Monica Chakravarti

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, which the respondent insurer denied.

The applicant applied to the Licence Appeal Tribunal for resolution of the dispute, seeking payment for physiotherapy, osteopathic treatment, and orthopaedic treatment.

The Tribunal found that the applicant failed to meet her onus to show that the proposed treatments were reasonable and necessary, noting a lack of contemporaneous medical evidence supporting the need for the treatments.

The application was dismissed in its entirety.

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

The respondent denied the medical benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and paid IRBs at a rate of $59.00 per week rather than the $800.00 claimed.

The Tribunal found that the applicant sustained psychological injuries, removing him from the MIG, but dismissed the claim for the disputed treatment plan as it was not shown to be reasonable and necessary.

The Tribunal also found that the applicant failed to prove his self-employment income and losses to support an IRB quantum of $800.00 per week, preferring the respondent's calculation of $59.00 per week.

Claims for interest and an award were dismissed.

The applicant sought statutory accident benefits following an alleged motor vehicle collision where the vehicle he was a passenger in struck a tree.

The respondent insurer denied the claim, arguing the collision was a staged accident and the applicant willfully misrepresented material facts.

The Licence Appeal Tribunal found copious inconsistencies between the accounts of the applicant, the driver, and the other passenger regarding the events leading up to the incident and the collision itself.

The Tribunal concluded the applicant failed to prove on a balance of probabilities that the incident was an 'accident' under the Schedule.

Furthermore, the Tribunal held that the applicant's inconsistent descriptions were made with the intent to mislead the insurer, constituting willful misrepresentation.

The applicant sought medical benefits for three physiotherapy treatment plans following a motor vehicle accident.

The respondent denied the plans, arguing the applicant could perform self-directed exercises.

The Tribunal found that the applicant suffered from chronic pain as a result of the accident, relying on the consensus of treating doctors and independent assessors.

The Tribunal concluded that the first and third treatment plans were reasonable and necessary to reduce pain and increase functionality, but denied the second plan as a duplication.

The Tribunal also admitted late-served surveillance evidence but gave it no weight, as it did not contradict the applicant's reported deterioration without treatment.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her income replacement benefits on the basis that she was not employed at the time of the accident.

The applicant sought to introduce new evidence, including paystubs and bank statements, and argued the Tribunal erred by failing to consider she was self-employed.

The adjudicator dismissed the request, finding that the applicant was aware of the respondent's position prior to the hearing and had the opportunity to obtain the documents.

Furthermore, the adjudicator found no error in the Tribunal's failure to consider self-employment, as this argument was never raised at the initial hearing and the evidence did not support it.

The respondent insurer requested a reconsideration of a decision which found that the applicant's accident-related injuries were not predominantly minor injuries and that a psychological assessment was reasonable and necessary.

The insurer argued the Tribunal erred in finding the applicant sustained a concussion and psychological impairment.

The adjudicator dismissed the request, finding that the insurer was attempting to reweigh the evidence and re-litigate issues already determined, failing to meet the high threshold for reconsideration under Rule 18.2(b) of the Common Rules.

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

The insurer paid benefits up to the Minor Injury Guideline (MIG) limit and denied further treatment plans.

The applicant argued she should be removed from the MIG due to a pre-existing fibromyalgia condition, physical injuries including a partial shoulder tear, and psychological injuries.

The Tribunal found insufficient evidence of a documented pre-existing condition that precluded recovery within the MIG.

The Tribunal also found the physical injuries met the definition of minor injuries and rejected the applicant's psychological evidence due to inconsistencies and omissions in self-reporting.

As the applicant remained within the MIG and its limits were exhausted, the disputed treatment plans were not payable.

The Tribunal also found the insurer's denial letters complied with the notice requirements under the Schedule.

The applicant and respondent both requested reconsideration of a Tribunal decision finding the applicant sustained predominantly minor injuries.

The applicant sought reconsideration based on new evidence, specifically a chronic pain report and an MRI.

The adjudicator dismissed the applicant's request, finding the new evidence could have reasonably been obtained prior to the hearing.

The respondent requested reconsideration because the original decision failed to address its request for costs.

The adjudicator granted the respondent's reconsideration request to address the costs issue, but ultimately declined to award costs, finding the applicant's conduct was not vexatious, frivolous, or in bad faith.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied an award and costs.

The applicant argued the Tribunal violated procedural fairness by allowing the respondent to submit case law after the hearing closed, demonstrated bias, and misinterpreted sections of the Statutory Accident Benefits Schedule.

The adjudicator dismissed the reconsideration, finding that the late case law was not relied upon in the original decision, the bias allegation was unsubstantiated, and the applicant was merely attempting to re-litigate the original findings.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming a substantial inability to perform the essential tasks of his pre-accident self-employment in renovation and landscaping.

