Paul Gosio

The applicant sought a determination that her accident-related impairments met the definition of a catastrophic impairment under the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant sustained a marked impairment in the areas of activities of daily living, concentration, persistence and pace, and adaptation due to a mental or behavioural disorder.

The Tribunal preferred the evidence of the applicant's experts, noting the applicant's pre-existing vulnerabilities and significant post-accident functional decompensation.

As the applicant met the catastrophic threshold under section 3(2)(f), the Tribunal did not need to determine whether she met the 55% whole person impairment threshold under section 3(2)(e).

The applicant was injured in a motor vehicle accident and subsequently sustained a disc herniation while performing deadlifts with a personal trainer to strengthen his back.

The respondent denied income replacement benefits, arguing the disc herniation was a separate injury not caused by the accident.

The Tribunal applied the 'but for' test and found the disc herniation was causally connected to the accident, as the applicant was performing the exercises to rehabilitate his accident-related back injury.

The Tribunal concluded the applicant suffered a substantial inability to perform the essential tasks of his employment for the first 104 weeks, and a complete inability to engage in suitable employment thereafter.

The applicant was awarded ongoing income replacement benefits and the cost of a vocational assessment.

The applicant was injured in a motor vehicle accident and received income replacement benefits for 104 weeks.

The insurer terminated the benefits, and the applicant sought reinstatement, arguing she suffered a complete inability to engage in any employment for which she was reasonably suited by education, training, or experience due to psychological and physical impairments.

The Tribunal dismissed the application, finding the applicant's self-reports and medical evidence insufficient to meet the post-104 week test, and preferred the respondent's objective functional and vocational assessments which identified suitable sedentary occupations.

The applicant was involved in a motor vehicle accident in 2005.

The respondent insurer denied attendant care benefits in April 2005 based on an occupational therapy assessment, even though the applicant had not expressly claimed them.

In 2015, after being deemed catastrophically impaired, the applicant applied for attendant care benefits.

The respondent denied the claim, arguing it was barred by the two-year limitation period triggered by the 2005 denial.

The Tribunal found that the 2005 denial was clear and unequivocal, and following the Court of Appeal's decision in Sietzema, a premature denial is sufficient to trigger the limitation period.

The applicant's claim was therefore statute-barred.

The applicant sought statutory accident benefits for two dental treatment plans related to temporomandibular joint pain following a motor vehicle accident.

The respondent denied the plans based on an insurer's examination which concluded further treatment was unlikely to be beneficial.

The adjudicator dismissed the application, finding the treatment plans were not reasonable and necessary because the applicant failed to provide any supporting medical evidence to contradict the respondent's expert.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for occupational therapy and assistive devices, including an orthopaedic memory foam mattress.

The respondent partially denied the first treatment plan and fully denied the second, arguing the goods and services were not related to the accident.

The Tribunal found that the applicant's emotional disturbances and physical injuries, including a history of osteoporosis and inability to sleep on her previous floor mat, justified the remaining occupational therapy sessions and the orthopaedic mattress.

Both treatment plans were deemed reasonable and necessary.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her physical and psychological impairments removed her from the Minor Injury Guideline (MIG) and entitled her to an income replacement benefit (IRB).

The adjudicator found that the applicant failed to provide compelling evidence of a pre-existing condition, chronic pain, or severe psychological impairment that would take her injuries outside the MIG.

Furthermore, relying on the respondent's medical assessments, the adjudicator concluded that the applicant did not suffer a substantial inability to perform the essential tasks of her pre-accident employment.

The application for medical benefits beyond the MIG cap and for an IRB was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including psychological treatment, physical rehabilitation, and the cost of a psychological assessment.

The adjudicator preferred the evidence of the applicant's psychologist over the insurer's assessor, finding the psychological treatment and assessment reasonable and necessary.

The physical rehabilitation plan was also approved based on ongoing pain.

However, the adjudicator dismissed the claim for a special award, finding the insurer gave reasonable consideration to the available information when denying the benefits.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The insurer denied several treatment plans on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant failed to provide a persuasive analysis or sufficient medical evidence to establish that the disputed treatment plans were reasonable and necessary.

The Tribunal preferred the insurer's section 44 examination evidence, which concluded the applicant sustained uncomplicated soft tissue injuries requiring no further facility-based care.

The application was dismissed.

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

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

The Licence Appeal Tribunal found that the applicant's psychological impairments, specifically Somatic Symptom Disorder and Posttraumatic Stress Disorder, took his injuries outside the MIG.

The Tribunal ordered the respondent to pay for a chronic pain assessment and two treatment plans for physiotherapy and chiropractic services, finding them reasonable and necessary.

Two other physiotherapy treatment plans were denied.

Interest was awarded on the overdue payments.

The applicant insurer sought repayment of $4,414.29 in income replacement benefits paid to the respondent following a motor vehicle accident.

The applicant alleged that the respondent had received short-term disability benefits in excess of 70% of his pre-accident income during the same period.

The only evidence provided by the applicant was a double-hearsay statement from a claims advisor regarding a conversation with the respondent's legal representative.

The Tribunal found this evidence insufficient to meet the applicant's burden of proof and dismissed the claim for repayment.