Rebecca Hines

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming for massage therapy and an attendant care re-assessment.

The Licence Appeal Tribunal found the massage therapy treatment plan partially reasonable and necessary, as the evidence showed it provided temporary relief of pain and improved function.

However, the Tribunal denied the attendant care re-assessment, finding the applicant's reported functional limitations were contradicted by social media evidence showing her traveling and participating in physical activities.

The applicant was awarded interest on the overdue massage therapy benefits but denied an award for unreasonable delay.

The applicant requested a reconsideration of a decision finding that her accident-related impairments fell within the Minor Injury Guideline (MIG).

She argued the adjudicator erred in assessing her credibility, weighing the medical evidence regarding chronic pain and psychological impairments, and sought to introduce new medical records.

The adjudicator dismissed the request, finding no significant errors of law or fact that would have changed the outcome.

The adjudicator also declined to admit the new evidence, noting it was either available before the hearing or of limited value.

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

The respondent denied treatment plans for chiropractic care and occupational therapy, and the applicant sought an award for unreasonable delay in paying income replacement benefits.

The Tribunal found the treatment plans reasonable and necessary, noting they were supported by the applicant's treating practitioners and consistent with the medical evidence, while rejecting the respondent's independent medical examinations as inconsistent.

The Tribunal awarded the treatment plans and interest but declined to order an award under Regulation 664, finding the respondent's two-month delay in paying the reinstated income replacement benefit was an error promptly corrected and did not constitute unreasonable conduct.

The applicant requested a reconsideration of a Tribunal decision which found that his accident-related impairments fell within the Minor Injury Guideline (MIG) and that he was not entitled to a disputed treatment plan.

The applicant argued that the adjudicator erred in law by rejecting his expert's diagnosis of chronic pain syndrome, misweighing medical evidence, and incorrectly applying sections 38(8) and 38(9) of the Statutory Accident Benefits Schedule regarding the insurer's notice of denial.

The Tribunal dismissed the reconsideration request, finding that the applicant was attempting to relitigate issues that had already failed at the initial hearing.

The Tribunal held that it had correctly weighed the medical evidence and that the insurer's notice of denial was sufficient to inform the applicant of the reasons for denial and the application of the MIG.

The applicant sought an award under Regulation 664, interest, and punitive damages for bad faith following the respondent's handling of her claim for non-earner benefits.

The Tribunal found that the respondent unreasonably withheld and delayed payment by suspending benefits prior to eligibility, failing to acknowledge an updated disability certificate, and ignoring requests for status updates.

The Tribunal ordered an award of 30% of the benefits paid, plus interest.

The Tribunal also held that it does not have jurisdiction to determine bad faith claims for punitive damages.

The applicant's request to add costs as an issue was granted.

The applicant sought statutory accident benefits following a rear-end motor vehicle accident.

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

The applicant contended he suffered from chronic pain and psychological impairments that removed him from the MIG.

The Tribunal found the applicant's injuries were predominantly minor, preferring the respondent's medical assessments over the applicant's self-reported chronic pain diagnosis.

The Tribunal approved a physiotherapy treatment plan up to the MIG limit.

It also found the respondent's notice denying a chronic pain program was deficient under s. 38(8) of the Schedule, making the plan payable if incurred until proper notice is provided.

Claims for a chronic pain assessment, interest, and a special award were dismissed.

The respondent insurer requested a reconsideration of a Tribunal decision which found that the applicant sustained a catastrophic impairment and was entitled to a Non-Earner Benefit (NEB).

The respondent argued the Tribunal made significant errors of fact and law regarding the Whole Person Impairment (WPI) percentages assigned for medication use, sleep disorder, occipital neuralgia, and mental and behavioural disorders, as well as in applying the legal test for the NEB.

The Adjudicator found that while the Tribunal erred in assigning a 3% WPI for medication use, deducting this amount still left the applicant meeting the catastrophic impairment threshold.

The Adjudicator dismissed the remaining arguments, finding no significant errors of law or fact in the Tribunal's assessment of the medical evidence or its application of the Heath test for the NEB.

The request for reconsideration was dismissed.

The applicant sought accident benefits following a 2015 motor vehicle accident.

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

The Tribunal found that the applicant's injuries were predominantly minor and that he failed to prove chronic pain or psychological impairments that would remove him from the MIG.

However, the Tribunal held that the respondent failed to provide adequate medical and other reasons for denying the treatment plans, violating s. 38(8) of the Schedule.

Applying Ferawana and Zheng, the Tribunal ordered the respondent to pay for the disputed treatment plans, provided they were incurred before proper notice was given.

The claim for interest was denied.

The applicant sought statutory accident benefits following an alleged motor vehicle accident.

The respondent insurer denied the claim on the basis that the applicant was not an occupant of the vehicle at the time of the collision.

