Jesse A. Boyce

The applicant sought a non-earner benefit and a medical rehabilitation benefit following a motor vehicle accident.

The insurer denied the benefits, arguing the applicant did not suffer a complete inability to carry on a normal life and that the treatment was not reasonable and necessary.

The Tribunal dismissed the application, finding the applicant failed to meet the stringent test for a non-earner benefit, largely due to a lack of detailed comparison between her pre- and post-accident functioning and the impact of her pre-existing conditions.

The Tribunal also found the proposed treatment plan was not reasonable and necessary, preferring the insurer's medical evidence that the applicant had reached maximum medical improvement.

The applicant, who was catastrophically impaired following a motor vehicle accident, sought payment for a psychovocational assessment, winter tires, and a wellness retreat in British Columbia.

The Licence Appeal Tribunal found that the psychovocational assessment was not payable as it was incurred prior to the submission of the treatment plan and was not reasonable and necessary given the volume of existing medical opinions.

The Tribunal also held that winter tires do not constitute a vehicle modification under the Schedule and that the wellness retreat was not reasonable and necessary.

The application was dismissed.

The insurer requested a reconsideration of a decision awarding the insured funding for catastrophic impairment assessments.

The insurer argued the adjudicator erred in law by finding the assessments were not true rebuttal reports and were prepared for the purpose of a catastrophic application under s. 45 of the Schedule.

The adjudicator dismissed the reconsideration request, finding no errors of law that would materially affect the outcome.

The adjudicator maintained that the insured's right to be assessed for catastrophic impairment was not exhausted and that the timing of the application did not invalidate the funding request.

The insured's request for costs was also denied.

The applicant was injured in a motor vehicle accident and sought a medical benefit of $1,071.41 for chiropractic services, which the respondent insurer denied.

The insurer argued the applicant had reached maximal medical recovery and should rely on a home-based exercise program.

The Tribunal found the treatment plan reasonable and necessary, noting the applicant's consistent reports of pain and the plan's modest scope aimed at pain reduction.

The applicant was awarded the medical benefit along with interest on the overdue payment.

The applicant sought payment for two treatment plans for chiropractic and massage therapy following a motor vehicle accident.

The respondent denied the plans on the basis that they were not reasonable and necessary, relying on an insurer's examination by a chiropractor.

The Tribunal found that the applicant failed to meet his burden of proving the treatment was reasonable and necessary, noting a lack of continuous medical records and the fact that the treatment plans were submitted 2.5 years after their creation.

The Tribunal accepted the respondent's expert evidence and dismissed the application, including the claim for an award for unreasonable delay.

The applicant insurer sought repayment of $19,170.90 in attendant care benefits paid to the respondent insured.

The insurer had paid the benefits based on the respondent's mother's Employment Insurance statement, pending further proof of her economic loss.

In a prior Tribunal decision, it was determined that the respondent failed to prove his mother sustained an economic loss in providing care.

The Tribunal found that the insurer paid the benefits directly to the respondent in error, as no evidence of economic loss was ever provided.

The Tribunal ordered the respondent to repay the $19,170.90 plus interest, finding that the insurer had provided proper notice within the 12-month limitation period.

The applicant, a pedestrian struck by a vehicle, sought statutory accident benefits for attendant care, assistive devices, and psychological and physiological treatment.

The insurer denied the claims.

The Licence Appeal Tribunal found that the applicant was entitled to the psychological treatment plan, as the evidence demonstrated that his pre-existing psychological issues were exacerbated by the accident.

However, the claims for attendant care and assistive devices were dismissed because the applicant failed to prove they were reasonable and necessary, and failed to provide evidence that the expenses were incurred.

A claim for a special award was also dismissed, as the insurer's denials were not improper.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident.

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

The applicant argued that pre-existing shoulder issues, psychological impairments, and chronic pain warranted removal from the MIG.

The Tribunal found insufficient evidence to support the applicant's claims, preferring the respondent's section 44 assessment reports which concluded the injuries were predominantly minor.

As the MIG limits had been exhausted, the application for further benefits, interest, and an award was dismissed.

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

The respondent insurer denied the benefits, arguing the applicant's injuries were predominantly minor and subject to the $3,500 limit of the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's meniscal tear and unopposed psychological diagnoses warranted removal from the MIG.

However, the Tribunal only approved one treatment plan for $2,800, finding the applicant failed to provide sufficient evidence to prove the remaining claimed expenses were reasonable and necessary.

The applicant sought an income replacement benefit (IRB) and medical benefits for chiropractic services following a motor vehicle accident.

The insurer denied the IRB on the basis that the applicant was not substantially unable to perform his essential work tasks and had not declared income.

The insurer also determined the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant failed to prove entitlement to an IRB, as he provided no medical evidence of inability to work and no financial documentation of pre-accident income.

The Tribunal also held the applicant's injuries were predominantly minor and that he failed to prove the disputed treatment plans were reasonable and necessary.

The application was dismissed.

The applicant sought a catastrophic impairment determination and various accident benefits following a motor vehicle accident.

