Ludmilla Jarda

The applicant passed away prior to the commencement of an application for statutory accident benefits.

The application was commenced by counsel without an estate trustee having been appointed.

The Licence Appeal Tribunal found that the application was not properly constituted and was an irremediable nullity, as a deceased person cannot pursue accident benefits and no lawfully authorized representative was appointed.

The application was dismissed as an abuse of process, and the respondent's request for costs was denied.

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

The Licence Appeal Tribunal found the applicant was entitled to reduced amounts for yoga therapy, occupational therapy services, and an attendant care needs assessment, finding them reasonable and necessary for symptom management and functional improvement.

The Tribunal denied claims for chiropractic and physiotherapy treatment, finding the applicant had reached maximum medical recovery for orthopaedic injuries.

The Tribunal also declined to order a special award under s. 10 of Regulation 664, finding the insurer's conduct was not excessive or imprudent.

The applicant sought attendant care benefits (ACB) following a motor vehicle accident.

The insurer partially paid the submitted invoices using the ratio method from Malitskiy due to a lack of sufficient particulars regarding the services provided.

The Tribunal upheld the use of the ratio method, finding the applicant failed to prove the full balance of the invoices was incurred under s. 3(7)(e) of the Schedule.

The Tribunal awarded a minor shortfall of $86.74 in ACB with interest, but dismissed the claim for an award under s. 10 of Regulation 664, finding the insurer's conduct was not unreasonable.

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

The respondent insurer denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed a psychological impairment warranted removal from the MIG.

The Tribunal found insufficient evidence of a psychological impairment, noting discrepancies in the applicant's psychological report and accepting the respondent's assessment that no psychological diagnosis existed.

The Tribunal concluded the applicant's injuries were predominantly minor.

However, because the respondent had not fully exhausted the $3,500 MIG limit, the Tribunal ordered the respondent to pay for the disputed treatment plans up to the remaining MIG balance, provided they were already incurred, pursuant to section 40(8) of the Schedule.

The applicant was injured in a motorcycle accident and sought various statutory accident benefits, including the cost of a replacement helmet, visitor expenses, assistive devices, and the unapproved balances of numerous treatment plans.

The Tribunal found that a helmet constitutes clothing under s. 24(1) of the Schedule and awarded its replacement cost.

The Tribunal also awarded a portion of the claimed visitor expenses that were supported by evidence.

However, the claims for assistive devices and the unapproved balances of the treatment plans were dismissed, as the applicant failed to prove they were reasonable and necessary or that they had been submitted to his extended health care provider.

The claim for a special award was also dismissed.

The applicant, who was struck by a car while riding his bicycle, sought $2,200 for an occupational therapy assessment and attendant care needs evaluation under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal dismissed the application, finding insufficient evidence that the treatment plan was reasonable and necessary.

The Tribunal preferred the insurer's medical evidence, noting the applicant's complex pre-existing medical history and a lack of contemporaneous medical records supporting accident-related functional impairments.

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

The respondent denied treatment plans for physiotherapy and a chronic pain assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and its $3,500 limit, which was exhausted.

The applicant argued she suffered from chronic pain and psychological impairments warranting removal from the MIG.

The adjudicator found the applicant sustained predominantly minor soft tissue injuries and failed to prove chronic pain with functional impairment or psychological impairment.

The adjudicator preferred the respondent's physiatry assessment over the applicant's medical evidence.

As the applicant remained within the MIG, the disputed treatment plans were denied, and no interest was payable.

The application was dismissed.

The applicant sought statutory accident benefits for medical cannabis and chiropractic treatment following a 2017 motor vehicle accident.

The respondent denied the benefits, relying on insurer examination reports indicating the applicant had reached maximal medical improvement and did not suffer from chronic pain or a sleep disorder as a result of the accident.

The adjudicator dismissed the application, finding the applicant failed to provide objective medical evidence to prove the treatment plans were reasonable and necessary.

The applicant insurer sought repayment of income replacement benefits (IRB) paid to the respondent following a motor vehicle accident, alleging an overpayment after the respondent returned to work.

The respondent disputed the repayment and sought approval for a psychological treatment plan.

The Tribunal found that the applicant provided sufficient notice of repayment and was entitled to a repayment of $1,828.56, plus interest, based on the respondent's employment income during the relevant period.

The Tribunal dismissed the respondent's claim for the treatment plan, finding insufficient evidence that it was reasonable and necessary, as previous similar plans were not fully utilized and no psychological diagnosis was provided.

The applicant's request for costs was denied.

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

The Tribunal found the applicant's injuries were predominantly minor soft-tissue injuries, rejecting the applicant's psychological expert evidence due to reliance on self-reporting and symptom magnification.

