Sandra Driesel

The applicant sought a determination of catastrophic impairment based on a mental and behavioural disorder (Criterion 8) following a 2019 motor vehicle accident.

The applicant relied on the opinions of an ABI specialist and an orthopaedic surgeon, neither of whom performed formal catastrophic impairment testing.

The respondent presented surveillance evidence showing the applicant performing activities of daily living unassisted, contradicting her self-reports, and a psychiatric assessment concluding she suffered only moderate impairments.

The Tribunal found the applicant failed to meet her burden of proving a catastrophic impairment, noting inconsistencies in her reporting and the lack of qualified psychological or psychiatric assessments supporting her claim.

The application was dismissed.

The applicant sought a determination of catastrophic impairment based on a mental and behavioural disorder following a 2017 motor vehicle accident.

The respondent argued the applicant's psychological impairments predated the accident and were caused by prior life events, including a 2013 accident and trauma in his home country.

The Tribunal found that the applicant was receiving disability benefits prior to the 2017 accident and had a documented history of similar physical and psychological symptoms.

Applying the 'but for' test, the Tribunal concluded the 2017 accident was not a necessary cause of the applicant's impairments and dismissed the application.

The applicant was injured in a motorcycle accident and sought a determination of catastrophic impairment.

The insurer initially denied the determination pending insurer examinations.

The applicant sought $14,238.00 for the cost of catastrophic examinations obtained to support his application.

The Tribunal found the applicant was not precluded from obtaining examinations before the insurer completed its own, and that the costs were reasonable and necessary.

The Tribunal ordered the insurer to pay the examination costs with interest, but denied the applicant's request for a special award, finding the insurer had not acted unreasonably.

The applicant sought a determination that she sustained a catastrophic impairment due to mental and behavioural disorders following a 2016 motor vehicle accident.

The adjudicator found inconsistencies in the applicant's self-reporting to various assessors, including failing to disclose a post-accident trip to Hawaii, criminal charges, and a subsequent motor vehicle accident.

The adjudicator concluded the applicant failed to prove she suffered a marked impairment in three spheres of functioning.

Furthermore, the applicant failed to satisfy the 'but for' causation test, as the evidence did not establish the 2016 accident was a necessary cause of her psychological impairments.

The application was dismissed.

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

The respondent insurer denied the claims and sought a preliminary determination on whether an 'accident' occurred and whether the applicant wilfully misrepresented material facts.

The applicant failed to attend the hearing.

Relying on engineering reports and crash data retrieval showing the other vehicle was parked and the applicant's airbags did not deploy, the adjudicator found the collision was a staged accident.

The adjudicator concluded the applicant was not involved in an 'accident' under s. 3(1) of the Schedule, wilfully misrepresented material facts, and ordered the applicant to repay $558.55 in benefits.

The applicant sought a section 10 award and costs, arguing the insurer unreasonably delayed removing him from the Minor Injury Guideline (MIG) and approving treatment plans following a motor vehicle accident.

The insurer had initially denied the plans based on section 44 examinations but later approved them upon receiving updated medical information.

The Tribunal found the insurer's initial reliance on its medical examinations was permissible and its subsequent approval of benefits demonstrated a continual assessment of the file, not unreasonable conduct.

The claims for an award and costs were dismissed.

The applicant was involved in a motor vehicle accident and failed to submit an application for accident benefits until nearly 17 months later.

The respondent raised a preliminary issue arguing the application was time-barred.

The Tribunal found that the applicant failed to provide a reasonable explanation for the delay, noting that he had sought medical attention for symptoms he attributed to the accident months earlier but did not contact his insurer.

The Tribunal concluded the applicant is barred from proceeding with his application.

The applicant sought payment for a psychological assessment following a motor vehicle accident.

The insurer denied the treatment plan and mailed an Explanation of Benefits (EOB) on November 4, 2016.

The applicant filed an application with the Licence Appeal Tribunal on February 27, 2019, more than two years after the denial.

The Tribunal found that the applicant was deemed to have received the EOB by mail on November 14, 2016, triggering the two-year limitation period under section 56 of the Statutory Accident Benefits Schedule.

As the application was filed beyond the limitation period, the appeal was statute-barred and dismissed.

The applicant sought statutory accident benefits 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 were subject to the $3,500 cap.

The applicant argued his injuries were not predominantly minor, citing a pre-existing condition and psychological impairment.

The Tribunal found no compelling evidence of a pre-existing condition that would prevent maximal recovery under the MIG, nor sufficient evidence of a psychological injury.

The Tribunal concluded the applicant's injuries fell within the MIG and dismissed the application.

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

The respondent denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 cap.

The applicant argued she developed chronic pain, which should exclude her from the MIG.

The Tribunal found that the applicant failed to provide medical evidence, such as clinical notes or assessments, to support her claim of chronic pain.

Consequently, the Tribunal concluded the applicant's injuries were predominantly minor and fell within the MIG.

The application for a $3,454.30 medical benefit for chiropractic services and interest was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and an orthopaedic assessment.

The respondent insurer denied the claims, arguing the applicant had reached maximal medical recovery.

The Licence Appeal Tribunal found the physiotherapy treatment plan reasonable and necessary, noting the applicant had not pursued surgery due to age-related risks and had not reached maximal medical recovery.

However, the Tribunal denied the request for an orthopaedic assessment, finding it duplicative of a recent examination by an orthopaedic consultant and lacking compelling evidence of a need for further assessment.

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

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

The applicant argued that pre-existing lower back and psychological conditions prevented her from achieving maximal recovery within the MIG limits.

The Tribunal found insufficient evidence of any pre-existing conditions that would warrant removal from the MIG.

Consequently, the applicant's injuries were deemed minor, and her claims for additional medical benefits and examination costs were dismissed.

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

The insurer denied funding for additional chiropractic treatments and assessments beyond the $3,500 Minor Injury Guideline (MIG) limit.

The Licence Appeal Tribunal found that the applicant's physical and psychological injuries fell within the MIG.

The Tribunal preferred the evidence of the insurer's medical experts, who provided extensive reports based on testing, over the applicant's practitioners, who failed to provide details of testing or lacked appropriate accreditation.

As the applicant had already exhausted the MIG funding limit, the claims for additional medical benefits and interest were dismissed.