The Tribunal found that the applicant failed to provide objective medical evidence demonstrating that his accident-related impairments prevented him from working.

The medical evidence primarily showed minor contusions and soft tissue injuries, and an insurer's examination concluded he did not suffer a substantial inability to work.

The application for IRBs, interest, and an award was dismissed.

The applicant sought an award under s. 10 of Regulation 664, arguing the respondent insurer unreasonably withheld and delayed income replacement benefits (IRBs) following a motor vehicle accident.

The Tribunal found the respondent acted unreasonably by relying solely on an insurer examination report that contradicted other medical evidence, and by failing to reassess the claim when new medical information, including surgical records, was provided.

The Tribunal awarded the applicant a lump sum of 35% of the withheld IRBs plus interest.

The applicant's request for costs was denied.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits (IRBs) and a chiropractic treatment plan.

The Licence Appeal Tribunal found that the respondent insurer failed to provide proper notice of denial for the IRBs under section 36(4) of the Schedule until October 30, 2017.

Consequently, the applicant was awarded IRBs from the date the completed disability certificate was submitted until the date of proper notice.

The Tribunal dismissed the claim for the treatment plan, finding the respondent's notice of denial was compliant and the applicant failed to prove the treatment was reasonable and necessary.

The applicant sought income replacement benefits (IRBs) and medical benefits for chiropractic treatment following a motor vehicle accident.

The adjudicator dismissed the application, finding the applicant lacked credibility due to contradictory evidence regarding his return to work and pre-existing chronic back pain.

The applicant failed to prove a substantial inability to perform the essential tasks of his pre-accident employment as a driver.

Furthermore, the adjudicator found the disputed treatment plans were not reasonable and necessary, as the applicant provided insufficient medical evidence linking his ongoing complaints to the accident.

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

The respondent insurer denied benefits, arguing the applicant knew or ought reasonably to have known he was driving without liability insurance, triggering the exclusion under s. 31(1)(a)(i) of the Schedule.

The Tribunal found that the applicant had requested his broker to adjust his coverage while the motorcycle was in storage, but did not know this meant liability coverage was removed.

Applying a subjective test, the Tribunal concluded the respondent failed to prove the applicant knew or ought reasonably to have known he lacked liability insurance.

The exclusion did not apply.

The applicant sought medical and rehabilitation benefits following a 2015 motor vehicle accident, including an occupational therapy re-assessment and two physiotherapy treatment plans.

The respondent denied the benefits, arguing they were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant failed to meet his burden of proving the treatments were reasonable and necessary, noting a lack of contemporaneous medical evidence supporting ongoing physiotherapy and an occupational therapy re-assessment.

The application was dismissed in its entirety.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, which the respondent insurer denied.

The Licence Appeal Tribunal found that the applicant was entitled to the cost of a neurological assessment, as his treating physician diagnosed a nerve injury and the insurer's assessors lacked access to those medical records.

However, the Tribunal dismissed the claims for a chronic pain assessment, a Functional Ability Evaluation, psychological treatment, and transportation costs for an orthopaedic assessment, finding them not reasonable and necessary due to pre-existing conditions, lack of contemporaneous evidence, and unpersuasive expert reports.

The claim for a special award under Regulation 664 was also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits (ACBs), an orthopedic mattress and pillow, and medicinal cannabis.

The Tribunal found the applicant did not meet her onus for the mattress, pillow, or cannabis, noting a lack of medical evidence and the fact that the mattress was purchased the morning after the accident.

The Tribunal partially granted the ACBs, awarding $537.00 per month based on the applicant's functional limitations with reaching and bending.

However, the Tribunal declined to deem the ACBs incurred under s. 3(8) of the Schedule, finding the insurer's reliance on s. 44 assessments to deny the benefits was not unreasonable.

Claims for a special award were dismissed, but interest was awarded on the payable ACBs.

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

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

The applicant applied to the Licence Appeal Tribunal, arguing that pre-existing chronic pain prevented him from achieving maximal medical recovery within the MIG limits.

The Tribunal found that the applicant failed to provide compelling medical evidence that his pre-existing conditions required treatment outside the MIG.

As the MIG limits were exhausted, the claim for a physiotherapy treatment plan was dismissed.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident.

The respondent denied the benefits, and the applicant applied to the Licence Appeal Tribunal.

The Tribunal found that the applicant failed to meet his onus of proving that the proposed chiropractic treatment plans were reasonable and necessary.

The applicant provided insufficient medical evidence to establish his accident-related physical injuries, particularly given a pre-existing back condition and a two-year gap in medical records following the accident.

The application was dismissed, and no interest or costs were awarded.

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

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

The Tribunal found the applicant failed to prove she sustained a concussion or chronic pain that would remove her from the MIG.

Furthermore, the applicant failed to provide the disputed treatment plans or sufficient medical evidence to prove they were reasonable and necessary.

The appeal was dismissed in its entirety.