Poeme Manigat

The applicant, who suffered a leg amputation in a motorcycle accident and was deemed catastrophically impaired, sought various statutory accident benefits denied by the respondent insurer.

The Licence Appeal Tribunal awarded attendant care benefits at a reduced rate of $3,000 per month, finding the applicant did not require 24-hour care.

The Tribunal also granted numerous medical and rehabilitation benefits, including occupational therapy, medical cannabis, and short-term alternative housing.

However, the claim for over $1.1 million for alternative accessible housing was denied because the applicant's housing expert failed to assess a potentially viable property jointly owned by the applicant.

The claim for a special award under Regulation 664 was dismissed as the insurer's conduct was not found to be unreasonable.

The applicant was injured in a motor vehicle accident and sought income replacement benefits, which the respondent insurer denied.

The respondent raised a preliminary issue that the applicant's dispute was statute-barred under section 56 of the Statutory Accident Benefits Schedule.

The Tribunal found that the two-year limitation period did not begin to run until the respondent properly delivered the denial notice to the applicant's counsel under section 64, which occurred years after the initial denial.

The preliminary issue was dismissed, allowing the applicant's claim to proceed.

The applicant requested a reconsideration of a decision finding that her motor vehicle accident injuries fell within the Minor Injury Guideline (MIG).

The applicant argued the Tribunal applied an incorrect test and failed to properly consider her pre-existing injuries and medical evidence.

The adjudicator dismissed the request, finding no error of law or fact.

The adjudicator held that the applicant failed to provide compelling evidence that her pre-existing injuries prevented maximal medical recovery within the MIG, and noted that the applicant had successfully returned to her pre-accident employment.

The respondent insurer requested a reconsideration of a Tribunal decision that awarded the applicant 1.5 hours of psychological treatment per session.

The insurer argued the Tribunal reversed the burden of proof and failed to consider relevant evidence regarding the applicant's psychological condition.

The adjudicator granted the reconsideration, finding that while the burden of proof was not reversed, the Tribunal had erred by failing to consider evidence of the applicant's post-accident personal difficulties, including a relationship breakdown and a family member's illness.

Upon reviewing this evidence, the adjudicator concluded the applicant failed to prove the motor vehicle accident caused the need for the additional 0.5 hours of treatment, and varied the original decision.

The applicant sought statutory accident benefits following a 2013 motor vehicle accident, claiming his injuries constituted a catastrophic impairment and fell outside the Minor Injury Guideline (MIG) due to pre-existing conditions.

The Licence Appeal Tribunal found that the applicant failed to provide sufficient medical evidence to prove a catastrophic impairment, relying instead on persuasive Insurer Examination reports that found no significant neurological or orthopaedic impairments.

Furthermore, the Tribunal held that the applicant did not demonstrate that his pre-existing injuries prevented him from achieving maximal recovery within the $3,500 MIG limit.

Claims for a special award and costs were also dismissed.

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

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

The applicant argued that pre-existing injuries and chronic pain took him outside the MIG.

The Tribunal found that the applicant failed to prove his pre-existing condition prevented him from achieving maximal recovery within the MIG, and the medical evidence did not support a finding of chronic pain.

The application was dismissed.

The applicant sought a medical and rehabilitation benefit of $14,804.51 for a multidisciplinary chronic pain program following a motor vehicle accident.

The adjudicator found that the insurer's initial notices of denial were defective under s. 38(8) of the Schedule because they lacked medical reasons and failed to include the required Insurer Examination reports.

Consequently, the insurer was liable to pay for any treatment incurred between the date the notice was due and the date the defect was cured.

However, on the substantive issue, the adjudicator concluded that the treatment plan was not reasonable and necessary, as the applicant had reached maximum medical recovery, returned to full-time work, and showed no ongoing musculoskeletal or psychological impairments.

Claims for an award and costs were dismissed.

The appellant appealed a Fire Marshal's review decision confirming an inspector's order regarding her residential property.

The property, originally designed as a single-family dwelling, was being used as a two-unit dwelling with an unregistered basement apartment.

The inspector ordered the appellant to either revert the residence to a single-family dwelling or obtain a building permit for a two-unit dwelling.

The appellant argued that physical modifications she made to the property mitigated the fire risk, rendering it compliant with the Fire Code without a building permit.

