Jesse A. Boyce

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

The respondent insurer denied a physiotherapy treatment plan 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 predominantly sprains and strains, and he failed to provide sufficient medical evidence of chronic pain, a psychological condition, or a pre-existing condition that would preclude recovery within the MIG.

Consequently, the treatment plan was deemed not reasonable and necessary, and the application was dismissed.

The respondent insurer requested a reconsideration of a Tribunal decision that awarded the applicant medical benefits for social work counselling and physiotherapy.

The insurer argued the Tribunal erred by disregarding the applicant's Examination Under Oath testimony and by overriding a previous Tribunal decision finding the applicant had reached maximal medical recovery.

The Vice-Chair dismissed the reconsideration request, finding that while the original adjudicator did not fully explain why she discounted the applicant's testimony, her reliance on the medical evidence provided sufficient rationale.

The Vice-Chair also found no error in the adjudicator's assessment of the physiotherapy plan, noting adjudicators are not bound by previous decisions and the adjudicator properly relied on the in-person medical examinations.

The respondent insurer filed a request for reconsideration of a decision finding that the applicant was entitled to payment of an income replacement benefit that was improperly deducted due to her receipt of Employment Insurance sickness benefits.

The insurer argued the Tribunal erred in law by determining that EI sickness benefits were not deductible as gross employment income under s. 7(3) of the Statutory Accident Benefits Schedule.

The Tribunal dismissed the request, finding no error of law in its original interpretation that a genuine conflict exists in the Schedule and that EI sickness benefits fall within the temporary disability benefit exclusion under s. 47(3)(f)(i).

The applicant requested a reconsideration of a Tribunal decision that denied payment for a $14,804.51 treatment plan.

The applicant argued the Tribunal erred in law and fact by finding the treatment plan was not reasonable and necessary, and by misapplying the notice requirements under s. 38 of the Schedule.

The Vice-Chair dismissed the request, finding no error in the adjudicator's determination that the insurer cured its defective notice and that the applicant failed to provide evidence of incurred treatment during the period of non-compliance.

The Tribunal's finding that the treatment plan was not reasonable and necessary was upheld.

The applicant sought a Non-Earner Benefit (NEB) following a motor vehicle accident.

The respondent insurer raised a preliminary issue that the claim was statute-barred under s. 56 of the Statutory Accident Benefits Schedule because the applicant failed to appeal the denial within the two-year limitation period.

The Tribunal found that the insurer's initial denial letter was clear and unequivocal, triggering the limitation period, which expired nearly a year before the application was filed.

The Tribunal declined to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act due to the significant delay.

The NEB claim was dismissed as statute-barred.

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

The insurer denied a treatment plan for psychological services, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's chronic pain warranted removal from the MIG.

However, the Tribunal dismissed the claim for psychological services, preferring the insurer's psychological assessment which found no objective evidence of a psychological impairment caused by the accident.

The claim for interest was also dismissed.

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

The respondent denied a treatment plan for chiropractic services, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued her pre-existing diabetes and Lupus, along with chronic pain, warranted removal from the MIG.

The Tribunal found the applicant's injuries were predominantly sprains and strains, and she failed to provide compelling medical evidence that her pre-existing conditions precluded recovery within the MIG.

Furthermore, the medical evidence did not support a diagnosis of chronic pain causing functional impairment.

The application was dismissed, and claims for interest and a section 10 award were denied.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied a $2,298 physiotherapy treatment plan.

The applicant argued that the adjudicator made an error of fact and sought to introduce new medical evidence.

The Tribunal dismissed the request, finding that the applicant was improperly attempting to reargue the merits of the case and that the new evidence would not have affected the original outcome.

The respondent's request for costs was also dismissed, as the reconsideration request was not found to be frivolous, vexatious, or in bad faith.

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 chronic pain and psychological impairments.

The Tribunal found the physical injuries were sprains and strains falling within the MIG, and rejected the applicant's psychological evidence in favour of the respondent's section 44 psychological assessment.

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

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

The insurer denied the claims and requested section 44 assessments, which the applicant failed to attend, arguing the notices were invalid.

The Tribunal found the insurer's notices complied with the Schedule and the assessments were reasonably required.

Consequently, the applicant was held to be statute-barred from proceeding with her application under section 55(1)2 of the Schedule due to her non-compliance.

The applicant was injured in a bicycle accident and received income replacement benefits (IRBs) for 104 weeks.

The insurer terminated the benefits at the 104-week mark based on multidisciplinary assessments concluding she did not suffer a complete inability to engage in employment for which she was reasonably suited.

The applicant sought ongoing IRBs, arguing she could only work part-time.

