Sarah Guergis

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his injuries fell outside the Minor Injury Guideline (MIG) due to a pre-existing wrist fracture, chronic pain, and psychological sequelae.

The Licence Appeal Tribunal found that the applicant's pre-existing condition had healed and would not preclude recovery within the MIG.

The Tribunal preferred the respondent's medical evidence over the applicant's chiropractor, finding insufficient evidence of chronic pain with functional impairment or psychological injury.

As the injuries were deemed minor, the disputed treatment plans were not payable, and claims for interest and a section 10 award were dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits for chiropractic services and health coordination and triage assessments.

The respondent denied the benefits.

The Tribunal found that the applicant failed to meet her burden of proving that the proposed treatment and assessments were reasonable and necessary.

The medical evidence provided, including clinical notes and records, did not sufficiently support the need for the specific treatments and assessments proposed.

The application was dismissed, and no interest or award was granted.

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

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

The applicant argued for removal from the MIG based on chronic pain and psychological impairment.

The Tribunal found that the applicant failed to provide sufficient medical evidence to meet the AMA Guides criteria for chronic pain or to establish a formal psychological diagnosis beyond minor injury sequelae.

The application was dismissed, and the applicant was held to the $3,500 MIG limit.

The applicant, who was 14 years old at the time of the motor vehicle accident, sought statutory accident benefits including non-earner benefits (NEBs) and various treatment plans.

The adjudicator found that the applicant demonstrated a complete inability to carry on a normal life due to chronic pain and psychological impairments, entitling her to NEBs of $185 per week for the disputed period.

A treatment plan for psychological services was also approved as reasonable and necessary.

However, the adjudicator denied plans for an attendant care assessment and driving reintegration services, finding insufficient evidence to support them.

The claim for an award for unreasonable delay was dismissed, but interest was awarded on the payable benefits.

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

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

The applicant argued for removal from the MIG based on chronic pain, a pre-existing condition, and the respondent's accidental overpayment of the MIG limit.

The Tribunal found insufficient evidence to establish chronic pain under the AMA Guides or a documented pre-existing condition that would delay recovery.

The Tribunal also held that an administrative overpayment of $63.78 did not estop the respondent from relying on the MIG limits.

The disputed treatment plan was found not payable as the respondent provided adequate notice of denial under s. 38(8) of the Schedule.

Claims for an award and interest were dismissed.

The applicant sought various medical and rehabilitation benefits, a physiatry assessment, and a disability certificate following a motor vehicle accident.

The Licence Appeal Tribunal found that the treatment plans for Botox injections, chiropractic services, massage therapy, psychological services, the physiatry assessment, and the disability certificate were reasonable and necessary.

However, the tribunal denied the treatment plan for a chronic pain program, finding that the applicant failed to establish that the costs were reasonable against the identified goals.

The tribunal awarded interest on the payable plans but declined to order a special award under s. 10 of Regulation 664.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident where windshield wiper fluid caused chemical burns to her eyes.

The Licence Appeal Tribunal found that while the applicant provided a reasonable explanation for her delay in producing medical records, she failed to submit a disability certificate (OCF-3) prior to the claimed IRB period.

Substantively, the Tribunal held that the applicant failed to meet her burden of proving she suffered a substantial inability to perform the essential tasks of her employment, as she did not provide sufficient evidence detailing those tasks or how her injuries prevented her from completing them.

The application for IRBs, interest, and an award was dismissed.

The Applicant sought payment for four treatment plans for psychological services and a chronic pain assessment following a motor vehicle accident, as well as an award for unreasonable delay.

The Tribunal found that the Applicant failed to meet their onus to establish that the treatment plans were reasonable and necessary, as they provided no specific submissions or evidence addressing the disputed plans.

The claims for the treatment plans, interest, and a section 10 award were dismissed.

The Applicant sought entitlement to statutory accident benefits for chiropractic services and a psychological assessment following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the Applicant failed to meet the onus of establishing that the proposed treatment plans were reasonable and necessary.

The Tribunal noted that the Applicant relied solely on the OCF-18 forms and self-reporting without providing sufficient medical evidence or explaining how the treatment goals would be met.

Claims for an award and interest were also dismissed.

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

The insurer denied various physiotherapy treatment plans and assessments on the basis that the Applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the Applicant failed to provide sufficient medical evidence, such as corroborating evidence of chronic pain, to warrant removal from the MIG.

Furthermore, the Tribunal rejected the Applicant's argument that the treatment plans were payable under s. 38(11) of the Schedule, finding that the insurer had provided reasonable explanations for its denials and complied with the notice requirements under s. 38(8).