The Fire Safety Commission dismissed the appeal, finding that the modifications did not satisfy section 2.1.2.2 of the Fire Code and the property remained a fire hazard because its use was contrary to its original design and no building permit had been obtained.

The applicant applied for statutory accident benefits after slipping and falling on ice while shoveling her parking spot.

The respondent denied the claim on the basis that the incident did not meet the definition of an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal dismissed the application, finding that the applicant did not meet the purpose or causation tests.

The Tribunal held that shoveling an empty parking spot is not an ordinary and well-known activity to which automobiles are put, and the use or operation of the vehicle was not the direct cause or dominant feature of the applicant's injuries.

The appellant appealed five inspection orders relating to five residential properties used to house its international employees.

The Fire Safety Commission found that the properties were being operated as boarding, lodging, or rooming houses rather than single dwelling units.

The Commission confirmed the inspector's orders, finding that the living arrangements, lack of proper lighting, cooking spaces, and emergency exits posed serious fire safety risks, and amended the compliance timelines.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for psychological services and a speech language pathology assessment.

The respondent insurer partially denied the psychological treatment plan, arguing that 1-hour sessions were sufficient rather than the 1.5-hour sessions recommended by the treating psychologist.

The respondent also denied the speech language pathology assessment.

The Licence Appeal Tribunal found that the 1.5-hour psychological sessions were reasonable and necessary, preferring the treating psychologist's recommendation.

However, the Tribunal denied the speech language pathology assessment, finding insufficient evidence of a speech impairment, as the pathologist had not examined the applicant before recommending the assessment.

The applicant was awarded the balance for the psychological services with interest.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and various medical assessments.

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

The Licence Appeal Tribunal found that the physiotherapy treatment plans were reasonable and necessary to help the applicant manage chronic pain, noting that the respondent's physiatry assessor's conclusion of no impairment was inconsistent with his own physical examination.

However, the Tribunal denied the claims for the impairment, catastrophic, and neurological assessments, finding insufficient evidence that they were required or would provide new information.

The applicant was awarded the physiotherapy costs with interest.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for occupational therapy and physiotherapy treatment plans.

The respondent denied the claims on the basis that the treatments were not reasonable and necessary.

At the hearing, the respondent raised a preliminary issue to exclude the applicant's affidavit, which the adjudicator dismissed, allowing the affidavit into evidence.

On the substantive issues, the adjudicator found that the applicant had reached maximum medical recovery and was able to perform her pre-accident activities, including full-time employment, without the need for further treatment.

The adjudicator concluded that the applicant failed to prove the treatment plans were reasonable and necessary, and dismissed the application.

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

The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that her pre-existing physical conditions and accident-related psychological injuries took her outside the MIG.

The Tribunal found that the applicant failed to prove her pre-existing condition prevented her from achieving maximal recovery within the MIG.

Furthermore, the Tribunal rejected the applicant's psychological evidence as inconsistent with her return to regular employment.

The application was dismissed.

The applicant insurer sought repayment of $7,600 in income replacement benefits (IRBs) paid to the respondent, alleging she wilfully misrepresented her employment status at the time of the accident.

The respondent claimed she was employed as a cleaner, but her testimony was contradicted by the alleged employer's Human Resources Director and documentary evidence, including bank statements and tax records.

The Tribunal found the respondent was not a credible witness and concluded she was unemployed at the time of the accident.

The Tribunal ordered the respondent to repay the $7,600 in IRBs plus interest due to wilful misrepresentation.

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 he suffered psychological injuries, relying on a psychological assessment diagnosing him with PTSD and depression.

The Tribunal found the applicant's self-reported normal daily routine and lack of psychological complaints to his family doctor contradicted the psychological diagnosis.

The Tribunal concluded the applicant's injuries fell within the MIG and dismissed the application for the cost of a psychological assessment.

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 Tribunal found that the applicant's physical and psychological injuries were minor and that she did not have a pre-existing condition that would prevent maximal recovery within the MIG limits.

Consequently, the applicant's claims for medical and rehabilitation benefits were dismissed as the $3,500 limit had been exhausted.

The Tribunal also dismissed the claim for income replacement benefits, finding insufficient evidence that the applicant suffered a substantial inability to perform the essential tasks of her pre-accident employment.