Michael Beauchesne

The applicant requested reconsideration of a Licence Appeal Tribunal decision that maintained him in the Minor Injury Guideline.

The parties had actually settled the claim on a full and final basis prior to the decision's release, but the applicant failed to advise the Tribunal.

The adjudicator granted the reconsideration and cancelled the decision as moot.

The respondent's request for costs was dismissed because the Tribunal lacks jurisdiction under Rule 19.2 to order costs on a reconsideration request, despite finding the applicant's conduct unreasonable and frivolous.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found her injuries fell within the Minor Injury Guideline (MIG) but awarded her costs for disputed treatment plans due to the insurer's defective notice.

The applicant argued the Tribunal erred in law and fact regarding the entitlement period for a physiotherapy treatment plan, the applicability of the MIG, and her claim for an award.

The adjudicator dismissed the reconsideration request, finding no errors of law or fact that would have changed the outcome, though a typographical error regarding the entitlement end date was corrected.

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

The Licence Appeal Tribunal found the applicant was entitled to the balance of treatment hours for equine-assisted psychotherapy at an hourly rate of $99.75, but denied claims for form completion fees, travel time, and chiropractic services.

The Tribunal also ordered the respondent to pay for a catastrophic impairment determination examination because its denial notice failed to provide medical reasons, violating section 38(8) of the Schedule.

The applicant's claim for an award under section 10 of Regulation 664 was dismissed.

The respondent insurer requested a reconsideration of a Tribunal decision that ordered it to pay for three psychological treatment plans.

The respondent argued the Tribunal acted outside its jurisdiction by ordering payment, as the expenses were only payable if incurred, and no evidence had been led on whether they were incurred.

The Tribunal agreed, finding that ordering the respondent to pay rather than declaring the applicant entitled to the expenses was a jurisdictional error.

The request for reconsideration was granted, and the order was varied to state the applicant is entitled to the disputed expenses.

The applicant, who was catastrophically impaired in a motor vehicle accident, sought medical benefits to cover the monthly fees of her long-term care facility, in addition to the maximum attendant care benefits she was already receiving.

The Licence Appeal Tribunal found that the facility fees were for services consistent with attendant care, not medical or hospital expenses under section 15 of the Statutory Accident Benefits Schedule.

The application was dismissed.

The applicant sought various statutory accident benefits following a motor vehicle accident, including a non-earner benefit, attendant care benefits, lost educational expenses, and medical benefits for assistive devices and chiropractic services.

The Tribunal found that the applicant failed to prove he suffered a complete inability to carry on a normal life, as required for the non-earner benefit.

The Tribunal also dismissed the claims for attendant care benefits because the expenses were not incurred and the respondent had not unreasonably withheld payment.

The claims for lost educational expenses and medical benefits were similarly dismissed for lack of sufficient evidence.

The application was dismissed in its entirety.

The applicant sought a determination that she sustained a catastrophic impairment under Criterion 8 (mental and behavioural disorders) following a 2012 motor vehicle accident.

The Tribunal first dismissed the applicant's preliminary motion for summary judgment, finding no jurisdiction to dispose of substantive issues without a hearing.

On the merits, the Tribunal preferred the evidence of the respondent's psychiatric expert over the applicant's expert, finding that the applicant's functional impairments were primarily caused by physical chronic pain rather than an accident-related mental or behavioural disorder.

The Tribunal concluded the applicant did not suffer a marked or extreme impairment in any of the four areas of functioning.

The application was dismissed, and the applicant was ordered to pay $250 in costs for unreasonable delays in producing disclosures.

The applicant sought statutory accident benefits following a motor vehicle accident but was denied by the respondent insurer on the basis that his 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 Tribunal found that the applicant failed to establish a diagnosis of chronic pain syndrome or continuous functional impairment arising from accident-related chronic pain.

The Tribunal also found the applicant did not meet the criteria for chronic pain under the AMA Guides.

Consequently, the applicant remains subject to the MIG and is not entitled to the disputed treatment plan for physiotherapy.

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

The applicant argued for removal from the MIG based on psychological impairment and chronic pain.

The Tribunal found insufficient evidence to substantiate a psychological impairment or functional limitations arising from chronic pain.

As the applicant remained within the MIG and the $3,500 limit was exhausted, the claims for additional medical and rehabilitation benefits were dismissed.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident.

The respondent denied the benefit on the basis that the applicant had returned to his pre-accident employment as a seasonal window cleaner for four months before a regular seasonal layoff.

The Tribunal found the respondent's denial notice complied with the Schedule.

On the merits, the Tribunal held the applicant failed to prove he suffered a substantial inability to perform his essential work tasks within the first 104 weeks, or a complete inability to engage in suitable employment thereafter.

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 prove his pre-existing conditions, chronic pain, or psychological impairments warranted removal from the MIG.

