Robert Maich

The applicant sought various statutory accident benefits following a 2017 motor vehicle accident.

The Licence Appeal Tribunal held a written hearing to determine entitlement to attendant care benefits, multiple treatment plans for social worker counselling, occupational therapy, assistive devices, medical cannabis, catastrophic impairment assessments, mileage, and a special award.

The Tribunal partially granted the attendant care benefits, excluding amounts for emotional support.

Claims for social worker counselling and social rehab counselling were dismissed or reduced to align with FSCO Guidelines, particularly rejecting excessive travel time and planning fees.

The Tribunal approved occupational therapy services, assistive devices (less amounts previously settled), medical cannabis, and capped the catastrophic impairment assessments at $2,000 each.

Claims for mileage and a special award were dismissed.

Interest was awarded on overdue benefits.

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

The Tribunal found that two of the treatment plans in dispute were barred by the doctrine of res judicata as they had been previously decided.

For the remaining claims submitted via OCF-6 forms, the Tribunal awarded $1,571.13 for massage, personal training, and osteopathic services, applying the Professional Services Guideline rate despite the absence of an approved OCF-18, as the treatments were for symptom relief during a denial period.

The Tribunal also awarded $346.20 for another OCF-6, limited to the remaining balance of a previously approved treatment plan.

The Tribunal granted a special award under s. 10 of O. Reg. 664 for the respondent's unreasonable delay in adjusting one of the OCF-6 claims, along with interest on overdue payments.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits, including a determination of catastrophic impairment.

The Licence Appeal Tribunal found that the applicant sustained a catastrophic impairment under Criterion 8, concluding she suffered a class 5 extreme impairment in social function and class 4 marked impairments in concentration, persistence, pace, and adaptation due to mental and behavioural disorders.

The Tribunal awarded attendant care benefits at a reduced rate of $785.25 per month and approved several medical and rehabilitation treatment plans, including occupational therapy, physiotherapy, aquatherapy, and pet therapy.

The Tribunal also ordered the respondent to pay a 50% special award under s. 10 of Reg. 664, totaling $7,336.27, finding that the insurer unreasonably denied critical treatment plans early in the applicant's recovery.

The applicant insurer sought repayment of $34,000 in settlement funds paid directly to the self-represented respondent, arguing the funds were paid in error because a Full and Final Release directed payment to the respondent's former legal counsel in trust.

The Licence Appeal Tribunal dismissed the application, finding that while the Settlement Disclosure Notice falls under its jurisdiction, the Full and Final Release does not.

The Tribunal concluded the insurer fulfilled its obligations under the Statutory Accident Benefits Schedule by paying the insured directly, and the dispute over the trust direction was a contractual solicitor-client issue outside the Tribunal's jurisdiction.

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

The respondent initially placed the applicant in the Minor Injury Guideline and denied treatment plans based on section 44 assessments.

After receiving further medical documentation, the respondent voluntarily removed the applicant from the guideline and approved the disputed treatment plans.

The applicant sought a special award under section 10 of Regulation 664, arguing the 90-day delay in adjusting the file was unreasonable.

The Tribunal dismissed the claim for an award, finding the insurer's reliance on its assessors and subsequent good-faith adjustment of the file upon receiving new evidence did not constitute excessive or imprudent delay.

The applicant was awarded interest on the overdue benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a concussion assessment and a physiotherapy treatment program.

The respondent insurer denied the benefits based on an insurer's examination report.

The Tribunal found the applicant's medical evidence, including assessments from a psychologist, a chronic pain physician, and a concussion management physiotherapist, outweighed the respondent's general practitioner report, which lacked specific concussion testing.

The Tribunal ordered the respondent to pay for the disputed treatment plans and interest on overdue payments.

However, the Tribunal dismissed the applicant's claim for a special award, finding the respondent's reliance on its medical reports was not unreasonable or arbitrary.

The applicant sought a special award under s. 10 of O. Reg. 664, alleging the respondent unreasonably delayed payment of an income replacement benefit (IRB).

The respondent argued the claim should be dismissed for procedural unfairness due to lack of particulars, which the Tribunal rejected.

The Tribunal found the respondent's conduct between February 29, 2024, and April 4, 2024, was excessive and imprudent, as the adjuster failed to actively review the file or address inconsistencies in the applicant's employment status until a complaint was lodged.

The Tribunal awarded the applicant $704.36, representing 50% of the IRB payable during the period of unreasonable delay, plus interest.

The self-represented applicant sought statutory accident benefits following a motor vehicle accident.

The Tribunal found that the applicant was barred from proceeding with several claims because he failed to attend a scheduled insurer's examination without providing a reasonable explanation, triggering the bar under section 55(1) of the Schedule.

For the remaining issues, the applicant failed to provide submissions addressing the Minor Injury Guideline or the reasonableness and necessity of the disputed treatment plans.

Consequently, the Tribunal held that the applicant remains subject to the Minor Injury Guideline and dismissed the claims for the treatment plans.

The applicant was injured in a severe motor vehicle accident and sought various statutory accident benefits, including attendant care benefits (ACB) and medical expenses, which the respondent insurer denied.

The Licence Appeal Tribunal found the applicant was entitled to ACB at the non-catastrophic maximum of $3,000 per month for a closed period, deeming the expenses incurred because the insurer unreasonably withheld payment during that time.

The Tribunal also approved a treatment plan for optometric services to investigate ongoing vision impairments and awarded partial reimbursement for prescription medications, an ambulance bill, and replacement glasses submitted on various OCF-6 forms.

Claims for an award under s. 10 of Regulation 664 were dismissed, but interest was awarded on all overdue benefits.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed psychological impairments, including PTSD and depression, warranted removal from the MIG.

