J. H. Bass

The applicant, a pedestrian struck by a vehicle, sought Income Replacement Benefits (IRBs) and funding for psychological and chronic pain assessments.

The insurer terminated IRBs after six months and denied the assessments, arguing the applicant's injuries fell within the Minor Injury Guidelines (MIG).

The Tribunal found the applicant did not suffer a substantial inability to perform his essential tasks for the first 104 weeks, nor a complete inability to engage in employment thereafter, relying on surveillance evidence showing him working and medical reports indicating symptom magnification.

The Tribunal also concluded the applicant's injuries were minor, dismissing the claims for the assessments.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to non-earner benefits, chiropractic services, and a chronic pain assessment.

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

The Licence Appeal Tribunal dismissed the application, finding that the applicant's extensive pre-accident medical history, including a prior workplace injury and chronic back pain, was the primary cause of his condition.

The Tribunal preferred the insurer's medical evidence and concluded the applicant did not suffer a complete inability to carry on a normal life as a result of the accident, nor were the proposed treatment and assessment plans reasonable and necessary.

The applicant was injured in a motor vehicle accident and sought funding for physiotherapy and a chronic pain treatment program under the Statutory Accident Benefits Schedule.

The insurer denied the treatment plans on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal reviewed the medical evidence, including reports from psychologists and orthopaedic surgeons, and found that the applicant had made significant progress in his recovery.

The Tribunal concluded that the proposed treatment plans were not reasonable or medically necessary and dismissed the application.

The applicant insurer sought repayment of $11,942.86 in income replacement benefits paid to the respondent following a motor vehicle accident.

The insurer argued the benefits were paid based on material misrepresentations regarding the respondent's employment status and receipt of Employment Insurance.

The Tribunal found that the respondent was neither employed for 26 of the 52 weeks preceding the accident nor receiving Employment Insurance at the time.

Concluding that the respondent made wilful misrepresentations to obtain the benefits, the Tribunal ordered the respondent to repay the full amount of $11,942.86 to the insurer.