The Tribunal also dismissed the claims for income replacement benefits, finding the applicant did not demonstrate a substantial or complete inability to perform the essential tasks of his self-employment.

Claims for attendant care benefits, treatment plans, interest, and an award were also dismissed.

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

The Tribunal found the applicant was barred from pursuing an income replacement benefit because he failed to provide reasonably required financial information to the insurer under section 33(1) of the Schedule.

However, the applicant was not barred from pursuing a psychological assessment despite missing an Insurer's Examination, as the insurer's notices failed to provide meaningful medical reasons as required by section 44(5).

On the substantive issues, the Tribunal denied the psychological assessment and therapy as not reasonable and necessary due to a lack of corroborating medical evidence, but awarded the applicant up to $2,500 for an accounting report used to calculate his income replacement benefit.

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

The Tribunal found the applicant failed to prove her injuries fell outside the Minor Injury Guideline (MIG), rejecting claims of chronic pain syndrome and psychological impairment.

However, the Tribunal held that the insurer failed to provide compliant denial notices under section 38(8) of the Schedule for both a physiotherapy treatment plan and a chronic pain assessment.

As a result, the insurer was prohibited from relying on the MIG for the periods of non-compliance and ordered to pay the incurred costs plus interest.

The applicant's claim for a special award was dismissed.

The applicant sought payment for various treatment plans (OCF-18s) and expenses (OCF-6) following a motor vehicle accident, which the respondent insurer denied.

The Tribunal first rejected the applicant's preliminary argument that the psychological treatment plans should be deemed approved under s. 38(11) of the Schedule, finding the insurer's non-medical reasons for denial were sufficient under s. 38(8).

On the merits, the Tribunal approved three treatment plans for psychological discharge reports, finding them distinct from formal reassessments.

However, the Tribunal denied the remaining plans for physical therapies and relaxation CDs, relying on an insurer's examination by a physiatrist and surveillance evidence showing the applicant had reached maximum therapeutic benefit and was engaging in activities inconsistent with his claimed impairments.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits and medical benefits for chiropractic services and assistive devices.

The respondent insurer denied the benefits.

The applicant argued that the respondent's notices of denial were deficient under the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant failed to prove the notices were non-compliant, as the respondent provided clear and principled medical reasons for its denials and requests for insurer's examinations.

The application was dismissed, and no interest or award was payable.

The insurer applied to the Licence Appeal Tribunal for repayment of $9,043.27 in income replacement benefits paid to the respondent following a motor vehicle accident.

The insurer alleged that the respondent wilfully misrepresented his employment status by failing to disclose that he had returned to work.

The adjudicator found that the respondent had fully returned to work and intentionally provided incomplete pay stubs and misleading statements in his statutory declaration.

The adjudicator rejected the respondent's argument that his accident-related injuries prevented him from continuing employment.

The Tribunal ordered the respondent to repay the benefits in full, plus interest, pursuant to section 52 of the Statutory Accident Benefits Schedule.

The applicant sought accident benefits following a motor vehicle accident, arguing her injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain.

The Tribunal found insufficient medical evidence of functional impairment or disability arising from the pain, noting the applicant had returned to work within the expected healing time for soft-tissue injuries.

The Tribunal concluded the applicant's injuries were predominantly minor and she remained subject to the MIG limit, dismissing her claims for 12 chiropractic treatment plans and interest.

Additionally, the Tribunal awarded $150 in costs to the respondent because the applicant acted unreasonably by failing to comply with written hearing deadlines without explanation.

The applicant sought entitlement to statutory accident benefits for physiotherapy services following a 2018 motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the proposed treatment plans were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's insurer's examination assessors, who concluded that further facility-based physical treatment was unlikely to provide any additional therapeutic benefit for the applicant's left elbow injury and chronic pain.

As no benefits were payable, claims for interest and a section 10 award were also dismissed.

The applicant, a minor whose parents were involved in a motor vehicle accident, sought statutory accident benefits for a psychoeducational assessment to address alleged psychological injuries resulting from the accident.

The respondent insurer denied the claim.

The Licence Appeal Tribunal found that the applicant failed to prove the assessment was reasonable and necessary, noting that the applicant's school performance and behaviour had improved and that the medical evidence did not specifically recommend the assessment.

The application was dismissed.

The applicant sought removal from the Minor Injury Guideline (MIG) following a motor vehicle accident, claiming chronic pain syndrome and a pre-existing condition of osteoarthritis.

The Tribunal found that the medical evidence, including normal neurological results and the applicant's reported functional abilities, did not support a diagnosis of chronic pain syndrome.

Furthermore, the applicant failed to prove that any pre-existing condition precluded maximal recovery within the MIG.

As the MIG limit was exhausted, the disputed treatment plans were denied, and no interest or award was payable.