The Tribunal dismissed the application, finding the applicant failed to provide compelling medical evidence to rebut the insurer's seven assessments.

The Tribunal noted the applicant's successful transition to part-time work as a baker and yoga instructor demonstrated an ability to engage in suitable employment.

The insurer requested a reconsideration of a Tribunal decision that awarded the insured interest on three treatment plans.

The insurer argued that it had complied with its obligations under section 38 of the Statutory Accident Benefits Schedule and had paid the treatment plans in full before the Tribunal application was filed.

The Tribunal agreed, finding that it had erred in law and fact by automatically applying section 51(4) to award interest.

The delay in the insurer's final determination was due to the insured's failure to attend scheduled assessments.

The reconsideration request was granted, and the order for interest was reversed.

The applicant was injured in a motorcycle accident and sought an income replacement benefit (IRB) from the respondent.

The respondent raised a preliminary issue regarding whether the motorcycle was insured at the time of the accident.

The Tribunal found that the motorcycle was not insured and that the applicant knew or ought reasonably to have known it was not insured, as he had previously secured insurance for another vehicle and failed to provide any evidence supporting his claim that he believed the vendor had arranged insurance.

The respondent was successful on the preliminary issue and is not required to pay an IRB.

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

The respondent denied a treatment plan for chiropractic services on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued her injuries, including chronic pain and pre-existing conditions, warranted removal from the MIG.

The Tribunal found the applicant's injuries were predominantly soft-tissue strains and sprains, and she failed to provide compelling medical evidence of a pre-existing condition or chronic pain with functional impairment that would preclude recovery within the MIG.

The application was dismissed, and claims for the treatment plan, interest, and a section 10 award were denied.

The applicant sought accident benefits for psychological treatment.

The insurer partially approved the treatment plan, paying the psychotherapist rate of $99.75 per hour instead of the claimed psychologist rate of $149.61 per hour, leaving a balance of $598.32.

The Tribunal found that the provider was an unregulated psychotherapist without specialized training in cognitive behavioural therapy, and the treatment plan did not propose such therapy.

The Tribunal held that the insurer's approved rate was reasonable and dismissed the claim for the balance.

The applicant tripped and fell while walking up her driveway, striking her face against the rear bumper of her parked SUV.

She sought statutory accident benefits, which the respondent insurer denied on the basis that the incident did not constitute an 'accident' under s. 3(1) of the Schedule.

The Tribunal applied the purpose and causation tests, finding that a parked vehicle falls within the ordinary scope of use and operation, and that the vehicle was the direct cause of the applicant's injuries.

The Tribunal concluded that the incident met the definition of an accident and directed the parties to schedule a case conference.

The applicant sought statutory accident benefits following a motorcycle accident, including non-earner benefits (NEB), medical benefits for physiotherapy and massage therapy, and an award for unreasonable delay.

The Licence Appeal Tribunal found the applicant was not entitled to the NEB because his pain did not practically prevent him from engaging in his pre-accident activities.

However, the Tribunal granted the medical benefits for physiotherapy and massage therapy, finding them reasonable and necessary to address ongoing pain.

The Tribunal also awarded a 10% penalty under s. 10 of O. Reg. 664, finding the insurer unreasonably delayed payment by denying treatment while simultaneously paying NEBs.

The applicant sought post-104-week attendant care benefits after being deemed catastrophically impaired.

The insurer argued the claim was statute-barred because it had denied pre-104-week attendant care benefits more than two years prior.

Applying the rule of discoverability from Tomec, the Tribunal held that the limitation period did not begin to run until the applicant was deemed catastrophically impaired, as he was not eligible for post-104-week benefits before that time.

The Tribunal found the claim was not statute-barred and allowed the application to proceed.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, arguing that chronic pain warranted removal from the Minor Injury Guideline (MIG).

The Tribunal preferred the respondent's section 44 medical examination, which diagnosed myofascial strain injuries treatable within the MIG, over the applicant's expert reports, which were found to be unsupported by objective medical evidence and the applicant's functional abilities.

The Tribunal concluded the applicant did not meet the burden of proving his injuries fell outside the MIG.

The disputed treatment plans were deemed not reasonable and necessary, and the application was dismissed.

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

The respondent initially denied treatment plans on the basis that the minor injury guideline applied, but later approved them.

The only remaining issue was whether the applicant was entitled to a special award under section 10 of O. Reg. 664 for unreasonable delay.

The Tribunal found that the respondent did not act unreasonably, as the applicant failed to timely provide compelling medical evidence and failed to attend a scheduled section 44 examination.

The claim for a special award was dismissed.