Margaret Sims

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

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

The applicant applied to the Licence Appeal Tribunal, arguing he should be removed from the MIG due to chronic pain.

The adjudicator applied the AMA Guidelines criteria and found the applicant suffered from chronic pain with functional impairment, removing him from the MIG.

The adjudicator concluded that the disputed treatment plans for chiropractic, massage, aquatic therapy, and a chronic pain assessment were reasonable and necessary.

The respondent was ordered to pay the disputed amounts plus interest.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic services, psychological services, and a chronic pain assessment.

The respondent insurer denied the treatment plans, arguing the applicant had not incurred treatment for several years and the plans were submitted near the five-year limit.

The Tribunal found the treatment plans were reasonable and necessary, noting the applicant had been confined to the Minor Injury Guideline (MIG) for over four years and had outstanding incurred treatment amounts.

The Tribunal deemed the expenses incurred under s. 3(8) of the Schedule because the respondent unreasonably withheld payment.

The Tribunal also ordered the respondent to pay a $2,500 award under s. 10 of O. Reg. 664 for behaving stubbornly and inflexibly in failing to adjust the claims in good faith after the applicant was removed from the MIG.

The applicant sought statutory accident benefits following a 2015 motor vehicle accident.

The respondent denied treatment plans for chronic pain and psychological assessments, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that the disputed treatments related to a subsequent 2020 accident.

The Tribunal found the applicant sustained minor injuries in the 2015 accident and failed to prove his impairments fell outside the MIG.

Furthermore, the Tribunal held the applicant did not meet his burden of establishing the disputed treatment plans were for injuries sustained in the 2015 accident rather than the 2020 accident.

The claims for benefits, interest, and a section 10 award were dismissed.

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

The Licence Appeal Tribunal considered whether treatment plans for injections, an adjustable mattress, and a pillow were reasonable and necessary.

The Tribunal found the injections and adjustable mattress were reasonable and necessary to treat the applicant's chronic pain and sleep disturbances resulting from the accident.

The claim for the pillow was denied as the applicant failed to justify an excessive documentation fee.

The respondent was ordered to pay for the injections and mattress, plus 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) limit of $3,500.

The applicant argued his injuries fell outside the MIG due to psychological impairments, chronic pain, and pre-existing conditions.

The Tribunal found that the applicant sustained predominantly minor injuries (back and shoulder sprains) and failed to prove on a balance of probabilities that he suffered from an accident-related psychological impairment or chronic pain syndrome that would warrant removal from the MIG.

The Tribunal also found no compelling evidence of a pre-existing condition that would prevent maximal recovery within the MIG limit.

As the MIG limits were exhausted, the disputed treatment plans were denied, and no award for unreasonable delay was granted.

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

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

The applicant argued that psychological and neurological impairments, as well as pre-existing conditions, removed him from the MIG.

The Tribunal found that the applicant's injuries were predominantly minor and that he failed to provide compelling medical evidence of pre-existing conditions that would prevent maximal recovery within the MIG limits.

However, because the respondent's initial notice of denial for one treatment plan was non-compliant with section 38(8) of the Schedule, the applicant was entitled to incurred costs for that plan up until a compliant notice was issued.

The remaining treatment plans and a claim for a special award were dismissed.

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

The insurer denied the benefits.

The Licence Appeal Tribunal found that the applicant suffered from a persistent and complex pattern of musculoskeletal complaints, primarily lower back pain, caused by the accident.

The Tribunal concluded that the proposed chiropractic treatments and the chronic pain assessment were reasonable and necessary.

The applicant was awarded the claimed amounts plus interest.