Robert Watt

The applicant was injured in a rear-end motor vehicle accident and sought $2,000 for an orthopaedic assessment under the Statutory Accident Benefits Schedule.

The respondent insurer denied the treatment plan.

The Licence Appeal Tribunal found that the applicant had significant pre-existing conditions and that the medical evidence did not establish an orthopaedic injury resulting from the accident.

Preferring the respondent's medical examination report, which found no physical impairments, the Tribunal concluded the assessment was not reasonable and necessary.

The application was dismissed.

The applicant sought an income replacement benefit and the cost of a chronic pain assessment following a motor vehicle accident.

The Tribunal found that the medical evidence, including reports from both the insurer's examiner and the applicant's own assessors, overwhelmingly indicated that the applicant suffered only minor soft tissue injuries and was capable of returning to work.

The applicant also failed to provide evidence that the chronic pain assessment was reasonable and necessary.

The application was dismissed.

The applicant, a pedestrian struck by a motor vehicle, sought a weekly non-earner benefit and interest on overdue payments.

The respondent denied the claim.

The Licence Appeal Tribunal found that the applicant failed to demonstrate a complete inability to carry on a normal life, as she was still able to engage in most pre-accident activities, albeit in a more limited manner.

Medical reports indicated she had recovered by at least 50%.

The application was dismissed.

The applicant, who has autism, was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, primarily for chiropractic services, as well as interest and an award under Regulation 664.

The Licence Appeal Tribunal dismissed the claims, finding that the applicant failed to prove on a balance of probabilities that her ongoing neck, shoulder, and back pain were caused by the accident.

Relying on insurer examination reports, the adjudicator concluded that the requested treatments were neither reasonable nor necessary, and consequently denied the claims for interest and a special award.

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

The central issue was whether the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant's medical experts opined that he suffered from chronic pain and psychological impairments outside the MIG.

However, the adjudicator preferred the insurer's medical examination and the applicant's own statements, which confirmed he was working full-time, attending school, and maintaining his social life.

The adjudicator concluded the injuries were predominantly minor and dismissed the application for benefits beyond the MIG cap, as well as claims for interest and a special award.

The applicant sought non-earner benefits following a motor vehicle accident.

The respondent denied the benefits based on insurer's examinations which concluded the applicant did not suffer a complete inability to carry on a normal life.

The Tribunal preferred the detailed reports of the respondent's assessors over the brief letter from the applicant's family physician.

The Tribunal found the applicant was able to continue his pre-accident activities and dismissed the claim for non-earner benefits, interest, and costs.

The applicant sought medical benefits for chiropractic services following a motor vehicle accident.

The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the treatment plans were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant's injuries were minor and subject to the MIG funding limit, as there was no compelling medical evidence of a pre-existing condition that would preclude recovery within the MIG.

The Tribunal also found that the applicant failed to prove the treatment plans were reasonable and necessary.

The application was dismissed.

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

The insurer argued the application was barred by the two-year limitation period, relying on an Explanation of Benefits (EOB) letter sent in July 2013.

The Tribunal found that the insurer breached its duty of good faith by failing to provide the required benefits information package.

Furthermore, the EOB letter did not constitute a clear and unequivocal denial because the applicant had not yet elected a specific benefit and the insurer's stated reason for denial was incorrect.

As a result, the limitation period was not triggered, and the applicant was permitted to proceed with her claim.

The respondent in a statutory accident benefits dispute brought a motion to exclude a letter from the case file, arguing it contained privileged case conference information and inflammatory content.

Following discussions between the parties, the respondent withdrew its motion.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits and various medical and rehabilitation benefits.

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

The Licence Appeal Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, as surveillance and medical evidence showed she retained significant functional abilities.

Furthermore, the Tribunal concluded the applicant's injuries were predominantly minor and she failed to prove a pre-existing medical condition that would exempt her from the MIG cap.

As the $3,500 cap was exhausted, the claims for additional medical benefits and examination costs were dismissed.

The applicant withdrew his application for statutory accident benefits before the scheduled hearing date.

