Lisa Yong

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found he did not sustain a catastrophic impairment.

The applicant argued that the Tribunal breached procedural fairness and made errors of law by excluding his written submissions, relying on the respondent's section 44 assessment reports without the assessors testifying, and ignoring his expert evidence.

The Tribunal dismissed the reconsideration request, finding that case law is not new evidence under Rule 18.2(c), the exclusion of written submissions in a videoconference hearing was proper, the applicant had the opportunity to summons the section 44 assessors but failed to do so, and the Tribunal is not required to comment on every piece of evidence in its decision.

The applicant was involved in a motor vehicle accident and sought a non-earner benefit (NEB) under the Statutory Accident Benefits Schedule.

The respondent insurer argued the application was statute-barred because the applicant failed to submit the OCF-1 form within the required timeframe.

The Tribunal found the applicant was not statute-barred, as the respondent failed to prove it sent the blank OCF-1 form to the applicant's correct address, meaning the 30-day time limit was never triggered.

However, on the substantive issue, the Tribunal dismissed the claim for a NEB.

The applicant failed to provide sufficient medical evidence comparing his pre- and post-accident functioning to establish a complete inability to carry on a normal life within 104 weeks of the accident.

Claims for interest and an award were consequently dismissed.

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

The insurer denied several treatment plans, 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's evidence of chronic pain and psychological impairment unpersuasive, as it was unsupported by contemporaneous medical records and contradicted by the insurer's examinations.

The Tribunal concluded the injuries were predominantly minor, the applicant remained subject to the MIG limit, and dismissed the application for the disputed treatment plans and interest.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident, including a non-earner benefit and funding for orthopaedic and psychological assessments.

The Licence Appeal Tribunal dismissed the application.

The claim for a non-earner benefit was barred because the applicant failed to submit a completed OCF-3 Disability Certificate within two years of the accident, as strictly required by section 32(3) of the Schedule.

The proposed assessments were found not to be reasonable and necessary, as the medical evidence did not support the need for them years after the accident.

Claims for an award and costs were also dismissed.

The applicant sought a determination of catastrophic impairment following a 2016 motor vehicle accident.

The Tribunal found the applicant did not meet the 55% whole person impairment threshold under Criterion 7, as his combined physical and psychological impairments totaled 42%.

However, the Tribunal concluded the applicant sustained a catastrophic impairment under Criterion 8, finding marked impairments in three domains: social functioning, activities of daily living, and adaptation.

The Tribunal largely preferred the evidence of the applicant's neuropsychologist and mother over the insurer's assessors.

The applicant's request for costs due to alleged spoilage of evidence was denied.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident, claiming catastrophic impairment under Criteria 7 (55% whole person impairment) and Criteria 8 (marked impairment in three of four domains).

The Licence Appeal Tribunal found the applicant's whole person impairment was 47%, falling short of the 55% threshold, and that he did not suffer marked impairment in social functioning.

The Tribunal denied most of the disputed treatment and assessment plans, finding them not reasonable and necessary, but approved a $2,665.50 chronic pain assessment.

Claims for attendant care benefits, an award for unreasonable delay, and costs were dismissed.

The applicant sought income replacement benefits (IRB) and approval for two treatment plans (interpretation services and an orthopaedic assessment) following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove she suffered a substantial inability to perform the essential tasks of her pre-accident employment as a customer service clerk.

The Tribunal also found the proposed treatment plans were not reasonable and necessary, as the applicant could communicate adequately in English and her injuries were uncomplicated soft tissue strains that did not warrant an orthopaedic assessment.

Claims for interest and a special award were consequently 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 Tribunal found that the applicant sustained predominantly minor soft tissue injuries and did not suffer from a pre-existing condition or chronic pain with functional impairment that would warrant removal from the MIG.

As the $3,500 MIG limit was exhausted, the disputed treatment plans were denied, and claims for interest and a section 10 award were dismissed.

The applicant sought statutory accident benefits, claiming a catastrophic impairment due to mental and behavioural disorders following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant did not sustain a marked impairment in social functioning, as his self-reports were inconsistent with direct observations by psychiatrists, family testimony, and surveillance evidence.

Because the applicant could not establish a marked impairment in at least three areas of function, the application was dismissed.

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

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

The applicant applied to the Licence Appeal Tribunal, arguing his physical injuries and a psychological impairment warranted removal from the MIG.

