Sam Moini

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs), medical benefits, and an award for unreasonable delay.

The Tribunal found the applicant suffered from accident-related chronic pain syndrome and adjustment disorder, which caused a substantial inability to perform the essential tasks of her pre-accident employment as a general labourer.

Consequently, she was awarded pre-104-week IRBs.

However, the Tribunal denied post-104-week IRBs, finding she did not suffer a complete inability to engage in reasonably suited employment, given her ongoing college studies and completion of a practicum in mental health counselling.

The Tribunal also approved treatment plans for chiropractic services, physiotherapy, and a chronic pain assessment, preferring the applicant's medical evidence over the respondent's assessors.

Claims for costs and a special award were dismissed, but interest on overdue benefits was granted.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits (IRBs), various treatment plans, an award, and interest.

The respondent denied the benefits, arguing the applicant's impairments were related to pre-existing conditions and did not cause a substantial or complete inability to work.

The Tribunal applied the "but for" test and found the accident was a necessary cause of the applicant's chronic pain and psychological impairments.

The Tribunal held the applicant was entitled to IRBs for both the pre-104 and post-104 periods, finding he suffered a complete inability to engage in reasonably suited employment due to his physical limitations, age, and lack of transferable skills.

The Tribunal also approved several treatment plans for psychological, chronic pain, and functional assessments, but denied others lacking evidentiary support.

The claim for an award was dismissed as the respondent's conduct was not unreasonable, but interest was awarded on overdue benefits.

The applicant sought a determination that he sustained a catastrophic impairment as a result of a 2016 motor vehicle accident, claiming marked impairments in social functioning and adaptation, and a whole person impairment (WPI) of 55% or more.

The Tribunal found that the applicant's psychological impairments were largely attributable to pre-existing substance abuse issues rather than the accident.

Preferring the evidence of the respondent's psychiatric assessor, the Tribunal concluded the applicant suffered only mild impairments and a 14% mental/behavioural WPI, falling short of the catastrophic impairment thresholds.

The application for attendant care benefits, assessment costs, and interest was dismissed.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident.

The Tribunal found that the applicant suffered an accident-related psychological impairment, specifically an adjustment disorder with mixed anxiety and depressed mood, which caused a substantial inability to perform the essential tasks of her pre-accident employment in customer service.

The Tribunal awarded IRBs in the amount of $287.88 per week for the disputed period, along with interest.

The applicant's claim for an award for unreasonable delay was dismissed, as the insurer's conduct was not found to be excessive or indicative of bad faith.

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

Prior to the hearing, the applicant withdrew all substantive issues, leaving only a preliminary issue regarding whether he was barred from benefits under section 31(1)(a)(i) of the Schedule for operating an uninsured vehicle.

The Tribunal held that it lacked jurisdiction to hear the preliminary issue as a stand-alone matter because the underlying benefits were no longer in dispute.

The respondent's request for costs was dismissed, as the applicant's conduct in withdrawing the issues and arguing the jurisdictional point was not unreasonable, frivolous, vexatious, or in bad faith.

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

A three-day videoconference hearing was scheduled, but the applicant failed to attend.

The Tribunal confirmed that the applicant had received proper notice of the hearing.

Proceeding in the applicant's absence pursuant to section 7(1) of the Statutory Powers Procedure Act, the Tribunal found that the applicant failed to present any evidence or submissions to meet their onus of proving entitlement to the disputed benefits.

The application was dismissed.

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

The applicant claimed entitlement to income replacement benefits (IRBs), various treatment plans, an IRB report, and an award for unreasonable delay.

The Tribunal found that the applicant's physical and psychological injuries were predominantly minor and did not warrant removal from the MIG, dismissing the claims for treatment plans beyond the $3,500 limit.

The Tribunal also dismissed the claim for IRBs, finding insufficient medical evidence to prove a substantial inability to perform essential employment tasks.

However, the Tribunal ordered the respondent to pay $2,034.00 for an IRB report, finding it reasonable and necessary to calculate the quantum of the claimed benefit, along with applicable interest.

The claim for an award was dismissed.

The applicant was involved in a motor vehicle accident and sought funding for chiropractic 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 funding limit had been exhausted.

The applicant argued that her consistent headaches and neck/back pain warranted removal from the MIG.

The Tribunal found that the medical evidence, including reports from a neurologist and physiatrist, supported a diagnosis of tension/cervicogenic headaches and neck/back strains, which fall under the definition of a minor injury.

The applicant failed to establish on a balance of probabilities that her injuries warranted removal from the MIG.

As the MIG limit was exhausted, the treatment plans and claim for interest were dismissed.

The applicant requested a reconsideration of a Tribunal decision that found she did not sustain a catastrophic impairment.

The applicant argued the Tribunal breached procedural fairness by shortening the hearing from 7 to 4 days and erred in its assessment of expert evidence, the AMA Guides, and causation.

The Tribunal dismissed the request, finding the shortened hearing was proportional given the reduced witness list and that the applicant was improperly attempting to re-weigh the evidence.

The Tribunal confirmed its preference for the respondent's psychiatric expert over the applicant's psychological expert.

The applicant sought accident benefits following a motor vehicle accident, claiming she sustained a catastrophic impairment due to psychological issues.

The Tribunal found that the applicant's extensive pre-existing psychological conditions were the primary cause of her impairments, and the accident was not a necessary cause.

The Tribunal preferred the respondent's medical evidence, noting the applicant's self-reports were inconsistent with her medical records, which showed improvement post-accident.

The application for catastrophic impairment, non-earner benefits, and other medical benefits was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to non-earner benefits, various treatment plans, and removal from the Minor Injury Guideline (MIG) due to chronic pain and psychological injuries.

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor and that he failed to meet the AMA Guides criteria for chronic pain or provide sufficient medical evidence of a psychological injury.

Furthermore, the applicant did not establish a complete inability to carry on a normal life to qualify for non-earner benefits.

The application was dismissed, and no benefits, interest, or awards were payable.

The applicant sought statutory accident benefits, claiming she sustained a catastrophic impairment under Criterion 8 (mental or behavioural disorder) following a motor vehicle accident.

The applicant argued she suffered a marked impairment in adaptation, relying on psychiatric and occupational therapy evidence.

The respondent contended the impairment was mild, pointing to pre-existing physical health issues and inconsistencies in the applicant's self-reported functioning.

The Tribunal found the applicant's evidence failed to differentiate between physical and mental impairments, concluding her limitations were primarily physical and pre-existing.

The Tribunal held the applicant suffered only a mild impairment in adaptation and did not meet the threshold for catastrophic impairment.

Both parties' requests for costs were dismissed.

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

The matter was scheduled for a videoconference hearing, but the applicant failed to attend without providing a reason.

The adjudicator proceeded in the applicant's absence pursuant to section 7(1) of the Statutory Powers and Procedures Act.

Because the applicant presented no evidence to demonstrate entitlement to the disputed treatment plans for psychological services and a chronic pain assessment, the application was dismissed.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming she was substantially unable to perform her pre-accident employment tasks.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to provide contemporaneous medical evidence of disability during the claim period.

The Tribunal relied on insurer's examinations and the applicant's successful enrollment in a computerized accounting program to conclude she was not disabled from her sedentary administrative duties.

Claims for an award and interest were consequently dismissed.

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

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

The Licence Appeal Tribunal found that the applicant provided no evidence to support removal from the MIG.

The Tribunal also rejected the applicant's argument that the treatment plans were payable due to a defective denial, finding that the respondent's denial letters provided sufficient medical reasons in compliance with s. 38(8) of the Schedule.

The application was dismissed.