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for psychological and chronic pain assessments.

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 failed to meet the burden of proving his injuries warranted removal from the MIG, noting that his reported sleep disturbances and headaches were attributable to a pre-existing sleep apnea diagnosis rather than the accident.

As the applicant remained within the MIG and the limits were exhausted, the treatment plans and claim for interest were dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including removal from the Minor Injury Guideline (MIG), non-earner benefits (NEBs), and various medical and rehabilitation benefits.

The applicant argued for removal from the MIG based on psychological impairments, non-minor physical impairments, and chronic pain.

The adjudicator found insufficient evidence of ongoing psychological symptoms, active physical treatment, or a formal chronic pain diagnosis to warrant removal from the MIG.

Furthermore, the applicant failed to establish a complete inability to carry on a normal life, as required for NEB entitlement, due to a lack of evidence comparing pre- and post-accident activities.

As the applicant remained within the MIG and the limits were exhausted, the claims for medical benefits and interest were dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including attendant care benefits and various treatment plans.

The respondent denied the claims.

The Tribunal found that the applicant failed to prove the attendant care benefits were incurred or reasonable and necessary, preferring the respondent's section 44 assessments.

The Tribunal also dismissed the claims for the outstanding balances of several partially approved treatment plans, finding the applicant did not meet her burden to establish their reasonableness and necessity.

The application was dismissed in its entirety.

The Applicant sought entitlement to various treatment plans and an award under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Respondent denied the plans and sought repayment of $12,800 in income replacement benefits, alleging the Applicant wilfully misrepresented her post-accident employment status.

The Tribunal dismissed the Applicant's claims, finding she failed to meet her burden to establish the reasonableness and necessity of the treatment plans or justify higher hourly rates.

The Tribunal granted the Respondent's request for repayment, holding that the Applicant's failure to respond to a section 33 request regarding her return to work constituted wilful misrepresentation, thereby exempting the Respondent from the standard 12-month notice period for repayment.

The applicant sought payment for two treatment plans for chiropractic services and interest following a motor vehicle accident.

The respondent denied the benefits based on an independent medical examination which concluded the injuries had largely resolved.

The adjudicator found that the applicant failed to meet the burden of proving the treatment plans were reasonable and necessary, noting a lack of formal referrals for chiropractic treatment and an absence of progress reports demonstrating that treatment goals were being met.

The application was dismissed and no interest was awarded.

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

The applicant argued for removal from the MIG due to the exacerbation of pre-existing physical and psychological conditions from a prior accident.

The Tribunal found insufficient compelling medical evidence to establish that the pre-existing conditions would prevent maximal recovery within the MIG limits.

Consequently, the applicant was not removed from the MIG, and the claims for treatment plans, an award for unreasonable delay, and interest were dismissed.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits after being deemed catastrophically impaired.

The Licence Appeal Tribunal found that the applicant was entitled to assessments proposed by Omega Medical Assessments and attendant care benefits of $2,126.07 per month, as the medical evidence supported their reasonableness and necessity.

However, claims for rehabilitation services, a speech-language pathology assessment, fitness classes, and housekeeping benefits were dismissed due to insufficient evidence or surveillance contradicting the applicant's claims.

Interest was awarded on the payable benefits.

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

The applicant also claimed entitlement to non-earner benefits, various treatment plans, and a special award for unreasonable delay.

The Licence Appeal Tribunal dismissed the application in its entirety, finding that the applicant failed to provide sufficient medical evidence to establish that his injuries warranted removal from the MIG or that he suffered a complete inability to carry on a normal life.

Consequently, the disputed treatment plans were not payable, and the claims for interest and a special award were denied.

The applicant was injured in a motor vehicle accident and sought payment for various treatment plans under the Statutory Accident Benefits Schedule.

The respondent insurer denied the portions of the treatment plans relating to provider mileage.

The Tribunal found that the mileage costs were reasonable and necessary because the applicant required environment-specific treatment in the community and at home due to his severe injuries.

The Tribunal ordered the respondent to pay the outstanding balances for the mileage expenses, plus interest.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for massage therapy, botox injections, and acupuncture.

The respondent insurer denied the treatment plans.

The Tribunal found that the applicant established the massage therapy was reasonable and necessary to treat ongoing chronic neck and back pain, supported by clinical records.

However, the applicant failed to provide sufficient medical evidence or submissions demonstrating that the botox injections and acupuncture were reasonable and necessary.

The Tribunal ordered the respondent to pay for the massage therapy with interest, but dismissed the claims for botox and acupuncture.