The Tribunal also held that the insurer's denial notices were compliant with the Schedule, and the disputed treatment plans were not payable.

The application was dismissed, and the respondent's request for costs due to the applicant's late filing of submissions was denied.

The applicant sought entitlement to a $2,000.00 chronic pain assessment and interest under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to demonstrate on a balance of probabilities that the assessment was reasonable and necessary.

The Tribunal concluded there was insufficient evidence to support a chronic pain diagnosis, noting the applicant did not meet three of the six criteria outlined in the AMA Guides.

As no benefits were payable, the claim for interest was also dismissed.

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

The respondent denied treatment plans for physiotherapy and a psychological assessment 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 prove he suffered from a psychological impairment or chronic pain that would warrant removal from the MIG.

Medical evidence indicated his musculoskeletal injuries had resolved.

As the MIG limit was exhausted, the applicant was not entitled to the disputed treatment plans or interest.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that his injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant failed to provide objective medical evidence to prove his injuries warranted removal from the MIG.

Relying on the insurer's physiatry assessment, the Tribunal concluded the applicant sustained soft tissue injuries that were predominantly minor.

As the applicant remained within the MIG and had exhausted the $3,500 limit, his claims for additional treatment plans, interest, and an award were 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) and the $3,500 limit had been exhausted.

The Tribunal found that the applicant failed to prove his injuries warranted removal from the MIG, as there was insufficient evidence of a pre-existing condition preventing recovery, chronic pain with functional impairment, or a psychological condition caused by the accident.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought payment for the unapproved balances of three treatment plans for psychological services and catastrophic impairment assessments.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the proposed hourly rate of $224.42 for psychological services was reasonable and necessary, as it exceeded the maximum rate in the Professional Services Guidelines.

The Tribunal also found the applicant failed to justify the cost of clinical file review assessments, which appeared to duplicate approved in-person assessments.

Claims for interest and an award were consequently dismissed.

The applicant sought an award under s. 10 of Regulation 664, alleging the respondent unreasonably delayed or withheld payment for a psychological assessment treatment plan.

The respondent had initially denied the plan because it would exceed the $50,000 statutory limit for medical and rehabilitation benefits.

Once the applicant confirmed he would not use remaining funds from previously approved plans, the respondent approved the treatment plan.

The Tribunal found the respondent's actions were not excessive, imprudent, stubborn, unyielding, or immoderate, and dismissed the claim for an award.

The applicant sought entitlement to various treatment plans and a SPECT scan following a 2017 motor vehicle accident.

The applicant argued the treatment plans were payable because the insurer failed to provide compliant denials within 10 days under s. 38 of the Schedule.

The Tribunal found the insurer's denials were timely and compliant.

On the merits, the Tribunal held the treatment plans were not reasonable and necessary, relying on insurer examinations that found the applicant had adequate functional abilities and no ongoing cognitive impairments.

The SPECT scan was denied as it was submitted beyond the 260-week limitation period.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits, income replacement benefits, and various medical and rehabilitation benefits.

The Licence Appeal Tribunal found that the applicant was not entitled to attendant care benefits as they were not reasonable and necessary, nor were they incurred.

The Tribunal held that the applicant was statute-barred from proceeding with her claims for income replacement benefits and a psychological assessment, declining to extend the limitation period under section 7 of the Licence Appeal Tribunal Act due to excessive delay and lack of merit.

The remaining medical and rehabilitation benefits, including bathroom renovations and pool accessories, were denied as not reasonable and necessary for predominantly minor soft tissue injuries.

The application was dismissed.

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

The respondent insurer denied benefits beyond the Minor Injury Guideline (MIG) limit and alleged the applicant was barred from receiving Income Replacement Benefits (IRB) due to a material misrepresentation regarding the use of his vehicle for ride-sharing.

The Tribunal found the respondent failed to prove the vehicle was used for ride-sharing, so the applicant was not barred from IRB and the respondent was not entitled to repayment of previously paid IRB.

However, the Tribunal concluded the applicant's injuries were predominantly minor, preferring the respondent's medical experts over the applicant's expert due to a lack of objective evidence.

As the MIG limit was exhausted, the applicant was not entitled to the disputed medical and attendant care benefits.

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 failed to prove his injuries, including alleged head and shoulder injuries and chronic pain, warranted removal from the MIG.

The Tribunal also dismissed the claim for income replacement benefits, finding insufficient evidence of a substantial inability to perform essential tasks of employment and a failure to produce post-accident income records.

Claims for treatment plans, interest, and an award for unreasonable delay were consequently dismissed.