Following a preliminary issue hearing, the adjudicator found the applicant's evidence to be inconsistent and lacking credibility, noting her failure to call key corroborating witnesses and her absence from the police motor vehicle accident report.

The adjudicator concluded that the applicant was not in the vehicle when the accident occurred and dismissed the application.

The applicant sought statutory accident benefits for physiotherapy and a chronic pain assessment following a motor vehicle accident.

The insurer denied the treatment plans, arguing the applicant's physical impairments were minor.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, noting that her family doctor's records did not mention the accident or support ongoing physical impairments.

The Tribunal preferred the evidence of the insurer's examination and dismissed the application.

The applicant sought statutory accident benefits following a rear-end collision, claiming his injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain syndrome and psychological impairments.

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor, relying on insurer examinations that concluded his physical and psychological symptoms did not warrant removal from the MIG.

The Tribunal gave little weight to the applicant's pain specialist report, finding it relied entirely on self-reporting and contradicted objective evidence.

The applicant's claims for a $13,667.32 chronic pain program, an award for unreasonable delay, interest, and costs were all dismissed.

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

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

The applicant argued she was removed from the MIG due to a partial rotator cuff tear, right arm radiculopathy, and a psychological impairment.

The Tribunal found that the applicant failed to prove on a balance of probabilities that she suffered from radiculopathy or an accident-related psychological impairment that would remove her from the MIG.

As the injuries were predominantly minor and the funding limit was exhausted, the claims for treatment plans and interest were dismissed.

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

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

The applicant argued she suffered from chronic pain and a psychological impairment that removed her from the MIG.

The Tribunal found the applicant's self-reported symptoms inconsistent and preferred the evidence of the insurer's examiners.

The Tribunal concluded the applicant sustained predominantly minor injuries, and the disputed treatment plans for chronic pain, psychological, and driving anxiety assessments were not reasonable and necessary.

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

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

The applicant argued she suffered from chronic pain and a psychological impairment, removing her from the MIG.

The Tribunal found that the applicant failed to provide sufficient medical evidence to support a diagnosis of chronic pain or a psychological impairment.

Relying on the respondent's insurer examinations, the Tribunal concluded the applicant's injuries were predominantly minor.

As the MIG limit was exhausted, the claims for further medical benefits and interest were dismissed.

The applicant sought medical benefits for chiropractic treatment and PRP injections following a motor vehicle accident.

The Tribunal found that while the accident exacerbated the applicant's pre-existing right shoulder rotator cuff tear, the proposed treatment plans were not reasonable and necessary.

The evidence indicated that past chiropractic treatment had not been effective in reducing pain, and there was insufficient evidence to support the efficacy of PRP injections for the impairment.

Both claims for medical benefits were dismissed.

The applicant, a pedestrian struck by a vehicle, sought statutory accident benefits for chiropractic treatment.

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

The Licence Appeal Tribunal found that the applicant failed to submit an evidentiary record to prove his injuries were not predominantly minor or that the disputed treatment plans were reasonable and necessary.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits from the respondent insurer.

The respondent denied several benefits and requested that the applicant attend multiple insurer examinations (IEs), which she failed to attend.

The respondent raised a preliminary issue seeking to bar the applicant's application pursuant to section 55 of the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant was barred from proceeding with her claims for an in-home attendant care assessment, a monthly attendant care benefit, and certain chiropractic services because the respondent's notices for those IEs complied with section 44(5) of the Schedule.

However, the Tribunal held that the applicant was not barred from proceeding with her claims for a non-earner benefit, a second in-home assessment, and other chiropractic services because the respondent's notices for those IEs were deficient and failed to provide sufficient medical reasons.

The applicant was injured in a motorcycle accident and sought a determination of catastrophic impairment (CAT) under the Statutory Accident Benefits Schedule, along with entitlement to three treatment plans.

The Tribunal found that the applicant's combined physical and psychological impairments resulted in a 48% whole person impairment, falling short of the 55% threshold required for a CAT designation under Criterion 7.

However, the Tribunal found the disputed treatment plans for physiotherapy and psychotherapy to be reasonable and necessary, ordering the respondent to pay them up to the medical and rehabilitation policy limit, plus interest.

The applicant sought payment for three assessments (two psychological and one physiatry) following a motor vehicle accident.

The Tribunal dismissed the claims for the psychological assessments, finding them to be a duplication of services and noting the applicant failed to provide evidence or submissions demonstrating they were reasonable and necessary.

The Tribunal dismissed the claim for the physiatry assessment for lack of jurisdiction, as the treatment plan had not been submitted or denied prior to the application being filed.

Claims for interest and an award were also dismissed.

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

After failing to comply with multiple Tribunal orders to properly file and format her document brief, the Tribunal issued a notice of intention to dismiss the application.

The applicant did not respond or comply within the provided timeframe.

Consequently, the Tribunal dismissed the application without a hearing, finding that the applicant had abandoned her appeal.