Melanie Malach

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident.

The respondent suspended IRBs due to the applicant's failure to provide requested financial documentation under s. 33 of the Schedule.

The Tribunal found the applicant did not provide a reasonable explanation for the 59-month delay in producing the documents, barring entitlement during the non-compliance period.

Furthermore, the Tribunal held the applicant failed to prove a complete inability to engage in any employment for the post-104 week period, noting she was off work due to maternity leaves rather than accident-related impairments.

The application was dismissed.

The applicant sought entitlement to statutory accident benefits following a motor vehicle accident, including a treatment plan for chiropractic services, a gym membership, and an ambulance fee.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to provide sufficient medical evidence to prove the chiropractic services and gym membership were reasonable and necessary.

The Tribunal also found the gym membership was not submitted via a treatment plan as required by s. 38(2) of the Schedule, and the ambulance fee had not been submitted to the applicant's extended health carrier as required by s. 47(2).

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

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

The Tribunal found the applicant's injuries were predominantly minor and she did not establish a pre-existing condition, chronic pain, or psychological impairment to warrant removal from the MIG.

The claims for a chronic pain assessment, psychological assessment, and Income Replacement Benefits (IRBs) were dismissed.

The Tribunal also ordered the applicant to repay $1,227.49 in overpaid IRBs to the respondent, as she had returned to work without notifying the insurer.

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

The respondent insurer scheduled multiple insurer's examinations under s. 44 of the Schedule to assess the applicant's entitlement to benefits.

The applicant failed to attend the scheduled examinations and did not provide a reasonable explanation for her non-attendance.

The Tribunal found that the notices of examination were proper and that the applicant's failure to attend barred her from proceeding with her application pursuant to s. 55(1)2 of the Schedule.

The application was dismissed.

The applicant sought income replacement benefits and approval of two treatment plans following a motor vehicle accident.

The respondent provided evidence that the treatment plans had already been approved and the income replacement benefits had been reinstated and subsequently increased.

As the applicant failed to file written submissions or adduce evidence to support a claim for an award under s. 10 of Reg. 664, the application was dismissed.

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

The respondent denied the proposed treatment plans for a psychological assessment and chiropractic treatment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that the respondent's denial notices did not comply with s. 38(8) of the Schedule and that he was therefore entitled to the benefits.

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

The Tribunal also found that the respondent's denial notices were valid and compliant with the Schedule.

The application was 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 failed to provide sufficient medical evidence to prove her injuries warranted removal from the MIG.

Consequently, her claims for a psychological assessment, chiropractic treatment, and ambulance services were dismissed.

The Tribunal also dismissed the claim for a non-earner benefit, finding the applicant did not establish a complete inability to carry on a normal life, as she failed to provide a comparative analysis of her pre- and post-accident activities.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit (NEB) and medical benefits for chiropractic and psychological services.

The respondent denied the benefits, citing the applicant's failure to comply with requests for medical records under s. 33 of the Schedule and relying on insurer examinations (IEs) that concluded the applicant did not suffer a complete inability to carry on a normal life.

The Tribunal dismissed the application, finding the applicant failed to provide medical evidence to refute the IE findings or establish that the treatment plans were reasonable and necessary.

Claims for an award and interest were also dismissed.

The applicant sought a non-earner benefit following a motor vehicle accident.

The respondent denied the benefit and requested insurer examinations under section 44 of the Schedule.

The adjudicator found that the applicant failed to meet her evidentiary burden to prove a complete inability to carry on a normal life, as she provided no comparative evidence of her pre- and post-accident activities and relied solely on an OCF-3.

The adjudicator accepted the conclusions of the respondent's insurer examination assessors and dismissed the application, including claims for interest and an award.

The applicant was injured in a motor vehicle accident and sought approval for a treatment plan for massage therapy, physiotherapy, and chiropractic services.

The insurer denied the plan, arguing the applicant's injuries were pre-existing and that he had reached maximum medical recovery.

The Tribunal applied the 'but for' test and found the accident was a necessary cause of the applicant's ongoing impairments.

Preferring the evidence of the applicant's treating chiropractor over the insurer's medical examiner, the Tribunal concluded the treatment plan was reasonable and necessary.

The applicant was awarded the treatment plan amount plus interest.

