Kathleen Wells

The applicant sought $1,602.05 for medication expenses, an award for unreasonable delay, and interest following a motor vehicle accident.

The applicant claimed the accident caused a re-emergence of epileptic seizures and psychological symptoms.

The Tribunal dismissed the application, finding the applicant failed to prove the medications were reasonable and necessary to treat accident-related injuries.

The Tribunal preferred the evidence of the insurer's neurologist, who found no traumatic neurological injury explaining the seizures, and noted the applicant's treating neurologist also found no connection to the accident.

As no benefits were payable, the claims for interest and an award were also dismissed.

The applicant sought entitlement to various treatment plans for home devices, a sleep system, workplace modifications, and kitchen devices following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove on a balance of probabilities that the proposed treatment plans were reasonable and necessary.

The Tribunal assigned little weight to the applicant's occupational therapist's recommendations due to a lack of contemporaneous assessment and failure to account for a subsequent accident.

Conversely, the Tribunal accepted the contemporaneous insurer's examination reports which concluded the treatments were not required.

Claims for interest and a special award were also dismissed.

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

The insurer denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant suffered from an accident-related psychological impairment, specifically Somatic Symptom Disorder and Adjustment Disorder, warranting removal from the MIG.

The Tribunal approved a treatment plan for a psychological assessment but denied other treatment plans for chronic pain, physiotherapy, guided exercise, and a social work assessment due to lack of supporting evidence.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing she should be removed from the Minor Injury Guideline (MIG) due to chronic pain with functional impairment.

The Tribunal found the applicant failed to prove on a balance of probabilities that her chronic pain was caused by the accident, noting her medical evidence was either remote in time, lacked detail, or failed to account for non-accident-related conditions such as psoriatic arthritis and a recent hospitalization for meningitis.

As the applicant remained within the MIG, her claims for physiotherapy treatment plans, interest, and an award for unreasonable delay were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that pre-existing conditions and chronic pain warranted removal from the MIG, and claimed entitlement to an income replacement benefit (IRB) and various physiotherapy treatment plans.

The Licence Appeal Tribunal found that the applicant failed to provide compelling medical evidence that her pre-existing conditions precluded recovery within the MIG, or that she suffered from chronic pain with functional impairment.

The Tribunal also dismissed the IRB claim as the applicant provided no evidence regarding her inability to perform the essential tasks of her employment.

The application was dismissed.

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

The Tribunal found the applicant did not meet the burden to be removed from the Minor Injury Guideline (MIG).

The applicant was awarded a non-earner benefit for a limited period due to the insurer's non-compliant denial notice under s. 36 of the Schedule.

One treatment plan for a psychological assessment was deemed payable due to a non-compliant denial notice under s. 38(8), while other treatment plans were denied.

Claims for an award were dismissed.

The applicant, a minor, 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 prove on a balance of probabilities that he suffered from a pre-existing condition, a physical impairment (concussion), or a psychological impairment that would warrant removal from the MIG.

As the applicant remained subject to the MIG limit, the disputed treatment plans were not considered.

Claims for an award and interest were also dismissed.

The applicant sought statutory accident benefits following a 2011 motor vehicle accident.

The applicant claimed entitlement to assistive devices (including an iPhone and Apple Watch, and incontinence supplies), prescription medication, mileage expenses, and an award for unreasonable delay.

The Tribunal found the applicant was entitled to incontinence supplies and one claim for mileage expenses, as they were reasonable and necessary.

The claims for the iPhone, Apple Watch, prescription medication, and remaining mileage expenses were dismissed for lack of supporting evidence.

The claim for an award under s. 10 of Reg. 664 was also dismissed, but interest was awarded on the outstanding amounts.

The applicant sought 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).

The Tribunal found that the applicant failed to prove on a balance of probabilities that she sustained physical or psychological injuries warranting removal from the MIG.

The Tribunal also found that the respondent's denial letters complied with the notice requirements under s. 38(8) of the Schedule, and therefore the treatment plans were not payable under s. 38(11).

The application was dismissed.

The applicant sought statutory accident benefits for chiropractic and physiotherapy treatment plans following a motor vehicle accident.

The Tribunal found that neither treatment plan was substantively reasonable and necessary, as contemporaneous medical records did not corroborate the applicant's reports of accident-related physical injuries.