The Tribunal found that the applicant's physical injuries were predominantly minor, noting a lack of compelling and contemporaneous evidence of ongoing complaints.

The Tribunal also found insufficient evidence of a psychological impairment, as the applicant had not made psychological complaints to his family doctor and the psychological assessment report was inconsistent with the medical evidence.

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

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

The respondent denied four physiotherapy treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued for removal from the MIG due to pre-existing psychological conditions and accident-related chronic pain.

The Tribunal found insufficient medical evidence that the pre-existing conditions prevented maximal medical recovery within the MIG.

Relying on the respondent's physiatry assessment, the Tribunal concluded the injuries were predominantly minor.

The application was dismissed.

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 Tribunal found that the applicant was statute-barred from claiming a psychological assessment due to her failure to attend scheduled insurer's examinations.

The Tribunal further held that the applicant failed to establish that her physical injuries, pre-existing conditions, alleged psychological impairment, or chronic pain warranted removal from the MIG.

However, the applicant was awarded $225.62 for a physiotherapy plan because the respondent failed to provide a compliant denial notice under s. 38(8) of the Schedule.

The claims for other treatment plans and an award under s. 10 of O. Reg. 664 were 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 psychological impairments and chronic pain.

The Licence Appeal Tribunal found that the applicant sustained predominantly minor soft tissue injuries.

The Tribunal preferred the respondent's insurer examination reports, finding insufficient evidence of a psychological impairment or chronic pain meeting the AMA Guides criteria.

The applicant's injuries were deemed subject to the $3,500 MIG limit, and the application for additional treatment plans was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of treatment plans for a neurological assessment, psychotherapy services, transportation costs for an orthopaedic assessment, and physiotherapy services.

The Licence Appeal Tribunal found that the neurological assessment and physiotherapy services were not reasonable and necessary, relying on insurer examination reports and the lack of objective improvement from past treatments.

The Tribunal also held that the applicant failed to justify a higher hourly rate for a psychotherapist and did not provide evidence of incurred transportation expenses.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits after slipping and falling on ice while attempting to open the passenger door of his parked vehicle.

The respondent insurer denied benefits, arguing the incident did not meet the definition of an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal applied the purpose and causation tests, finding that opening the vehicle door was an ordinary use of an automobile and the dominant feature of the incident.

The Tribunal concluded that the icy ground was not an intervening act that broke the chain of causation, and therefore the incident qualified as an accident.

The applicant sought various medical and rehabilitation 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 sustained predominantly minor injuries and failed to establish that her pre-existing conditions, chronic pain, or psychological impairments warranted removal from the MIG.

The application was dismissed, though the applicant remained entitled to benefits already incurred up to the $3,500 MIG limit.

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

The Tribunal found the applicant was barred from receiving a non-earner benefit under s. 31(1)(d)(i) of the Schedule because she was convicted of a criminal offence on the day of the accident.

The Tribunal also held that the applicant's injuries were predominantly minor and subject to the $3,500 Minor Injury Guideline limit, as the medical evidence showed her psychological conditions pre-dated the accident and were not exacerbated by it.

The application for treatment plans and an award was dismissed.

The applicant sought entitlement to statutory accident benefits for various treatment and assessment plans following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the plans were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's independent medical examiners, who found no substantial impairment and concluded the applicant had reached maximum medical improvement, over the applicant's medical evidence which lacked contemporaneous support.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found him to be within the Minor Injury Guideline and not entitled to several disputed treatment plans.

The applicant argued the Tribunal made errors of law in applying the test for adequate medical reasons under s. 38(8) of the Statutory Accident Benefits Schedule and failing to consider the consequences of s. 38(11).

The adjudicator granted the reconsideration in part, finding an error of law was made regarding the plans for an attendant care assessment, functional ability evaluation, and psychological assessment.

The adjudicator varied the decision, holding the insurer liable to pay for those plans once incurred, as the insurer's denial notices were deficient and could no longer be cured.

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 impairment.

The Tribunal found the applicant's injuries were predominantly minor soft-tissue injuries, relying on hospital records and insurer examinations that showed normal range of motion and insignificant psychological symptoms.

As the applicant failed to establish chronic pain with functional impairment or a psychological condition warranting removal from the MIG, and the $3,500 limit was already exhausted, the disputed treatment plans and interest were denied.