Sandeep Johal

The applicant was injured in a motorcycle accident and sought statutory accident benefits for physiotherapy, a neurological assessment, and a chronic pain assessment.

The Licence Appeal Tribunal found that the physiotherapy treatment was reasonable and necessary based on the physical findings of limited flexion and recommendations from treating neurologists, rejecting the insurer's orthopaedic assessment.

However, the Tribunal denied the requests for neurological and chronic pain assessments, finding insufficient evidence to support their necessity.

Claims for an award and costs were also dismissed.

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).

Prior to the hearing, the respondent approved the disputed treatment plans.

The remaining issues were whether the applicant was entitled to an award for unreasonably delayed payments and whether either party was entitled to costs.

The Tribunal found that the respondent unreasonably withheld payments by maintaining its MIG denial despite having an independent medical examination report diagnosing a psychological impairment outside the MIG.

The Tribunal awarded the applicant 25% of the delayed benefits, totaling $2,316.38, plus interest.

Both parties' requests for costs were dismissed.

The applicant sought reconsideration of a decision finding her appeal for an income replacement benefit was statute-barred.

The Tribunal considered whether section 7 of the Licence Appeal Tribunal Act applies to extend limitation periods under the Statutory Accident Benefits Schedule.

Preferring previous Executive Chair decisions over a conflicting adjudicator decision, the Tribunal found section 7 does apply.

Applying the four-factor test for extensions of time, the Tribunal found the 13-day delay was caused by a law firm error, the applicant had a bona fide intention to appeal, and there was no prejudice to the respondent.

The extension was granted.

The applicant was injured in a motor vehicle accident and sought a determination of catastrophic impairment under the Statutory Accident Benefits Schedule based on a spinal cord injury.

The respondent denied the designation, arguing that the applicant's ASIA Impairment Scale grade was not yet "permanent" because the injury had the potential to improve over the initial 18-24 months.

The adjudicator found that the applicant met the definition of catastrophic impairment, noting that her ASIA Impairment Scale score of "D" satisfied the criteria and there was no evidence she would improve to a normal "E" score.

The adjudicator rejected the respondent's argument that a 24-month waiting period was required, as paragraph 1 of section 3.1(1) contains no such temporal requirement.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for various physiotherapy, chiropractic, and assessment treatment plans.

The respondent denied the benefits, arguing in part that one claim was statute-barred by the two-year limitation period and that the applicant had reached maximum medical recovery.

The Tribunal applied section 7 of the LAT Act to extend the limitation period, finding the 19-day delay caused no prejudice.

The Tribunal further found all disputed treatment plans and assessments to be reasonable and necessary, rejecting the respondent's insurer examination report due to the applicant's consistent, documented chronic pain.

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

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

The Tribunal found the Minor Injury Guideline issue premature as no treatment plans were in dispute.

The Tribunal dismissed the claim for a non-earner benefit, finding the applicant failed to provide evidence comparing his pre- and post-accident activities to establish a complete inability to carry on a normal life as required by the Heath test.

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

The respondent denied the benefit, arguing the applicant's injuries were caused by a pre-existing psychiatric condition.

The Tribunal found that the applicant failed to prove on a balance of probabilities that the accident was a necessary cause of his impairments.

Furthermore, the applicant failed to meet the test for a non-earner benefit, as he did not demonstrate a complete inability to carry on a normal life as a result of and within 104 weeks of the accident.

The application was dismissed.

The applicant sought medical benefits for physiotherapy, massage, chiropractic treatment, and a mattress topper following a motor vehicle accident.

The respondent denied the benefits.

As a preliminary issue, the adjudicator admitted the applicant's late-filed clinical notes, finding no breach of procedural fairness.

On the merits, the adjudicator dismissed the application, finding the treatments were not reasonable and necessary based on imaging results, clinical notes showing no improvement, and the respondent's insurer examination report.

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

The respondent insurer denied the treatment plans.

The Licence Appeal Tribunal found that two of the treatment plans were reasonable and necessary to provide pain relief, relying on the applicant's medical evidence over the insurer's examination report.

A third treatment plan was denied as it was a duplication of a previously approved plan.

The applicant was also awarded interest on the overdue benefits.

The applicant was injured in three separate motor vehicle accidents and sought a non-earner benefit and medical benefits.

The respondent denied the benefits on the basis that the applicant failed to attend section 44 insurer examinations.

The respondent raised a preliminary issue that the applicant was barred from proceeding with the Tribunal application due to this non-attendance.

The Tribunal found that the respondent made reasonable attempts to accommodate the applicant's scheduling requests and that the applicant failed to provide a reasonable explanation for his non-attendance.