However, the Tribunal concluded that the insurer's denial notice for the physiotherapy treatment plan failed to comply with the specificity requirements of s. 38(8) of the Schedule.

Consequently, the physiotherapy treatment plan was deemed payable under s. 38(11).

The claim for an award under s. 10 of Regulation 664 was dismissed.

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

The respondent denied two treatment plans for chiropractic and massage therapy services on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to prove his injuries warranted removal from the MIG.

However, the Tribunal held that the respondent's denial notices for both treatment plans were defective and failed to comply with s. 38(8) of the Schedule because they were confusing and not clear and unequivocal.

Consequently, pursuant to s. 38(11), the treatment plans are payable once incurred and properly invoiced.

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 impairment.

The Tribunal found the applicant failed to establish on a balance of probabilities that he suffered from chronic pain with functional impairment or a psychological impairment as a result of the accident.

Consequently, the applicant remained subject to the MIG limit, and the claims for treatment plans, an award, and interest were dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for various treatment plans, including chiropractic, physiotherapy, and psychological services.

The respondent insurer partially approved several plans but denied transportation expenses and disputed the hourly rate for a social worker.

The respondent also fully denied a subsequent chiropractic treatment plan based on an insurer's examination which found no objective evidence of continuing impairments.

The Tribunal found that the applicant failed to meet his burden to prove the denied amounts and the fully denied treatment plan were reasonable and necessary.

The Tribunal also found the insurer's denial notices were compliant with the Schedule.

The application was dismissed in its entirety.

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

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

The applicant applied to the Licence Appeal Tribunal, arguing for removal from the MIG due to pre-existing conditions, physical injuries including a concussion, and psychological impairments.

The adjudicator found insufficient medical evidence to support the applicant's claims, noting that complaints of concussion and psychological symptoms arose more than a year after the accident and following a separate assault.

The application was dismissed, and the applicant was found to remain subject to the MIG limit.

The applicant sought statutory accident benefits for a psychological assessment and two dental claims following a motor vehicle accident.

The applicant passed away prior to the hearing.

The Tribunal found the psychological assessment was not reasonable and necessary as there was insufficient evidence of worsening symptoms since a prior assessment.

The Tribunal also found the dental claims were not payable, as the respondent's denial letter complied with the notice requirements under s. 38(8) of the Schedule and relied on an insurer's examination report concluding the dental issues were not accident-related.

The application was dismissed in its entirety.

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

The respondent denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on a concussion and psychological impairments.

The Tribunal found that the applicant failed to prove on a balance of probabilities that she sustained injuries warranting removal from the MIG, noting that the concussion and psychological diagnoses were made by a chiropractor outside his scope of practice, and medical records did not corroborate accident-related psychological impairments.

The application was dismissed.

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

The respondent denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed a psychological impairment warranted removal from the MIG and sought an income replacement benefit (IRB) and treatment plans.

The Tribunal found the applicant did not meet the burden of proving a psychological impairment or a substantial inability to perform the essential tasks of his employment as an Uber driver.

The Tribunal concluded the applicant's injuries were predominantly minor, subject to the MIG limit, and dismissed the claims for IRB, treatment plans, interest, and an award.

The applicant, a minor, 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 for removal from the MIG due to psychological impairment and alleged the respondent's denial notice was non-compliant with s. 38(8) of the Schedule.

The Tribunal found insufficient evidence of psychological impairment to warrant removal from the MIG.

The Tribunal also held that the respondent's denial notice was compliant and, relying on Zheng, noted that an improper denial does not permanently remove an insured from the MIG.

The application was dismissed.

The applicant sought payment for various treatment plans and expenses for chiropractic, psychological, and acupuncture services following a motor vehicle accident, as well as an award for unreasonable delay.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide contemporaneous medical evidence or sufficient submissions to meet her burden of proving the treatments were reasonable and necessary.

As no benefits were payable, claims for interest and a punitive award were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, funding for a psychological assessment, and physiotherapy services.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that she suffered a complete inability to carry on a normal life, noting inconsistencies in her self-reporting and a failure to provide evidence of her pre-accident activities.

The Tribunal assigned little weight to the applicant's expert reports due to methodological flaws and reliance on incomplete medical records.

The claims for the remaining balances of the psychological assessment and physiotherapy services were dismissed as they exceeded the maximum amounts permitted under the Schedule and Guidelines.

The application was dismissed in its entirety.