Nathan Prince

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of treatment plans for psychological, occupational therapy, and physiotherapy services, as well as transportation costs and a claim for an award.

The Tribunal found the psychological, occupational therapy, and physiotherapy plans reasonable and necessary, preferring the evidence of the applicant's assessors and treating practitioners over the respondent's section 44 assessors.

However, the Tribunal denied the transportation expenses associated with the occupational therapy and physiotherapy plans, as the applicant failed to demonstrate compliance with the Schedule's transportation expense guidelines.

The claim for an award under section 10 of Regulation 664 was also dismissed due to a lack of submissions.

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

The Tribunal found the applicant was statute-barred from claiming income replacement benefits because she failed to dispute the denial within the two-year limitation period.

While the claims for a chronic pain assessment and functional abilities evaluation were not statute-barred due to invalid denial notices, the Tribunal dismissed all claims for medical and rehabilitation benefits, finding the applicant failed to demonstrate they were reasonable and necessary.

Claims for interest, an award, and costs were also dismissed.

The applicant sought entitlement to statutory accident benefits for a hot tub ($17,095.00) and physiotherapy services ($3,251.55) following a motor vehicle accident.

The adjudicator found that the applicant failed to demonstrate on a balance of probabilities that either treatment plan was reasonable and necessary.

The applicant did not provide copies of the treatment plans, and the medical evidence did not support the necessity of a hot tub over less expensive alternatives or the need for ongoing physiotherapy.

The application was dismissed.

The applicant sought a determination that she sustained a catastrophic impairment under s. 3.1(1)8 of the Statutory Accident Benefits Schedule following a motor vehicle accident.

The parties agreed the applicant had a Class 3 impairment in activities of daily living and a Class 4 impairment in adaptation.

The dispute centered on whether she had Class 4 impairments in social functioning and concentration, persistence, and pace.

The Tribunal preferred the respondent's psychiatric evidence, finding the applicant maintained close family relationships and could sustain focus for daily tasks.

The Tribunal concluded the applicant suffered only Class 3 impairments in the disputed spheres and therefore did not meet the criteria for catastrophic impairment.

The applicant sought payment for two physiotherapy treatment plans totaling $3,600.96 following a motor vehicle accident.

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

The Tribunal noted a lack of contemporaneous medical evidence, as the applicant's medical records predated the proposed treatment plans by over two years, and held that a treatment plan alone is insufficient to establish entitlement to a benefit.

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

The respondent insurer denied a treatment plan for an occupational therapy assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant demonstrated she suffered from chronic pain with functional impairment, warranting removal from the MIG, based on a chronic pain assessment and consistent reporting of ongoing pain and withdrawal from activities.

The Tribunal ordered the respondent to pay the $2,195.01 treatment plan plus interest, finding it reasonable and necessary.

However, the Tribunal denied the applicant's request for a special award, concluding the insurer's reliance on its medical examination report, while ultimately unpersuasive, was not unreasonable.

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

The respondent denied various treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The Tribunal found that the applicant failed to demonstrate chronic pain with functional impairment, a pre-existing condition, or a psychological impairment that would warrant removal from the MIG.

As the MIG limit was exhausted, the disputed treatment plans and claim for interest were dismissed.

The applicant sought statutory accident benefits following a 2019 motor vehicle accident, specifically a $19,097.00 treatment plan for a catastrophic impairment (CAT) assessment and an award for unreasonable delay.

The Tribunal found the applicant was entitled to $9,266.00 for the CAT assessment, approving the physiatry, psychiatry, and occupational therapy components, but denying duplicative or premature elements like the intake assessment and OCF-19 completion.

The Tribunal admitted several late or disputed medical reports, finding them relevant and not prejudicial.

The claim for a special award was dismissed as the insurer's denial was not unreasonable, though interest was awarded on the overdue assessment costs.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits (IRBs), various treatment plans, and removal from the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to prove her injuries fell outside the MIG, as contemporaneous medical evidence and expert assessments indicated she suffered only soft-tissue sprain/strain injuries.

The Tribunal also dismissed the claim for IRBs, finding the applicant did not demonstrate a substantial inability to perform her pre-accident employment tasks or a complete inability to engage in any employment, noting she had returned to work post-accident and was deemed fit for sedentary duties.

As the applicant remained within the MIG and the limits were exhausted, the disputed treatment plans and claims for interest were denied.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing her injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain and psychological impairments.

The respondent denied the claims, relying on section 44 assessments which found no significant functional or psychological impairments.

The Tribunal found the applicant's self-reported limitations inconsistent with physical examinations and preferred the respondent's comprehensive psychological assessment over the applicant's provisional phone-based diagnosis.

The Tribunal concluded the applicant's injuries fell within the MIG and dismissed the claims for additional treatment plans and interest.

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

At the outset of the hearing, the respondent agreed to fund the disputed medical benefits and income replacement benefits.

The hearing proceeded on the issues of interest, a special award, and costs.

The Tribunal found that the respondent unreasonably delayed the payment of benefits by failing to make a determination after receiving requested disclosure and completing an examination under oath, ordering a 15% special award.

Interest was awarded on the overdue benefits, but the applicant's request for costs was denied as the respondent's conduct did not meet the high threshold of being unreasonable, frivolous, vexatious, or in bad faith.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his chronic pain and psychological impairments warranted removal from the Minor Injury Guideline (MIG).

The Tribunal applied the AMA Guides criteria for chronic pain and found the applicant did not demonstrate sufficient functional impairment, as he maintained his pre-accident routines, work, and social life.

The Tribunal also found insufficient evidence of a psychological impairment, noting the applicant's own self-reporting denied significant anxiety or depression.

As the applicant remained within the MIG and the $3,500 limit was exhausted, the disputed treatment plans and claim for a special award were dismissed.

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

The insurer 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 right shoulder injury, multiple morbidities, and chronic pain.

The Tribunal found that the applicant failed to provide compelling medical evidence that his pre-existing conditions would preclude maximal recovery within the MIG.

Furthermore, applying the AMA Guides, the Tribunal concluded the applicant did not demonstrate chronic pain with functional impairment.

The disputed treatment plans for chiropractic services and the cost of an OCF-3 were deemed not reasonable and necessary.

The application was dismissed.

The applicant was injured while riding her bicycle when she veered off the road to avoid an oncoming, unidentified vehicle driving erratically.

The respondent denied her claim for statutory accident benefits, arguing the incident did not meet the definition of an 'accident' under the Schedule because no vehicle was involved.

The Tribunal found the applicant credible and concluded that a vehicle was involved, satisfying both the purpose and causation tests.

The Tribunal determined the applicant's impairments fell outside the Minor Injury Guideline and ordered the respondent to pay the disputed medical and examination expenses up to the Guideline limits.

The Tribunal dismissed the claim for a special award but ordered the respondent to pay $500 in costs for unreasonable conduct during the proceeding.