to establish entitlement to the benefits claimed and dismissed the application.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically a treatment plan for chiropractic services.

The respondent insurer denied the treatment plan on the basis that the impairments were not caused by the accident and the treatment was not reasonable and necessary.

The Tribunal found that the applicant failed to prove causation, noting extensive pre-existing medical conditions and prior physical trauma.

The Tribunal also accepted the respondent's medical examination report, which concluded that the applicant had reached maximum benefit from facility-based treatment.

The application was dismissed, along with claims for interest and a special award.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a physiatry assessment and chiropractic services.

The respondent insurer denied the treatment plans based on insurer's examinations indicating the applicant had reached maximum medical recovery and that his shoulder issues stemmed from a pre-existing hockey injury.

The Tribunal applied the 'but for' test for causation and accepted the medical evidence that the applicant's ongoing impairments were not caused by the accident.

The Tribunal found the proposed treatment plans were neither reasonable nor necessary.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his injuries fell outside the Minor Injury Guideline (MIG) due to pre-existing conditions, psychological impairments, and chronic pain.

The Licence Appeal Tribunal found the applicant failed to provide compelling medical evidence of pre-existing conditions or psychological injuries that would prevent maximal recovery within the MIG limits.

The Tribunal preferred the insurer's medical examinations, which concluded the injuries were minor soft tissue strains.

As the applicant's injuries were deemed minor and the $3,500 MIG limit was exhausted, the claims for additional physiotherapy and orthopaedic assessments were dismissed.