The respondent brought a motion for costs, arguing the applicant wasted time with adjournments and should have withdrawn earlier.

The Tribunal dismissed the motion, finding insufficient evidence that the applicant's conduct was unreasonable, frivolous, vexatious, or in bad faith under Rule 19.1 and section 17.1(2) of the SPPA.

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

The respondent denied a treatment plan for physiotherapy and requested an insurer's examination under section 44 of the Schedule, which the applicant refused to attend.

The Tribunal found the applicant in non-compliance with section 44, barring the claim for the treatment plan.

The Tribunal also found that the applicant did not suffer a complete inability to carry on a normal life within 104 weeks of the accident, dismissing the claim for a non-earner benefit.

Finally, the Tribunal concluded that the applicant's injuries fell within the Minor Injury Guideline, as there was insufficient evidence of chronic pain or pre-existing conditions to warrant removal from the guideline.

The application was dismissed.

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

After a case conference, the applicant was ordered to file written submissions but failed to do so and did not request an extension.

The respondent brought a motion to dismiss the application as an abuse of process.

The adjudicator found the applicant's failure to comply with the order and communicate with the respondent constituted an abuse of process.

The motion was granted and the application was dismissed without costs, as awarding costs against the applicant would render any potential recovery moot.

The applicant applied for a $10,000 death benefit following her mother's death in a motor vehicle accident.

The insurer denied the claim on the basis that the applicant, an adult child living at home and working full-time, was not principally dependent on her mother for financial support or care.

The Tribunal found that the applicant earned sufficient income to be self-supporting and failed to prove that her mother provided more than 50% of her financial needs.

The application for death benefits and interest was dismissed.

The applicant sought a $10,000 death benefit following her mother's death in a motor vehicle accident, claiming she was principally dependent on her mother for financial support and care.

The Licence Appeal Tribunal found that the applicant, who was employed and earning over $44,000 annually, was capable of meeting her own financial needs and was not financially dependent on her mother.

The application for the death benefit and associated interest was dismissed.

The applicant sought non-earner benefits following a motor vehicle accident.

The Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, as he was still able to engage in substantially all of his pre-accident activities, albeit with some pain and restrictions.

The Tribunal also denied the applicant's request to admit a late-filed medical report.

The application was dismissed.

The applicant insurer sought to recover an overpayment of $17,200.00 in income replacement benefits paid to the respondent after she had returned to full-time work.

The respondent argued that the notice of repayment was defective.

The adjudicator found that the notice met the requirements of section 52 of the Statutory Accident Benefits Schedule and ordered the respondent to repay the overpayment plus interest.

The applicant's request for costs was denied due to insufficient evidence of unreasonable conduct.

The applicant was injured in a motor vehicle accident and sought medical benefits for chiropractic treatment.

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

The Tribunal found that the applicant failed to prove her injuries fell outside the MIG or that she had a pre-existing condition preventing maximal recovery within the MIG limit.

The Tribunal also found the proposed treatment plans were not reasonable and necessary.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought an Income Replacement Benefit (IRB).

The insurer sought to deduct post-accident business income earned by the applicant in 2016 from the IRB under section 7(3)(b) of the Statutory Accident Benefits Schedule.

The applicant argued he was not actively engaged in the business post-accident, having hired another chiropractor to run day-to-day operations.

The Tribunal found that the applicant remained actively engaged in major business decisions and that the Schedule does not distinguish between active and passive income for the purposes of deduction.

The Tribunal held that the insurer was entitled to deduct the post-accident business income, reducing the applicant's IRB entitlement to zero.

The applicant, who was self-employed running a house cleaning business, sought increased Income Replacement Benefits (IRB) following a motor vehicle accident.

The dispute centered on the calculation of post-accident fixed business costs, specifically whether expenses like home office and management fees should be deducted when the applicant was not actively working.

The Tribunal agreed with the respondent insurer's calculation, finding that expenses not actually incurred post-accident should not be included.

The Tribunal also dismissed the applicant's claim for a special award, finding the insurer acted reasonably under section 33 of the Schedule in withholding benefits until the applicant provided requested bank statements to verify her post-accident income.