Sandeep Johal

The applicant sought statutory accident benefits for physical and psychological injuries allegedly sustained in a motor vehicle accident.

The respondent denied the claims, arguing that the accident was not the cause of the applicant's impairments, pointing to extensive pre-existing medical and psychological issues, including trauma from Syria and family legal troubles.

The Tribunal applied the 'but for' test and found that the applicant failed to prove the accident was a necessary cause of her impairments.

Furthermore, the Tribunal found that the requested medical benefits and catastrophic impairment assessments were not reasonable and necessary, or were duplicative and contrary to the Schedule.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits.

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

The applicant argued that she suffered from chronic pain and had pre-existing conditions that warranted removal from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence or a diagnosis of chronic pain from a qualified expert.

Furthermore, the applicant did not provide compelling evidence that her pre-existing conditions would prevent maximal recovery within the MIG limits.

The Tribunal concluded the applicant's injuries were predominantly minor and subject to the MIG.

As the MIG limits were exhausted, the claims for additional benefits and interest were dismissed.

The applicant was injured in a motor vehicle accident and sought a medical benefit of $3,744.32 for chiropractic treatment under the Statutory Accident Benefits Schedule.

The respondent denied the treatment plan on the basis that it was not reasonable and necessary.

The Licence Appeal Tribunal applied a three-part test and found that the applicant failed to provide compelling contemporaneous medical evidence to support the need for treatment three years post-accident.

Relying on an insurer's examination report which noted the applicant's condition was static, the Tribunal concluded the treatment plan was not reasonable and necessary.

The claims for interest and an award were also dismissed.

The applicant was injured in a 2015 motor vehicle accident and sought accident benefits, which the respondent insurer denied on the basis that her injuries fell within the Minor Injury Guideline (MIG).

The applicant had significant pre-existing injuries from prior accidents.

The Tribunal found that the subject accident exacerbated her pre-existing conditions and caused chronic pain, removing her from the MIG.

The Tribunal ordered the respondent to pay for a psychological assessment, finding it reasonable and necessary, along with interest.

However, the Tribunal dismissed the claims for an In-Home Attendant Care assessment and a non-earner benefit, as the applicant failed to prove a complete inability to carry on a normal life.

The applicant sought Income Replacement Benefits (IRBs) following a motor vehicle accident.

The respondent insurer claimed a deduction for post-accident payments the applicant received from her mother's business, where she had been employed prior to the accident.

The applicant argued the payments were a gift, as she was not actively working.

The Tribunal found that the payments constituted employment income, noting they were paid in the same manner as pre-accident wages, with standard tax deductions, and reported as income to the CRA.

The Tribunal concluded the applicant failed to provide contemporaneous evidence to rebut the presumption of employment income and establish the legal elements of a gift.

The respondent was entitled to deduct the income, reducing the IRB payable to nil.

The applicant was injured in a motor vehicle accident and sought medical benefits under the Statutory Accident Benefits Schedule.

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

The applicant argued he should be removed from the MIG due to psychological injuries and pre-existing conditions.

The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered a psychological impairment or that his pre-existing conditions would prevent maximal recovery under the MIG limit.

As the MIG limits were exhausted, the claims for additional medical benefits and interest were dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for occupational therapy, an optometry assessment, and a gym membership.

The respondent insurer denied the benefits.

The Tribunal found that the applicant had proven on a balance of probabilities that the claimed treatment plans and assessments were reasonable and necessary to treat her concussion and psychological symptoms.

The Tribunal placed less weight on the insurer's examination reports.

The applicant was awarded the claimed benefits and interest, but her claim for an award was dismissed.

The respondent's request for costs was also dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought medical and income replacement benefits.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that he did not suffer a substantial inability to perform his employment tasks as a taxi driver.

The adjudicator found that the applicant's injuries were predominantly minor and that he failed to prove on a balance of probabilities that his knee injuries, degenerative disc disease, psychological impairments, or chronic pain were caused by the accident or warranted removal from the MIG.

As the MIG limits were exhausted, the medical benefits claims were dismissed.

The adjudicator also dismissed the claim for income replacement benefits, finding insufficient evidence that the applicant was substantially unable to perform the essential tasks of his employment.

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

The parties agreed the applicant was entitled to IRBs but disputed the quantum.

The self-represented applicant relied on an accounting report that calculated pre-accident income based on the 52 weeks prior to the accident, while the respondent relied on a report calculating income based on the last completed taxation year pursuant to s. 4(3) of the Schedule.

The Tribunal preferred the respondent's accounting report as it complied with the Schedule and relied on documentary evidence.

The Tribunal ordered IRBs payable in accordance with the respondent's calculations, plus interest on overdue payments.

The applicant was injured in a rear-end motor vehicle collision and sought statutory accident benefits, including a chiropractic treatment plan.

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

The Licence Appeal Tribunal found that the applicant's physical injuries were minor and that she failed to provide compelling evidence of a psychological impairment or that her pre-existing conditions would prevent maximal recovery under the MIG limit.

