Lisa Holland

The applicant sought payment for a treatment plan totaling $22,200 for catastrophic impairment assessments following a motor vehicle accident.

The adjudicator found that the applicant failed to meet his burden of proving the assessments were reasonable and necessary, noting that the applicant did not provide a copy of the proposed treatment plan or make submissions addressing its necessity.

The application was dismissed.

The applicant sought income replacement benefits (IRBs) post-104 weeks, as well as payment for chiropractic services and catastrophic assessments following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove a complete inability to engage in suitable employment, relying on surveillance evidence and independent medical examinations showing the applicant could perform employment-type activities.

The Tribunal also found the proposed treatment plans and assessments were not reasonable and necessary, as they were duplicative of previously completed programs or lacked justification.

Claims for interest and an award were consequently dismissed.

The applicant sought entitlement to statutory accident benefits for an orthopaedic assessment and physiotherapy services following a motor vehicle accident.

The adjudicator found that the applicant failed to meet her burden of proving the treatment plans were reasonable and necessary, noting that she did not submit the plans into evidence or provide specific submissions on their goals.

Relying on insurer examination reports which indicated the applicant had uncomplicated soft tissue injuries and was working 13 hours a day without restrictions, the adjudicator dismissed the claims for treatment, interest, and a special award.

The applicant sought payment for various treatment plans, including occupational therapy, psychological and orthopaedic assessments, and workplace modification devices, following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to establish on a balance of probabilities that the proposed treatment plans were reasonable and necessary.

Medical evidence indicated the applicant had reached functional recovery and returned to pre-accident activities without accommodations.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming the unapproved portions of several treatment plans for psychological and occupational therapy services.

The respondent had partially approved the plans but denied the higher hourly rate proposed for a psychotherapist and the costs for brokerage services.

The Tribunal found that the applicant failed to demonstrate why the psychotherapist should be paid at a rate equivalent to a psychologist, exceeding the Professional Services Guideline.

Furthermore, the applicant provided no evidence to justify the brokerage services, which are excluded under the Guideline.

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

The applicant sought an income replacement benefit (IRB) and funding for four psychological treatment plans following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove a substantial inability to perform the essential tasks of his pre-accident employment, noting he had been laid off due to a shortage of work and received regular employment insurance benefits.

The Tribunal also denied the treatment plans, concluding the applicant did not provide sufficient explanation or evidence to justify the outstanding amounts for brokerage, planning, and documentation support services beyond what the insurer had already approved.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident.

In a previous 2020 decision, the Tribunal found the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant brought a second application seeking removal from the MIG based on alleged new medical evidence and claiming entitlement to additional treatment plans.

The Tribunal held that the doctrine of res judicata barred the applicant from relitigating the MIG issue, as the new medical reports did not constitute fresh evidence that would conclusively impeach the original result.

The Tribunal also found the respondent provided proper notice of denial for the disputed treatment plans.

The application was dismissed.

The applicant sought entitlement to a $4,008.42 physiotherapy treatment plan following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to provide contemporaneous medical evidence from a qualified physical rehabilitation specialist to support the plan.

The Tribunal preferred the evidence of the respondent's physiatrist, who concluded the applicant had full range of motion and the treatment was not reasonable and necessary.

Claims for interest and a section 10 award were also dismissed.

The applicant sought payment for two treatment plans for psychological services following a motor vehicle accident.

The Tribunal found the applicant failed to establish that the outstanding balance of the first plan was payable, as he did not justify a higher hourly rate for a psychotherapist or the need for additional brokerage, planning, and documentation services.

The Tribunal also denied the second plan, relying on an insurer's examination report indicating the applicant had reached maximum medical improvement and had no interest in further psychotherapy.

The application was dismissed in its entirety.

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

The respondent denied a treatment plan for physiotherapy services, asserting the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued the denial notice was invalid under s. 38(8) of the Schedule, rendering the benefits payable.

The Tribunal found the respondent's denial notice was valid, as it provided clear medical and other reasons, including a request for specific pre-accident medical records.

The applicant failed to demonstrate that her injuries warranted removal from the MIG.

The application was dismissed, with no entitlement to the disputed treatment plan, interest, or an award.

The applicant sought entitlement to statutory accident benefits for a neuro-optometric assessment and occupational therapy services following a motor vehicle accident.

