Lisa Holland

The applicant sought statutory accident benefits following a motor vehicle accident, including post-104-week income replacement benefits, attendant care benefits, and various treatment plans.

The respondent insurer denied the benefits based on insurer examinations and non-compliance with requests for information.

The Tribunal found that the respondent's denial notices were compliant with the Statutory Accident Benefits Schedule.

The applicant failed to provide substantive submissions or evidence to demonstrate that the claimed benefits were reasonable and necessary, relying instead on procedural arguments regarding the denial notices.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, including removal from the Minor Injury Guideline (MIG), income replacement benefits (IRBs), and approval of treatment plans.

The Licence Appeal Tribunal found that the applicant failed to prove his injuries, including alleged chronic pain and psychological impairments, warranted removal from the MIG.

As the $3,500 MIG limit was exhausted, the disputed treatment plans were not payable.

The Tribunal also dismissed the claim for IRBs, finding insufficient evidence that the applicant suffered a substantial inability to perform the essential tasks of his pre-accident employment as a warehouse worker.

Claims for interest and an award were consequently dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to removal from the Minor Injury Guideline (MIG) due to a left knee injury, chronic pain, and psychological impairments.

The adjudicator found that the applicant failed to prove her injuries warranted removal from the MIG, noting pre-existing osteoarthritis and a lack of contemporaneous reporting of knee pain.

The adjudicator also determined that the respondent provided proper medical reasons for denying the disputed treatment plans under s. 38(8) of the Schedule.

The claim for non-earner benefits was dismissed as the applicant did not establish a complete inability to carry on a normal life, having returned to her pre-accident activities.

The application was dismissed in its entirety.

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

The respondent insurer raised a preliminary issue that the applicant was statute-barred from proceeding because he submitted his application for benefits (OCF-1) beyond the 30-day prescribed time limit.

The Tribunal found that the respondent failed to prove it properly delivered the application package or explained the process to the applicant, who had limited English skills and had not consented to email delivery.

Applying the Horvath factors, the Tribunal concluded the applicant had a reasonable explanation for the delay and allowed the claim to proceed.

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

In a prior decision, the Tribunal determined that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant filed a new application seeking payment for additional treatment plans, arguing he should be removed from the MIG.

The respondent raised a preliminary issue that the application was barred by res judicata.

The Tribunal found that the issue of the MIG had already been decided in a final decision between the same parties.

The Tribunal rejected the applicant's argument that new treatment plans constituted fresh evidence warranting a waiver of res judicata.

The application was dismissed.

The applicant requested a reconsideration of a previous Tribunal decision denying various statutory accident benefits, including attendant care benefits and multiple treatment plans.

The Tribunal found no material breach of procedural fairness.

However, it found an error of law in failing to determine if attendant care benefits were reasonable and necessary, though it ultimately concluded they were not.

The Tribunal also found an error of law and fact regarding three physiotherapy treatment plans, determining that the applicant was entitled to them because she had been removed from the Minor Injury Guideline and her treating neurologist had recommended the treatment.

The remainder of the reconsideration request was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, attendant care benefits, and various treatment plans for assessments and therapy.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to establish a complete inability to carry on a normal life, noting her pre-existing arteriovenous malformation and lack of evidence comparing pre- and post-accident functional abilities.

The Tribunal also dismissed the claims for treatment plans and attendant care benefits due to insufficient medical evidence and failure to prove the expenses were incurred.

Claims for an award, interest, and costs were also dismissed.

The applicant sought statutory accident benefits for oculo-visual treatment and physical therapy following a motor vehicle accident.

The respondent denied the treatment plans.

The applicant argued the denial notices were procedurally defective under s. 38(8) of the Schedule but made no submissions on the substantive reasonableness and necessity of the treatments.

The Tribunal found the respondent's denial notices were compliant with the Schedule, providing clear medical and other reasons.

As the applicant failed to establish the treatments were reasonable and necessary, the claims were dismissed, along with claims for interest and an award.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident, claiming he was unable to return to his pre-accident self-employment as an Uber driver due to psychological and neurological injuries.

The respondent insurer denied the benefit, arguing the applicant provided inconsistent information about his employment and failed to produce post-accident income documentation.

The Tribunal found that the applicant failed to demonstrate a substantial inability to perform the essential tasks of his pre-accident employment, noting a lack of medical evidence of ongoing symptoms and contradictory reports regarding his driving anxiety.

The application for an IRB was dismissed.

The applicant was involved in a motor vehicle accident and notified the insurer on the same day, resulting in a property damage claim.

Over four years later, the applicant sought statutory accident benefits.

The insurer raised a preliminary issue that the applicant was statute-barred under s. 32(1) of the Schedule for failing to report injuries or an intention to claim benefits within seven days.

Applying the Divisional Court's binding decision in Hussein v. Intact, the Tribunal found that reporting the accident itself satisfied the notice requirement under s. 32(1).

