Kathleen Wells

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 claimed she suffered from chronic pain, but provided only emergency room records from the day of the accident showing a normal X-ray.

The Tribunal found the applicant failed to meet her burden of proving chronic pain with functional impairment to warrant removal from the MIG.

As the applicant remained within the MIG, the disputed treatment plans were not considered, and 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) and that the applicant failed to attend an insurer's examination.

The Tribunal found the applicant was not barred from proceeding because the respondent's notices of examination were defective.

On the substantive issues, the Tribunal held the applicant's injuries were predominantly minor and subject to the MIG limit.

The applicant was not entitled to a non-earner benefit.

However, three treatment plans for chiropractic services were payable because the respondent's denial notices failed to comply with s. 38(8) of the Schedule.

A claim for an award under s. 10 of Reg. 664 was dismissed.

The applicant sought $3,922.47 for chiropractic services following a motor vehicle accident, along with an award for unreasonable delay and interest.

The adjudicator found that the applicant failed to meet her burden of proving the treatment plan was reasonable and necessary, as the medical evidence provided was dated shortly after the accident and did not support the need for treatment 22 months later.

The adjudicator accepted the respondent's insurer examination report, which concluded the applicant had reached maximum medical recovery.

The application for benefits, an award, and interest was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for various assessments and treatments.

The respondent insurer denied the treatment plans.

The applicant argued the treatment plans were payable under s. 38(11) of the Schedule because the respondent's denial notices failed to comply with the strict medical and other reasons requirements of s. 38(8).

The Tribunal agreed with the applicant for four of the five treatment plans, finding the denial notices lacked sufficient detail for an unsophisticated person to make an informed decision.

The Tribunal ordered the respondent to pay for the psychotherapy, chronic pain, hyperbaric oxygen, and social work assessments, plus interest, but dismissed the claim for an orthopaedic assessment and a special award.

The applicant sought statutory accident benefits for psychological services following a motor vehicle accident.

The respondent insurer denied portions of four treatment plans, arguing that the first plan was barred by the two-year limitation period and that the hourly rate requested for a social worker in the subsequent plans was unreasonable.

The Tribunal found that the limitation period was not triggered for the first plan because the insurer's initial notice of denial was unclear and non-compliant.

However, the Tribunal dismissed the claims on the merits, finding that the applicant failed to provide objective medical evidence to support the first treatment plan and failed to prove that the higher hourly rate of $149.61 for a social worker was reasonable compared to the $100.00 rate approved by the insurer.

The application was dismissed in its entirety.

The applicant sought statutory 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 applicant argued for removal from the MIG due to pre-existing scoliosis and chronic pain.

The Tribunal found that while the applicant had a documented pre-existing condition, there was no compelling medical evidence that it precluded his recovery within the MIG.

The Tribunal also found insufficient evidence of chronic pain with functional impairment.

As the applicant remained within the MIG, the disputed treatment plans were not considered, and the application was dismissed.

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

The Tribunal found the applicant was barred from claiming an income replacement benefit due to the expiry of the two-year limitation period, as the insurer's denial was clear and unequivocal.

The Tribunal determined the applicant's injuries fell within the Minor Injury Guideline (MIG) as there was insufficient evidence of physical or psychological impairments warranting removal.

However, several treatment plans were deemed payable because the insurer's denial notices failed to comply with the specificity requirements of s. 38(8) of the Schedule.

Claims for other treatment plans and an award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including psychological services and an attendant care assessment.

The Tribunal found the claim for the attendant care assessment was barred by the two-year limitation period under s. 56 of the Schedule.

The claims for psychological services were dismissed because the applicant failed to lead evidence for one treatment plan and failed to prove the requested hourly rate for a psychotherapist was reasonable and necessary for the other.

The application was dismissed in its entirety.

The applicant sought entitlement to various statutory accident benefits following a motor vehicle accident, including multiple treatment plans and attendant care benefits.

The Tribunal found that the applicant failed to meet her onus to prove that the majority of the treatment plans and the attendant care benefits were reasonable and necessary.

However, the Tribunal ordered the respondent to pay $2,013.20 for occupational services because the respondent's denial notice failed to provide sufficient medical reasons as required by section 38(8) of the Schedule.

Claims for a section 10 award and the cost of an OCF-3 were 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) and raised a preliminary issue that the application should be barred due to the applicant's failure to attend insurer examinations.

The Tribunal found the notice of examination was non-compliant, so the application was not barred.

However, the Tribunal concluded the applicant failed to prove on a balance of probabilities that he suffered from a psychological impairment or chronic pain with functional impairment.

Consequently, the applicant's injuries were deemed predominantly minor, keeping him subject to the $3,500 MIG limit, and the application for additional treatment plans and an award was dismissed.

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 he should be removed from the MIG due to chronic pain.