The respondent denied the treatment plans, relying on insurer's examinations which concluded the applicant's ongoing symptoms were related to pre-existing conditions rather than the accident.

The Tribunal found the applicant failed to meet her burden of proving the treatment plans were reasonable and necessary, noting a lack of corroborating medical evidence and significant pre-existing health issues.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including attendant care benefits and various treatment plans for occupational therapy, physiotherapy, optometry, social work, and medical assessments.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline and the expenses were not reasonable and necessary.

The Licence Appeal Tribunal dismissed the application, finding that the attendant care benefits were not incurred and the applicant failed to prove on a balance of probabilities that the proposed treatment plans were reasonable and necessary for her accident-related injuries.

Claims for interest and an award were also 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 for removal from the MIG based on psychological impairments.

The Tribunal found the applicant failed to provide sufficient medical evidence of an accident-related psychological impairment, relying instead on self-reports to a psychologist without corroboration from her treating physician.

The Tribunal concluded the applicant's injuries were predominantly minor and subject to the MIG limits.

Consequently, the disputed treatment plan for a psychological assessment was not payable.

Claims for an award and interest were also 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 focused his arguments on alleged procedural errors by the respondent, claiming the respondent failed to provide proper medical reasons for denying the income replacement benefit (IRB) and treatment plans under sections 36(4) and 38(8) of the Schedule.

The Tribunal found that the applicant failed to provide substantive medical evidence to warrant removal from the MIG or entitlement to an IRB.

Furthermore, the Tribunal held that the respondent's denials were procedurally valid, as they requested specific medical information necessary to determine entitlement.

The application was dismissed.

The applicant sought a non-earner benefit and payment for vision therapy and chiropractic services following a motor vehicle accident.

The respondent denied the benefits.

The applicant argued that the respondent failed to comply with the procedural requirements of the Schedule, rendering the benefits payable.

The Tribunal found that the respondent provided compliant denials and that the applicant failed to establish substantive entitlement to the benefits.

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 Tribunal found the applicant failed to establish a psychological impairment warranting removal from the MIG.

The Tribunal also found the applicant did not establish substantive entitlement to non-earner benefits (NEBs) as she failed to demonstrate a complete inability to carry on a normal life.

However, the Tribunal awarded NEBs for a limited period (September 29 to November 20, 2022) due to the respondent's procedural non-compliance with s. 36(4) of the Schedule.

Claims for an award and further interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing her injuries—including chronic pain, psychological impairments, post-concussive syndrome, and pre-existing conditions—warranted removal from the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found the applicant failed to provide compelling medical evidence or documentation from treating physicians to substantiate her claims for removal from the MIG.

As the applicant's injuries were deemed predominantly minor and the MIG limits were exhausted, her claims for various treatment plans, interest, and a punitive award were dismissed.

The applicant sought entitlement to statutory accident benefits for an occupational therapy assessment, social worker counselling, and chiropractic services following a motor vehicle accident.

The applicant argued the respondent's denial notices were procedurally defective under s. 38(8) of the Schedule.

The Tribunal found that while one denial was late, the applicant failed to prove the expenses were incurred during the period of non-compliance.

The Tribunal concluded the respondent's notices provided clear medical reasons for the denials, relying on insurer's examinations.

As the applicant made no submissions on the substantive reasonableness and necessity of the treatment plans, the application was dismissed.

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

The Licence Appeal Tribunal found the applicant failed to meet her burden of proof, as medical evidence indicated her injuries were predominantly minor soft tissue injuries that had largely resolved.

Because the MIG limits were exhausted, the Tribunal dismissed the claims for additional chiropractic, physiotherapy, and psychological assessment treatment plans.

The Tribunal also found the respondent provided proper notice of denial under s. 38(8) of the Schedule, and denied claims for interest and a special award.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's denial of treatment plans for physiotherapy, a social work assessment, and an orthopaedic assessment.

The applicant argued the insurer's denial notices were procedurally defective under s. 38(8) of the Schedule.

The Tribunal found the insurer's denial notices were compliant and properly relied on an Insurer's Examination report.

As the applicant failed to provide submissions on the substantive reasonableness and necessity of the plans, the application was dismissed.

The insurer's request for costs due to the inadvertent inclusion of a settlement document was also denied.