Kieffer Norton

The applicant was involved in a motor vehicle accident and sought statutory accident benefits for physiotherapy and an attendant care assessment.

The respondent denied the benefits.

The Tribunal found that the applicant failed to prove on a balance of probabilities that the treatment plans were reasonable and necessary, noting that the applicant's family doctor records did not mention accident-related pain and the respondent's examiner found no musculoskeletal impairments.

The Tribunal also found the respondent's denial letter was sufficient under s. 38(8) of the Schedule.

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

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

The insurer denied a treatment plan for chiropractic services on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The Tribunal found that the applicant failed to provide compelling medical evidence to warrant removal from the MIG, noting that imaging showing a shoulder tear was conducted 16 months post-accident and was not causally linked to the collision.

As the MIG limit was exhausted, the treatment plan and claim for interest were dismissed.

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

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

The Tribunal found that the applicant sustained a psychological impairment (PTSD) as a result of the accident, warranting removal from the MIG.

The Tribunal also found the proposed treatment plan for a psychological assessment to be reasonable and necessary, and awarded interest on overdue benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for psychological and chiropractic treatment plans.

The insurer denied the benefits.

The Tribunal found the applicant was entitled to the psychological assessment and the October 2020 chiropractic treatment plan, as they were reasonable and necessary to address impairments resulting from the accident.

However, the Tribunal dismissed the claims for the 2022 chiropractic treatment plans due to insufficient evidence of their necessity and effectiveness.

The applicant was awarded interest on the overdue payments but denied an award under s. 10 of Reg. 664 as the insurer's actions were not unreasonable.

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

The Licence Appeal Tribunal found that the applicant's injuries were predominantly soft tissue in nature and that there was insufficient objective medical evidence to substantiate the claims of psychological impairment or chronic pain.

Consequently, the applicant remained subject to the $3,500 MIG limit, and the disputed treatment plans, special award, and interest were denied.

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 psychological impairments and chronic pain.

The adjudicator found that the applicant failed to provide sufficient medical evidence, such as clinical notes and records, to establish a psychological impairment or chronic pain with functional impairment.

Consequently, the applicant's injuries were deemed predominantly minor, and having exhausted the $3,500 MIG limit, she was not entitled to the disputed treatment plans or interest.

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 contended that pre-existing conditions and a psychological impairment warranted removal from the MIG.

The Tribunal found insufficient evidence of pre-existing physical conditions precluding recovery within the MIG.

Furthermore, the Tribunal preferred the respondent's medical evidence, which concluded the applicant was not psychologically impaired, over the applicant's evidence.

The application was dismissed, and the disputed treatment plans, interest, and award were denied.

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

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

The Tribunal found that the applicant's diagnosed whiplash and strains were minor injuries under the Schedule.

The applicant failed to prove that pre-existing conditions prevented maximal medical recovery within the MIG, and subsequent imaging occurred after a second motor vehicle accident.

The application was dismissed, and the applicant remained subject to the $3,500 MIG limit.

The applicant sought statutory accident benefits following a 2017 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 her psychological and chronic pain impairments were caused by the 2017 accident, noting a failure by her medical assessors to account for a prior 2014 accident.

The application for treatment plans, an award for unreasonable delay, and interest was dismissed.

The applicant sought $1,389.76 for a Hello Fresh meal kit delivery service as a rehabilitation benefit following a motor vehicle accident.

The applicant argued the meal kits would assist with cognitive recovery and reduce demands on his wife.

The Licence Appeal Tribunal found that while the meal kits might provide a cognitive exercise, they were not necessary because the applicant was already receiving an attendant care benefit that included assistance with meal preparation.

The Tribunal dismissed the application, finding the expense was not reasonable and necessary, and denied claims for interest and an award.

The applicant was injured in a motor vehicle accident and sought payment for three treatment plans for psychological services.

The insurer approved the plans but disputed the 1.5-hour session length, arguing for 1-hour sessions.

The Tribunal found the 1.5-hour sessions reasonable and necessary, noting that both the treating psychologist and the insurer's assessor agreed the applicant was improving and needed additional sessions.

The Tribunal ordered payment of the disputed balances and interest, but denied the applicant's request for a special award, finding the insurer did not act unreasonably in questioning the session length.

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

The respondent denied the claims, asserting the applicant's injuries fell within the Minor Injury Guideline (MIG) and its $3,500 limit.

The applicant argued that pre-existing conditions, including age, cardiovascular illness, and prior accident injuries, as well as a psychological diagnosis, warranted removal from the MIG.

The Tribunal found insufficient compelling medical evidence to support removal from the MIG.

As the applicant remained subject to the MIG, the disputed treatment plans were not payable, and the application was dismissed.