The Tribunal found the applicant's self-reporting to the psychological assessors was inconsistent and unreliable, particularly regarding his pre-existing conditions and post-accident work activities.

Consequently, the Tribunal assigned little weight to the expert psychological reports.

The Tribunal concluded the applicant failed to meet his burden of proof, held that his injuries were predominantly minor, and dismissed the claims for chiropractic and psychological treatment plans.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming physical and psychological injuries that warranted removal from the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor.

The Tribunal assigned little weight to the applicant's psychological assessment due to its reliance on self-reporting and failure to account for a pre-existing mental health history.

Consequently, the applicant was not entitled to the disputed treatment plans for psychological and physiotherapy services, nor to interest.

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

The Tribunal first addressed preliminary limitation period issues, finding the claim for non-earner benefits (NEB) and one chiropractic plan were not statute-barred due to delayed unequivocal denials, while two other plans were barred.

On the substantive issues, the Tribunal removed the applicant from the Minor Injury Guideline (MIG) based on evidence of chronic pain with functional impairment and somatic symptom disorder.

The applicant was awarded NEB for a closed period due to the insurer's non-compliance with notice provisions, but failed to meet the substantive test for ongoing NEB.

The Tribunal approved several treatment plans for psychological, neurological, and chiropractic services as reasonable and necessary, but denied the applicant's request for a special award.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and a chiropractic treatment plan.

The Licence Appeal Tribunal dismissed the claim for the non-earner benefit, finding the applicant's inconsistent self-reporting of her pre-accident activities and pre-existing conditions precluded a clear comparison under the Heath test.

However, the Tribunal approved the chiropractic treatment plan, noting the respondent's own occupational therapy assessor found the treatment relieved the applicant's pain.

The Tribunal also ordered the respondent to pay a 50% award under s. 10 of Reg. 664 ($1,300) for unreasonably withholding approval of the treatment plan despite having its own assessor's supportive report.

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

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

The applicant claimed his psychological injuries and hearing loss warranted removal from the MIG.

The Tribunal found the applicant failed to establish that his psychological condition or hearing loss removed him from the MIG, noting a lack of objective evidence and causation issues.

However, the Tribunal ordered the respondent to pay for two assessments because it failed to provide timely notices of denial under s. 38(8) of the Schedule.

The applicant's request for an award for unreasonable delay was dismissed.

The applicant, who sustained catastrophic impairments in a motor vehicle accident, sought payment for various treatment plans, including occupational therapy, physiotherapy, and medical cannabis.

The respondent denied the benefits.

The Tribunal found that the medical cannabis was reasonable and necessary, noting the applicant's indigenous cultural preference for natural remedies and supporting medical evidence.

The Tribunal also awarded travel expenses for service providers, recognizing the remote nature of the applicant's underserviced reservation.

However, the Tribunal denied several claims for full OCF-18 form completion fees, finding one hour to be reasonable, and denied further physiotherapy and social work counselling due to a lack of compelling evidence from the applicant.

The applicant, an intercity bus driver, was injured in a motor vehicle accident and sought post-104 income replacement benefits (IRBs).

The respondent denied the benefits, arguing the applicant's return to part-time work as a mail courier demonstrated she did not suffer a complete inability to engage in suitable employment.

The Tribunal found that the applicant's cognitive decline, photophobia, and reduced stamina rendered her unable to perform the highly responsible duties of an intercity bus driver.

Relying on the applicant's recent neurological and neuropsychological assessments, the Tribunal concluded her condition had deteriorated over time and she met the post-104 test as of September 27, 2023.

The applicant was awarded IRBs from that date onward, plus interest.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including an income replacement benefit (IRB) and various medical assessments and treatment plans.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal found that the applicant was substantially unable to perform the essential tasks of his self-employment, specifically overhead lifting and setting up his business, and awarded IRB from June 16, 2022 to June 30, 2023.

The Tribunal also approved several psychological, psychiatric, and chronic pain assessments, as well as chiropractic treatment plans, finding them reasonable and necessary.

However, the Tribunal denied a nutritional assessment and certain psychological and chiropractic treatment plans where the applicant failed to meet his burden of proof or had not utilized previously approved treatments.

Interest was awarded on overdue benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for various psychological and physical treatment plans.

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

The Tribunal found that the applicant failed to discharge his burden to prove his injuries warranted removal from the MIG.

The Tribunal preferred the respondent's psychological expert over the applicant's expert, noting the applicant's expert failed to address contradictory medical records.

As the MIG limits were exhausted, the treatment plans were not payable.

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

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

The Tribunal found that the applicant suffered from chronic pain, removing him from the MIG.

The Tribunal approved the disputed treatment plans for physiotherapy, chiropractic, and massage therapy, as well as a physiatry assessment, finding them reasonable and necessary.

The claim for medication expenses was denied because the applicant had not first submitted it to his extended health coverage.

Interest was awarded on all overdue benefits.

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

The applicant claimed entitlement to attendant care benefits and several treatment plans, including occupational therapy, physiotherapy, spinal decompression therapy, and various assessments.

The Tribunal found that the applicant did not meet the burden of proving entitlement to attendant care benefits, as the medical evidence indicated functional range of motion and independence in self-care tasks.

The Tribunal also denied the claims for occupational therapy, physiotherapy, and the neurological and chronic pain assessments, either because the applicant failed to provide sufficient submissions or because the insurer's denials were compliant with the Schedule.

However, the Tribunal granted the claim for spinal decompression therapy, finding it reasonable and necessary based on a physician's recommendation supported by objective diagnostic imaging.

The applicant was also awarded interest on the overdue payment.