The respondent insurer requested a neuropsychological insurer's examination (IE) to assess the catastrophic impairment claim, which the applicant refused to attend.

The insurer raised preliminary issues arguing the applicant was barred from proceeding with the catastrophic claim until he attended the IE, and that his claims for income replacement and medical benefits were statute-barred for missing the two-year limitation period.

The Tribunal found the neuropsychological IE was reasonably necessary to respond to the applicant's neurologist's diagnosis of a mild traumatic brain injury.

The Tribunal also found the non-catastrophic claims were statute-barred and declined to extend the limitation period under s. 7 of the LAT Act due to significant, unexplained delays.

The applicant is barred from proceeding until he attends the IE.

The applicant was injured in a motorcycle accident and claimed attendant care benefits for services provided by his wife.

The insurer denied payment because the wife, a retired nurse, did not provide the services in the course of her employment and did not sustain an economic loss.

The Licence Appeal Tribunal agreed, finding that the applicant failed to prove an economic loss as required by the Statutory Accident Benefits Schedule.

The Tribunal also found the claimed amounts excessive and unsupported by the evidence, and dismissed claims for a special award and interest.

The applicant sought various medical and rehabilitation benefits following a motor vehicle accident.

The respondent insurer removed the applicant from the Minor Injury Guideline (MIG) due to psychological impairments but denied several treatment plans.

The Tribunal found that the physical treatment plans were not reasonable and necessary as the physical injuries were predominantly minor.

However, the Tribunal approved the psychological treatment and assessments at reduced rates in accordance with the Professional Fee Guideline, and approved a chronic pain assessment to investigate the connection between the applicant's subjective pain and psychological diagnoses.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule after being removed from the Minor Injury Guideline.

The insurer denied treatment plans for a cognitive assessment, chiropractic and massage treatments, and the remaining cost of a partially approved psychological assessment.

The Tribunal found the cognitive assessment and physical treatments were reasonable and necessary given the applicant's reported concussion symptoms and ongoing chronic pain.

However, the Tribunal dismissed the claim for the remaining cost of the psychological assessment, finding the applicant failed to prove why the additional time and cost were necessary beyond the insurer's partial approval.

The applicant sought an increased Income Replacement Benefit (IRB) following a motor vehicle accident, arguing the insurer failed to include income from self-employment and a short-term job.

The Tribunal found the applicant failed to report this income under the Income Tax Act, meaning it could not be used to calculate the IRB pursuant to s. 4(5) of the Schedule.

The Tribunal also found that while the insurer breached the 10-day response timeline under s. 36(4), it cured the breach by paying the full IRB owed for the period in dispute.

The application for increased IRB, interest, and an award was dismissed.

The applicant sought medical and rehabilitation 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 Tribunal found that the applicant's physical injuries were soft-tissue in nature and that there was insufficient evidence of chronic pain or psychological impairment to warrant removal from the MIG.

As the MIG limits had been exhausted, the disputed treatment and assessment plans were deemed not reasonable and necessary.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The parties disputed the quantum of the income replacement benefit (IRB), entitlement to various medical and rehabilitation benefits, transportation costs, and a special award.

The Tribunal determined the correct IRB quantum was $297.88 per week, finding the insurer's calculation incorrectly identified the start of the 52-week pre-accident period.

The Tribunal granted the cost of a hydrotherapy treatment plan and transportation expenses, finding them reasonable and necessary.

However, the Tribunal denied a physiotherapy treatment plan and the remainder of an in-home assessment, concluding the applicant had reached maximum medical improvement for facility-based treatment.

The claim for a special award was dismissed as the insurer did not unreasonably withhold or delay payments.

The applicant, who sustained a catastrophic impairment in a motor vehicle accident, sought attendant care benefits for services allegedly provided by his wife.

The insurer denied the claim on the basis that the wife did not meet the requirements for a provider under the Schedule and did not incur an economic loss.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that the attendant care services were provided by his wife over and above the professional care already received.

Furthermore, the applicant did not prove that his wife sustained an economic loss as a result of providing the care.

The claims for attendant care benefits, interest, and a special award were dismissed.

The applicant was injured in a motor vehicle accident and sought payment for two treatment plans for physiotherapy, chiropractic treatment, and massage totaling $5,769.84.

The respondent denied the plans as not reasonable and necessary.

The Tribunal found that the applicant failed to provide sufficient medical evidence to support the need for further facility-based treatment, relying instead on the uncontroverted report of the respondent's physiatrist who found no accident-related impairments.

The application was dismissed.

The applicant sought a catastrophic impairment determination and various statutory accident benefits following a motor vehicle accident.

The respondent insurer requested a neuropsychological insurer's examination, which the applicant refused to attend.

The respondent raised preliminary issues arguing the applicant was barred from proceeding with the catastrophic impairment claim for failing to attend the examination, and barred from proceeding with the other benefits claims for missing the two-year limitation period.

The Tribunal held that the neuropsychological examination was reasonably necessary and barred the catastrophic impairment claim until the applicant attends.

The Tribunal also found the remaining claims were statute-barred and declined to extend the limitation period under s. 7 of the LAT Act.