J.R. Richards

The applicant sought a non-earner benefit, medical benefits for transportation, and interest following a motor vehicle accident.

The applicant claimed that chronic pain completely prevented him from engaging in his pre-accident activities.

The respondent relied on surveillance evidence showing the applicant working as a pizza delivery driver and engaging in strenuous physical activity, as well as medical assessments indicating normal objective findings.

The Tribunal found the applicant's subjective reports of pain lacked credibility and were contradicted by the surveillance and objective medical evidence.

The application was dismissed in its entirety.

The applicant was injured in a motorcycle accident and received income replacement benefits.

The insurer suspended benefits after the applicant refused to attend an insurer's examination, arguing the insurer failed to provide valid 'medical and any other reasons' as required by section 44 of the Statutory Accident Benefits Schedule.

The Tribunal found that the insurer's stated reasons—to determine timelines for recovery and future prognosis—were valid, given the applicant's ongoing treatment and potential need for surgery.

Consequently, the applicant was precluded from receiving benefits during the period of non-compliance, and his claim for a special award was dismissed.

The insurer brought a preliminary motion arguing that the applicant's claim for attendant care benefits was barred by the two-year limitation period.

The insurer had sent Explanation of Benefits forms stating the applicant did not qualify for attendant care benefits under the Minor Injury Guideline before the applicant had submitted an Assessment of Attendant Care Needs form.

The Tribunal dismissed the motion, finding that a limitation period cannot begin to run before a benefit is actually claimed.

Furthermore, the language used in the insurer's forms stating there was 'no coverage' was not a clear and unequivocal denial sufficient to trigger the limitation period.

The applicant sought statutory accident benefits and filed an application for dispute resolution after the insurer denied a treatment plan.

Prior to the case conference, the insurer approved the treatment plan, but the applicant sought costs for preparing the application.

The Tribunal held a preliminary issue hearing to determine if it had jurisdiction to consider the costs request after the main issue was resolved.

The Tribunal found that the proceeding had not ended because the application was not withdrawn and the costs issue remained outstanding, concluding it had jurisdiction to consider the request under Rule 19.1.