The insurer failed to fulfill its reciprocal obligation under s. 32(2) to inquire about injuries and provide application forms.

Consequently, the applicant was not statute-barred and was permitted to proceed to a substantive hearing.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs), medical benefits, and catastrophic assessment costs.

The Licence Appeal Tribunal dismissed the application.

The Tribunal found the applicant was not entitled to pre-104-week IRBs because she failed to prove a substantial inability to perform her pre-accident employment, noting she was on employment insurance for pre-existing conditions prior to the accident and had indicated she did not intend to return to her job.

The claim for post-104-week IRBs was also dismissed as the applicant provided no evidence of a complete inability to engage in suitable employment.

Claims for outstanding treatment plan balances, including provider travel time and comprehensive file reviews, were denied as the applicant failed to establish they were reasonable and necessary or payable under the Schedule.

The minor applicant was involved in a motor vehicle accident at age three.

The respondent insurer denied benefits because the application (OCF-1) was submitted nearly two years after the accident, outside the timelines in the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant had a reasonable explanation for the delay, as he was a minor under a legal disability, entirely reliant on his guardians, and his psychological injuries were not immediately apparent.

The applicant was permitted to proceed with his claim.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit, a psychological assessment, and removal from the Minor Injury Guideline (MIG) due to psychological impairments.

The Tribunal found that the applicant failed to prove a psychological diagnosis or impairment that would warrant removal from the MIG, noting he had returned to his pre-accident academic and social activities.

The claim for a non-earner benefit was dismissed as the applicant did not establish a complete inability to carry on a normal life.

The application was dismissed in its entirety.

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

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

The applicant argued that the denial notices were non-compliant with s. 38(8) of the Schedule, meaning the two-year limitation period under s. 56 was not triggered.

The Tribunal found that the respondent's denial notices provided sufficient medical and other reasons by identifying the MIG and requesting compelling medical evidence to the contrary.

Consequently, the applicant was statute-barred from disputing those plans.

The Tribunal also dismissed the claim for a cognitive communication assessment, finding it was not reasonable and necessary, and denied the request for an award.

The applicant sought statutory accident benefits following a motor vehicle accident but failed to file written submissions or evidence for the hearing.

The respondent requested the application be dismissed as abandoned and sought $500 in costs.

The Tribunal proceeded with the written hearing, finding the applicant failed to meet her evidentiary burden to establish entitlement to the claimed benefits, including psychological services, a chronic pain assessment, and travel expenses.

The application was dismissed.

The Tribunal denied the respondent's request for costs, finding the applicant's failure to file submissions was not inherently unreasonable, frivolous, vexatious, or in bad faith, and the respondent suffered no prejudice.

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

The insurer sought repayment of $20,297.71 for duplicative income replacement benefit (IRB) payments made in error.

The applicant failed to file submissions or participate in the written hearing.

The Tribunal proceeded in the applicant's absence and found the insurer was entitled to the IRB repayment under section 52 of the Schedule, as the insurer provided proper notice within the 12-month period.

The applicant's claims for an award and interest were dismissed.

The applicant sought various statutory accident benefits following a November 2019 motor vehicle accident.

The Tribunal found the applicant was statute-barred from proceeding with a claim for an orthopaedic assessment due to her failure to attend a scheduled insurer's examination without a reasonable explanation.

Regarding the substantive claims, the Tribunal denied the majority of the disputed treatment plans for chiropractic services, massage therapy, and assistive devices, finding the applicant failed to prove they were reasonable and necessary on a balance of probabilities.

The Tribunal awarded $200 for documentation support activity with interest, but denied the claim for a section 10 award.

The applicant sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent insurer denied portions of several treatment plans for physiotherapy, occupational therapy, and psychological services, as well as transportation expenses.

The adjudicator found that the respondent's denial notices were compliant with section 38(8) of the Schedule.

The applicant failed to prove that the disputed physiotherapy, occupational therapy, and transportation expenses were reasonable and necessary.

However, the adjudicator found that the proposed psychological services were reasonable and necessary based on the treating psychologist's evidence of ongoing symptoms.

The claim for an award for unreasonable delay was dismissed.

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

In a prior 2024 decision, the Tribunal determined the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant filed a second application seeking removal from the MIG based on new treatment plans and medical reports.

The respondent raised the preliminary issue of res judicata.

The Tribunal found that the three preconditions for issue estoppel were met and that the new medical reports did not constitute fresh, previously unavailable evidence that would impeach the original result.

The application was dismissed as barred by res judicata.

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

The adjudicator found that the applicant was statute-barred from disputing a chronic pain assessment because she failed to file an application within the two-year limitation period after receiving valid denials from the insurer.

The adjudicator also dismissed claims for a psycho-vocational assessment, finding the applicant had returned to her pre-accident employment, and for psychological services, as the applicant failed to justify the need for longer sessions at a higher rate than approved.

A claim for chiropractic services was denied because the expense was incurred before a treatment plan was submitted.

Claims for interest and an award were consequently dismissed.