Melissa Shea

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

The Tribunal found that the applicant did not suffer a marked impairment in social functioning, as she demonstrated abilities compatible with some useful functioning, such as maintaining friendships, dating, and travelling.

Consequently, she did not meet the threshold for catastrophic impairment.

The Tribunal approved treatment plans for massage therapy, physiotherapy, and specific occupational therapy items (snow removal and a cervical pillow) as reasonable and necessary, but denied funding for general occupational therapy and the unapproved balance of catastrophic impairment assessments.

The applicant's claim for an award for unreasonable delay was dismissed, but she was awarded $500 in costs due to the respondent's failure to produce an adjuster at the hearing.

The applicant sought statutory accident benefits following a 2019 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant was statute-barred from disputing a 2019 physiotherapy treatment plan because she failed to apply within the two-year limitation period, and there were no reasonable grounds to extend the time under s. 7 of the LAT Act.

The Tribunal further held that the applicant's injuries fell within the Minor Injury Guideline (MIG), as she failed to establish that her chronic pain or psychological impairments were caused by the subject accident rather than a prior 2016 accident.

Consequently, the disputed treatment plans were not payable, and claims for interest and a special award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits and payment for various treatment plans.

The Licence Appeal Tribunal found the applicant was entitled to attendant care benefits of $1,879.82 per month, rejecting both the applicant's claim for $6,000 and the insurer's approval of $715.88.

The Tribunal denied the treatment plan for physio/vestibular services because it was not submitted through the HCAI system.

The Tribunal also denied the disputed amounts for occupational therapy and social work services, finding the insurer's approved hourly rate for the social worker was appropriate and that mileage expenses for treatment providers to travel to the applicant's home were not authorized transportation expenses under the Schedule.

The applicant sought a determination that he sustained a catastrophic impairment following a motor vehicle accident, relying on Criteria 7 and 8 of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal dismissed the application, finding the applicant did not meet the 55% whole-person impairment threshold under Criterion 7 or demonstrate three marked impairments under Criterion 8.

The Tribunal gave no weight to the reports of the applicant's medical experts who failed to attend the hearing for cross-examination, and preferred the evidence of the respondent's assessors, which showed only mild physical and psychological impairments.

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

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to meet his burden of proof.

Specifically, the applicant did not provide submissions or evidence regarding his pre- and post-accident activities, making it impossible to apply the comparative analysis required by Heath to determine if he suffered a complete inability to carry on a normal life.

The applicant sought a determination that he sustained a catastrophic impairment as a result of a motor vehicle accident under Criteria 7 and 8 of the Statutory Accident Benefits Schedule.

The Tribunal weighed competing multidisciplinary expert reports.

The Tribunal gave no weight to the applicant's orthopaedic and psychiatric experts because they failed to attend the hearing for cross-examination, and found the applicant's occupational therapist's evidence unreliable due to inconsistencies with observed function.

Preferring the respondent's experts, the Tribunal found the applicant sustained a 5% physical WPI and 5% psychological WPI, failing to meet the 55% threshold under Criterion 7, and sustained only mild impairments in the spheres of functioning under Criterion 8.

The application was dismissed.

The applicant sought income replacement benefits following a motor vehicle accident, claiming substantial post-accident business losses from her self-employment as a pet store owner.

The respondent insurer denied the benefits and sought repayment of an alleged overpayment.

The Tribunal found that the applicant failed to meet her burden of proving the quantum of her income replacement benefits, as her claimed business losses were unsupported by documentary evidence and not proven to be caused by the accident.

The Tribunal also dismissed the respondent's claim for repayment, finding its accounting evidence lacked sufficient detail to establish the overpayment calculation.

Both claims 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).

The applicant argued for removal from the MIG due to chronic pain and psychological impairment.

The Tribunal found insufficient medical evidence to establish chronic pain with functional impairment or a psychological impairment caused by the accident.

As the applicant remained subject to the MIG and the limits were exhausted, the disputed treatment plans and interest were denied.

The respondent requested a reconsideration of a Tribunal decision that removed the applicant from the Minor Injury Guideline (MIG) due to psychological impairment and approved treatment plans.

The respondent argued the Tribunal breached procedural fairness and made errors of law and fact by ignoring evidence and misapplying case law.

The Adjudicator dismissed the request, finding no breach of procedural fairness or errors of law or fact, noting that the respondent was improperly attempting to re-litigate the case and re-weigh the evidence.

The applicant sought statutory accident benefits following an alleged motor vehicle incident.

The applicant failed to attend the scheduled videoconference hearing despite receiving proper notice.

The Licence Appeal Tribunal proceeded in the applicant's absence pursuant to the Statutory Powers and Procedures Act.

As the applicant bore the burden of proving the incident met the definition of an 'accident' under section 3(1) of the Schedule and presented no evidence, the Tribunal found the burden was not met and dismissed the application.

The applicant, a minor injured in a motor vehicle accident, sought attendant care benefits under the Statutory Accident Benefits Schedule.

The claim was narrowed to the period between February 8, 2022, and May 5, 2022.

The Tribunal found that the applicant's mother provided the care but did not sustain an economic loss, meaning the expenses were not 'incurred' under section 3(7)(e) of the Schedule.

The Tribunal also rejected the argument that the expenses should be deemed incurred based on the Suarez decision, as that case pertained to section 38, not section 42.

The application for attendant care benefits was dismissed.

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

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

The applicant applied to the Licence Appeal Tribunal.

The adjudicator found that the applicant should be removed from the MIG due to a psychological impairment, supported by expert evidence of post-traumatic stress disorder and depression.

The adjudicator approved the disputed treatment plans for physiotherapy, psychological services, and a psychological assessment as reasonable and necessary.

The claim for an award under section 10 of Regulation 664 was dismissed, as the respondent's reliance on its assessors was not unreasonable.

Interest was awarded on overdue benefits.