Meray Daoud

The applicant sought income replacement benefits and the cost of vocational and functional abilities assessments following a motor vehicle accident.

The adjudicator found that the applicant failed to prove on a balance of probabilities that she suffered a substantial inability to perform the essential tasks of her pre-accident employment as a kitchen assistant.

The medical evidence submitted by the applicant lacked sufficient detail regarding her job duties and how her limitations impeded her capacity to work.

The claims for the cost of examinations were also dismissed as the applicant failed to prove they were reasonable and necessary.

Consequently, claims for interest and an award for unreasonable delay were denied.

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

The Licence Appeal Tribunal found that the respondent insurer failed to comply with the notice requirements under the Statutory Accident Benefits Schedule.

Specifically, the insurer failed to respond after receiving medical documents requested under section 33 for the non-earner benefit, and provided deficient medical reasons for denying the treatment plan.

As a result of these procedural breaches, both benefits were deemed payable.

The Tribunal also ordered a 20% special award under section 10 of Regulation 664, finding that the insurer unreasonably withheld payment by completely neglecting to adjust the non-earner benefit claim after receiving the requested documents.

The minor applicant was struck by a garbage truck at age six and sought statutory accident benefits, claiming a catastrophic impairment.

The respondent insurer denied the catastrophic designation.

The Licence Appeal Tribunal considered competing neuropsychological evidence regarding the applicant's functioning and adaptation in the school setting.

The Tribunal preferred the evidence of the applicant's expert and found that the applicant sustained a class 4 marked impairment in adaptation due to mental and behavioural disorders caused by the accident.

The Tribunal concluded the applicant sustained a catastrophic impairment and is entitled to expanded benefits.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and several medical and rehabilitation treatment plans.

The Licence Appeal Tribunal found that the applicant failed to meet the burden of proving a complete inability to carry on a normal life, noting a lack of detailed evidence regarding pre- and post-accident activities.

The Tribunal also dismissed the claims for medical benefits, preferring the respondent's orthopaedic assessment over the applicant's treating chiropractor, and finding the applicant's evidence insufficient to establish that the treatments were reasonable and necessary.

The application was dismissed in its entirety, and the applicant's request for costs was denied.

The applicant was involved in a rear-end motor vehicle accident and sought a catastrophic impairment designation due to psychological impairments.

The insurer denied the claim.

The Tribunal applied the 'but for' test for causation, finding the accident caused the impairments despite pre-existing anxiety.

Relying on the applicant's expert and credible lay testimony, the Tribunal concluded the applicant sustained a class 4 'marked' impairment in both activities of daily living and adaptation.

The Tribunal rejected the respondent expert's 'moderate' rating as it improperly relied on future possibilities of improvement.

The applicant was deemed catastrophically impaired.

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

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

The applicant contended that chronic pain syndrome, psychological impairments, jaw injury, and post-traumatic headaches removed her from the MIG.

The Tribunal found the applicant's evidence, including an orthopaedic report diagnosing chronic pain syndrome, lacked objective medical findings and corroboration.

Conversely, the Tribunal accepted the respondent's independent medical examinations, which concluded the injuries were predominantly minor soft tissue sprains and strains.

The Tribunal held the applicant sustained predominantly minor injuries and dismissed the claims for treatment plans, cost of examinations, and an award for delayed payments.

The applicant's request for costs was also denied.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for an in-home assessment and chiropractic services.

The insurer denied the treatment plans.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that the proposed treatments were reasonable and necessary.

The medical evidence, including reports from the applicant's own orthopedic surgeons, indicated that the applicant had plateaued and that conservative therapy would not be beneficial.

The application was dismissed.

The applicant sought income replacement benefits following a motor vehicle accident, claiming he was unable to perform his pre-accident work as a self-employed mason.

The adjudicator dismissed the application, finding insufficient contemporaneous medical evidence to prove a substantial inability to perform the essential tasks of his employment.

The adjudicator noted that functional testing was deemed invalid due to the applicant's sub-maximal effort, and no financial documentation was provided to demonstrate an actual loss of income during the disputed period.

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

The respondent denied the benefits on February 15, 2011.

The applicant filed an application with the Licence Appeal Tribunal over six years later.

The applicant argued the limitation period had not run because the respondent failed to request a new disability certificate prior to scheduling assessments, and because the denial was not clear and unequivocal.

The Tribunal found that the denial was clear and unequivocal, and that the failure to request a new disability certificate did not warrant extending the limitation period.

The application was dismissed as statute-barred, and the respondent's request for costs was denied.

The applicant sought payment for an in-home assessment under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent denied the claim on the basis that the expense was incurred before the treatment plan (OCF-18) was submitted, contrary to section 38(2) of the Schedule.

The applicant brought a motion to preclude the respondent from relying on this defence, arguing it was raised late.

The Adjudicator dismissed the motion, finding no prejudice to the applicant.

On the substantive issue, the Adjudicator found the applicant failed to comply with section 38(2) by incurring the expense prior to submitting the OCF-18, and therefore the cost of the assessment was not payable.

The applicant sought a non-earner benefit and payment for two physiotherapy treatment plans following a motor vehicle accident.

The Tribunal found that the claim for the non-earner benefit was statute-barred, as the application was filed more than two years after the clear and unequivocal denial by the respondent.

The Tribunal also dismissed the claims for the medical benefits, finding that the applicant failed to provide sufficient contemporaneous medical evidence to prove the treatment plans were reasonable and necessary.

The respondent's request for costs was denied.

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

The insurer denied a treatment plan and requested an insurer's examination under s. 44 of the Schedule.

The applicant refused to attend, arguing the Notice of Examination did not provide sufficient medical reasons.

The Tribunal found that the insurer's notice complied with s. 44 by referencing medical reports and questioning the nature of the impairment and appropriate treatment.

Consequently, under s. 55(1)(2) of the Schedule, the applicant is precluded from proceeding with her application to the Tribunal until she attends the requested assessments.

Both parties' requests for costs were denied.

The minor applicant was injured while riding a dirt bike on a privately owned track.

He sought statutory accident benefits, which the respondent denied.

At a preliminary issue hearing, the Tribunal had to determine whether the motorcycle was an 'automobile' and whether the incident was an 'accident' under the Schedule.

The Tribunal found that the motorcycle was not required to be insured under the Off-Road Vehicles Act because it fell under the exemption for vehicles driven at a 'closed course competition'.

Consequently, the motorcycle was not an 'automobile' and the incident was not an 'accident'.

The application for benefits was dismissed.

The applicant sought statutory accident benefits after tripping on an uneven curb shortly after disembarking from a vehicle.

The respondent denied the claim, arguing the incident did not meet the definition of an 'accident' under the Schedule.

The Tribunal found that the use or operation of the vehicle was not the direct cause of the injuries, as the chain of causation was broken by an intervening act—the uneven curb.

The application was dismissed, and the respondent's request for costs was denied.