The Tribunal found the applicant did not establish on a balance of probabilities that he suffered from chronic pain with functional impairment, noting he did not meet three of the six criteria in the AMA Guides and had returned to work and normal household chores.

The application was dismissed.

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

The Tribunal found the applicant was statute-barred from pursuing a non-earner benefit because he failed to attend scheduled insurer's examinations without a reasonable explanation.

The Tribunal also held that the applicant's injuries fell within the Minor Injury Guideline (MIG), as he failed to provide compelling medical evidence of physical or psychological impairments warranting removal.

While two treatment plans for physiotherapy were denied, a treatment plan for a psychological assessment was deemed payable because the insurer's denial notice failed to mention the MIG, violating section 38(9) of the Schedule.

The applicant sought statutory accident benefits, including an income replacement benefit (IRB) and medication expenses, following a motor vehicle accident.

The respondent denied the benefits and argued the applicant was statute-barred for missing insurer's examinations.

The Tribunal found the applicant was not statute-barred as she attended rescheduled examinations.

However, the Tribunal dismissed the substantive claims, finding the applicant failed to prove a substantial or complete inability to perform the essential tasks of her employment as an Uber driver, relying on the respondent's psychological assessments.

The claims for medication expenses, interest, and a section 10 award were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a psychological impairment warranting removal from the Minor Injury Guideline (MIG).

The respondent denied the treatment plans for a psychological assessment and psychological services.

The Tribunal found that the applicant failed to provide objective medical evidence to corroborate her self-reported psychological symptoms, assigning little weight to her psychological associate's report and preferring the respondent's s. 44 psychological assessment.

The Tribunal concluded the applicant's injuries were predominantly minor and subject to the $3,500 MIG limit.

The Tribunal also found the respondent's denial notices complied with s. 38(8) of the Schedule, dismissing the claims for the treatment plans, interest, and an award.

The applicant sought statutory accident benefits following a motor vehicle accident, including funding for a psychological assessment, psychological services, and chiropractic services.

The respondent denied the treatment plans.

The Tribunal found that the applicant failed to meet his burden of proving the treatment plans were reasonable and necessary, noting a lack of contemporaneous medical evidence corroborating his self-reported symptoms and relying on the respondent's s. 44 assessments which found no accident-related impairments warranting the proposed treatments.

The application was dismissed, and claims for interest and an award were denied.

The applicant sought entitlement to several treatment plans for physiotherapy and an occupational therapy assessment following a motor vehicle accident.

The insurer denied the plans, but the applicant argued the denial notices were defective.

The Tribunal found that the insurer's denial notices failed to comply with the strict requirements of s. 38(8) of the Schedule, as they lacked sufficient medical reasons and failed to clearly explain the Minor Injury Guideline.

Consequently, under s. 38(11), the treatment plans were payable.

The applicant's claim for a special award was dismissed due to insufficient evidence of unreasonable conduct by the insurer.

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

The respondent denied various treatment plans and assessments on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG due to psychological impairment and chronic pain.

The Tribunal found the applicant's evidence, including reports from a chiropractor and a psychological assessment, lacked weight and corroboration.

Relying on the respondent's insurer's examinations, the Tribunal concluded the applicant did not suffer a psychological impairment or meet the AMA Guides criteria for chronic pain with functional impairment.

As the applicant remained within the MIG, the disputed treatment plans were not payable, and claims for interest and an award were dismissed.

The applicant sought payment for four treatment plans, arguing the respondent insurer failed to provide sufficient medical reasons in its denial notices as required by s. 38(8) of the Statutory Accident Benefits Schedule.

The Tribunal found that the respondent's denial letters were compliant, as they clearly relied on and excerpted independent medical examination reports that directly addressed the requested treatments.

Because the notices were compliant, the applicant was not entitled to the treatment plans under s. 38(11).

The application was dismissed, and claims for interest and an award were denied.

The applicant sought accident benefits following a motor vehicle accident, claiming her injuries warranted removal from the Minor Injury Guideline (MIG) due to pre-existing conditions, chronic pain, and psychological impairment.

The Licence Appeal Tribunal found that the applicant failed to prove her pre-existing conditions precluded recovery within the MIG, or that she suffered from chronic pain with functional impairment or a psychological impairment caused by the accident.

As the applicant remained subject to the MIG limit, her claims for a psychological assessment, an award, and interest were dismissed.

The applicant sought non-earner benefits and funding for a psychological assessment following a motor vehicle accident.

The Tribunal found the claim for non-earner benefits was statute-barred under s. 36 of the Schedule because the applicant failed to submit a completed disability certificate (OCF-3).

The Tribunal also denied the remaining $1,000 for the psychological assessment treatment plan, finding the applicant failed to prove the document support fee for a medical file review was reasonable and necessary.

Claims for interest and an award were dismissed.