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

The matter proceeded to a written hearing, but neither party filed submissions.

The Tribunal proceeded with the hearing pursuant to s. 7(2) of the Statutory Powers Procedure Act.

As the applicant bore the onus of proving entitlement and failed to file any evidence or submissions, the application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident where a vehicle crashed into her workplace lunchroom.

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

The adjudicator found that the applicant failed to prove she suffered from chronic pain or a psychological condition that would warrant removal from the MIG, noting significant inconsistencies in her self-reporting, particularly her failure to disclose her participation in a physically demanding, full-time Personal Support Worker program shortly after the accident.

Consequently, the disputed treatment plans were denied.

However, the adjudicator awarded an Income Replacement Benefit for a closed period from the date the disability certificate was submitted until the date the applicant's family doctor cleared her to participate in the PSW program.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to four physical therapy treatment plans and one supervised exercise program.

The Licence Appeal Tribunal found the physical therapy treatment plans reasonable and necessary based on the applicant's ongoing complaints and treating physician's recommendations, giving little weight to the insurer's examination reports.

However, the Tribunal denied the exercise program as the applicant provided insufficient evidence to establish its reasonableness and necessity.

The applicant was awarded the physical therapy plans with interest.

The applicant insurer sought repayment of $51,215.17 in attendant care benefits paid to the respondent, alleging wilful misrepresentation and fraud.

The respondent failed to participate in the written hearing.

Relying on surveillance evidence and the respondent's own admissions during an Examination Under Oath, the Tribunal found that the respondent wilfully misrepresented the attendant care services he received.

The Tribunal ordered the respondent to repay the full amount of $51,215.17 plus interest.

The applicant's request for costs was denied as the respondent's failure to participate did not amount to bad faith or unreasonable conduct.

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 a pre-existing condition from a prior accident, concussion, chronic pain, and psychological impairment.

The Tribunal found the applicant failed to provide sufficient medical evidence to support removal from the MIG on any of these grounds.

The medical reports relied upon by the applicant were primarily related to a previous accident and did not establish that the subject accident caused or exacerbated conditions precluding recovery within the MIG.

The application for disputed treatment plans, interest, and an award 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 applicant argued that ongoing neck and back pain, along with psychological impairments, warranted removal from the MIG.

The Tribunal found that the applicant failed to establish a chronic pain condition or psychological impairment that would justify removal from the MIG, noting a lack of specialist referrals and the applicant's return to full-time work.

The Tribunal also found the respondent's denial notices were compliant with the Schedule.

The application was dismissed.

The applicant sought payment of the $1,125.30 balance of a psychological treatment plan following a motor vehicle accident.

The insurer had approved the treatment sessions but denied costs for reviewing external material, progress reports, scoring, brokerage services, and tax.

The applicant argued the denial was deficient under s. 38(8) of the Schedule for failing to provide a medical reason.

The Tribunal, applying Varriano, held that non-medical reasons are sufficient where no medical basis exists.

The Tribunal found the insurer's reasons clear and sufficient, and the applicant failed to provide evidence that the disputed administrative fees were reasonable, necessary, or permitted beyond the Guideline maximums.

The application was 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 claimed she suffered from a psychological condition warranting removal from the MIG.

The Tribunal found the applicant's medical evidence, including a psychological assessment, insufficient to establish a psychological impairment, preferring the respondent's independent examination report.

The Tribunal concluded the injuries were predominantly minor, the disputed treatment plans were not payable, and the respondent's denial notices complied with the Schedule.

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 chronic pain and a psychological condition.

The Tribunal found insufficient evidence of functional impairment due to pain or a psychological condition to warrant removal from the MIG.

As the MIG limit was exhausted, the disputed treatment plans for chiropractic services and a psychological assessment were denied.

Claims for an award and interest were also dismissed.

The applicant sought entitlement to income replacement benefits (IRBs) and various treatment plans following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the claim for IRBs, finding the applicant failed to provide sufficient medical evidence or required employment information to establish a substantial inability to perform the essential tasks of his employment.

The Tribunal also denied the enhanced hourly rates sought for a psychotherapist and social worker, as well as the costs for progress reports, but awarded $200 for the cost of completing one treatment plan.

The claim for a special award under s. 10 of Regulation 664 was dismissed as there was no evidence of unreasonable delay by the insurer.