As the MIG limits were exhausted, the application for the treatment plan and interest was dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought medical benefits under the Statutory Accident Benefits Schedule.

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

The applicant argued that psychological impairments and pre-existing conditions (toe fracture, tuberculosis, sciatica) removed him from the MIG.

The Tribunal found that the applicant's physical injuries were predominantly minor and that he failed to provide compelling evidence from a health practitioner that his pre-existing conditions would prevent maximal recovery under the MIG limit.

The Tribunal also found insufficient evidence of a psychological impairment.

As the $3,500 MIG limit was exhausted, the disputed treatment plans and interest were denied.

The applicant was injured in a motor vehicle accident and sought medical benefits and an income replacement benefit (IRB).

The respondent denied the benefits, placing the applicant in the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's injuries were predominantly minor and that he failed to provide compelling medical evidence of a psychological impairment or chronic pain that would remove him from the MIG.

As the MIG limits were exhausted, the psychological assessment was not payable.

The Tribunal also dismissed the claim for an IRB, finding the applicant failed to prove a substantial inability to perform the essential tasks of his employment.

The applicant was injured in a motor vehicle accident and sought medical benefits, which the respondent insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant suffered from a psychological impairment (adjustment disorder) that removed him from the MIG.

The Tribunal ordered the respondent to pay for three chiropractic treatment plans, finding them reasonable and necessary to alleviate ongoing pain.

One psychological treatment plan was partially approved, while others and a cognitive assessment were denied.

Interest was awarded on the overdue payments.

The respondent insurer requested a reconsideration of a decision granting the applicant funding for a multi-disciplinary catastrophic impairment assessment.

The insurer argued the Tribunal erred in law by applying the 'reasonable and necessary' test under section 15 of the Statutory Accident Benefits Schedule instead of section 25, and by relying on procedural fairness to justify the funding.

The Tribunal dismissed the request, finding that while referencing section 15 was an error, it was not significant enough to change the outcome because section 25 still requires assessments to be necessary and costs to be reasonable.

The Tribunal also held that denying the applicant her first set of catastrophic assessments would be procedurally unfair, as it would leave her with no evidence to challenge the insurer's denial.

The applicant was injured in a motor vehicle accident and sought medical benefits, which the respondent denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing that pre-existing conditions and psychological impairments warranted removal from the MIG.

The Tribunal found that the applicant failed to provide compelling evidence that his pre-existing knee injury would prevent maximal recovery under the MIG.

Furthermore, the Tribunal preferred the respondent's psychological assessment, which included validity testing indicating symptom magnification, over the applicant's psychological report.

Consequently, the Tribunal concluded the applicant's injuries were predominantly minor, and since the MIG limits were exhausted, the claims for further benefits, interest, and an award were dismissed.

The applicant brought a motion seeking clarification of a previous Tribunal order regarding the production of redacted adjuster log notes.

The applicant argued the order was ambiguous and requested that the respondent provide a sufficient explanation for each redaction to allow for challenges to claims of privilege.

The Tribunal found no ambiguity in the original order but held that simply stating 'Solicitor-Client Privilege' or 'Litigation Privilege' was not a reasonable explanation.

The Tribunal ordered the respondent to provide an explanation or summary for each redaction without compromising the privilege.

The applicant was injured in a rear-end motor vehicle collision and sought statutory accident benefits.

The respondent insurer denied a chiropractic treatment plan on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's documented anxiety and insomnia, for which she was prescribed medication by her family doctor, constituted a psychological impairment that removed her from the MIG.

The Tribunal further held that the $999.59 chiropractic treatment plan was reasonable and necessary, noting that the insurer's own examiner diagnosed a sprain/strain and WAD injury despite concluding no ongoing impairment existed.

The applicant was awarded the medical benefit and interest.

The applicant was injured in a rear-end motor vehicle collision and sought medical benefits beyond the Minor Injury Guideline (MIG) limit, claiming psychological impairments.

The Tribunal found that the applicant's injuries were predominantly minor and that she failed to prove on a balance of probabilities that she suffered a psychological injury warranting removal from the MIG.

The Tribunal placed little weight on the applicant's psychological report because the test scores indicated minimal depression and anxiety, contradicting the psychologist's diagnosis.

The respondent's request for a $50 repayment due to an alleged overpayment was dismissed as there was no evidence of wilful misrepresentation by the applicant.

The applicant was injured in a motor vehicle accident and sought payment for a Functional Abilities Evaluation, a chronic pain assessment, and a neurological assessment under the Statutory Accident Benefits Schedule.

The respondent denied the benefits on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant failed to provide sufficient medical evidence to prove on a balance of probabilities that the requested assessments were reasonable and necessary.

The application was dismissed and no interest was awarded.

The applicant sought to dispute the denial of a non-earner benefit and a physiotherapy treatment plan more than two years after the insurer's refusal.

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

The Tribunal found that it had jurisdiction to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act, 1999.

However, applying the four-part test for an extension of time, the Tribunal concluded that the applicant failed to demonstrate a bona fide intention to appeal within the limitation period or provide a compelling explanation for the delay.

The application was dismissed as statute-barred.