The Tribunal held that the applicant is barred under section 55(2) of the Schedule from proceeding with his application until he attends the required insurer examinations.

The applicant requested a reconsideration of a Tribunal decision denying his claims for pre-104-week and post-104-week income replacement benefits (IRBs).

The applicant argued the Tribunal erred in law by misapplying the IRB tests and erred in fact by discrediting his medical expert's report.

The adjudicator dismissed the reconsideration request, finding that the Tribunal applied the correct legal tests under the Statutory Accident Benefits Schedule and reasonably weighed the evidence.

The adjudicator noted that the Tribunal was entitled to give less weight to the applicant's expert report because it relied on self-reporting that was inconsistent with the medical records.

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

The parties entered into a settlement agreement on June 5, 2017.

The respondent raised a preliminary issue that the applicant was precluded from claiming attendant care benefits and a medical benefit based on this settlement.

The Tribunal found that the settlement agreement regarding the attendant care benefits was based on a mutual mistake and was not binding, requiring the applicant to return the settlement funds before disputing the benefit.

However, the settlement of the medical benefit for treatment in China was found to be valid and binding, precluding the applicant from disputing its denial.

The applicant was injured in a motor vehicle accident and sought medical benefits, cost of examinations, and a non-earner benefit.

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

The Tribunal found that the applicant failed to prove on a balance of probabilities that she suffered from chronic pain, a psychological impairment, or a pre-existing condition that would remove her from the MIG.

Furthermore, the applicant did not meet the Heath test to establish a complete inability to carry on a normal life.

The application for benefits was dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits and the cost of examinations 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 Licence Appeal Tribunal found that the applicant's physical injuries, including sprains and strains, met the definition of minor injuries.

The Tribunal preferred the respondent's psychological assessment over the applicant's, concluding that the applicant did not suffer from a psychological impairment that would remove her from the MIG.

Furthermore, the applicant failed to provide compelling evidence that any pre-existing conditions would prevent her maximal recovery within the MIG limit.

The application was dismissed.

The applicant sought a determination of catastrophic impairment following a motor vehicle accident.

The respondent denied the designation but failed to request an insurer examination (IE) within the 10-day timeline required by section 45(3)(b) of the Schedule.

The applicant argued he was not required to attend an IE requested months later.

The Tribunal held that the Schedule does not prescribe a consequence for non-compliance with section 45 timelines.

Citing procedural fairness and the respondent's ongoing duty to adjust the claim, the Tribunal ordered the applicant to attend the IE and stayed the appeal application for four months to allow the assessment to be completed.

The applicant was injured in a motor vehicle accident and sought medical benefits for physiotherapy services.

The respondent 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 sustained predominantly minor injuries, as defined in the Schedule, and failed to provide compelling evidence of a pre-existing medical condition that would prevent maximal recovery within the MIG limits.

Consequently, the applicant was not entitled to the disputed treatment plan or interest.

The applicant sought reconsideration of a decision finding her appeal for income replacement benefits was statute-barred and denying an extension of the limitation period under section 7 of the Licence Appeal Tribunal Act.

The adjudicator upheld the finding that the limitation period had expired, as the insurer's notice of denial was valid.

However, the adjudicator found the Tribunal breached procedural fairness by deciding the section 7 extension issue based on a lack of submissions without first requesting submissions from the parties.

The reconsideration was granted in part, allowing the parties to provide written submissions on the section 7 issue.

The applicant requested a reconsideration of a previous Tribunal decision which found his injuries fell within the Minor Injury Guideline (MIG) and denied his claim for an Income Replacement Benefit (IRB).

The applicant argued the Tribunal made significant errors of fact and law regarding his pre-existing conditions, psychological injuries, and inability to work, and sought to introduce new medical evidence.

The adjudicator dismissed the request, finding no significant errors in the original decision and concluding that the new evidence could have been obtained earlier and would not have changed the outcome.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation 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 Tribunal found that the applicant's physical injuries, including cervical and thoracic strains, were predominantly minor.

The Tribunal also found that the applicant failed to provide compelling evidence of a psychological injury or a pre-existing medical condition that would remove her from the MIG.

Consequently, the applicant is subject to the $3,500 MIG limit, and the claims for additional treatment plans and examination costs were dismissed.

The applicant sought income replacement benefits following a 2002 motor vehicle accident, which the respondent denied in 2011.

The applicant commenced an application at the Tribunal five years after the two-year limitation period expired.

The Tribunal found the respondent's denial was valid and clear, triggering the limitation period.

Applying the four-factor test for extending time under section 7 of the LAT Act, the Tribunal declined to extend the limitation period due to the significant five-year delay and resulting prejudice to the respondent.

The application was dismissed as statute-barred.