Sarah Guergis

The applicant sought a special award under s. 10 of Reg. 664 and interest, alleging the respondent unreasonably delayed or withheld payment for treatment plans and non-earner benefits following a motor vehicle accident.

The substantive benefit claims were resolved prior to the hearing.

The Tribunal found that the respondent's conduct in requesting further documentation under s. 33 and the subsequent timeline did not rise to the threshold of being excessive, imprudent, stubborn, inflexible, unyielding, or immoderate.

The claims for an award and interest were dismissed.

The respondent insurer requested a reconsideration of a Tribunal decision that awarded the applicant entitlement to a psychological services treatment plan and a chronic pain management program.

The insurer argued the Tribunal erred in law and fact by approving a higher hourly rate for a psychotherapist and by misapprehending the credentials and evidence of its medical expert.

The Tribunal dismissed the request, finding that the psychotherapist was supervised and entitled to the higher rate, and that the adjudicator's assessment of the medical evidence did not constitute a significant error of law or fact that would have changed the outcome.

The reconsideration request was dismissed.

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

The insurer partially denied several treatment plans for physiotherapy and psychological services, as well as visitor expenses.

The Tribunal found that the insurer failed to provide adequate medical reasons under s. 38(8) of the Schedule for one physiotherapy plan, making the balance payable.

The Tribunal also found the applicant was entitled to a higher hourly rate for a psychotherapist in two psychological treatment plans.

The remaining claims for travel, administrative reports, and visitor expenses were dismissed as they were not reasonable and necessary.

No special award was granted.

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

The Licence Appeal Tribunal considered claims for psychological services, dental services, and a chronic pain management program.

The Tribunal awarded the psychological services, finding the hourly rate for psychotherapy reasonable.

The Tribunal also awarded the chronic pain management program, accepting the applicant's expert evidence that treatment was necessary despite the respondent's argument that the applicant did not meet the criteria for chronic pain syndrome.

The claim for dental services was dismissed due to insufficient evidence linking the injuries to the accident.

Interest was awarded on the overdue payments.

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

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

The Tribunal found that while the Applicant's physical injuries did not warrant removal from the MIG, his psychological injuries, specifically an adjustment disorder, did justify removal.

The Tribunal approved two treatment plans for psychological services as reasonable and necessary, but denied a treatment plan for chiropractic services.

Interest was awarded on the overdue psychological benefits.

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

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

The Tribunal found the applicant suffered from accident-related chronic pain with functional impairment, warranting removal from the MIG.

The Tribunal awarded the claimed medication expenses as reasonable and necessary for pain management and associated mental health challenges.

However, the claim for chiropractic services was denied due to insufficient evidence of reasonableness and necessity.

No interest was awarded.

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

The Licence Appeal Tribunal found that the applicant was entitled to medical assessments from Omega Medical Assessments, including an intake assessment, neurological assessment, and EMG test, as they were reasonable and necessary to assess her impairments.

The Tribunal also awarded attendant care benefits of $2,168.14 per month, finding sufficient evidence of the applicant's need for assistance with personal care and mobility.

However, the Tribunal denied treatment plans for rehabilitation services, a speech-language pathology assessment, fitness classes, and a meal program, as the applicant failed to meet her burden of proving their reasonableness and necessity.

Claims for housekeeping benefits for two specific months were also denied due to surveillance evidence contradicting the applicant's reported residence.

Interest was awarded on the payable benefits.

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

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 sustained a concussion and physical injuries causing functional impairment, and had pre-existing conditions that warranted removal from the MIG.

The Tribunal found that the applicant failed to provide sufficient medical evidence to establish a concussion, chronic pain with functional impairment, or a pre-existing condition that would prevent maximal recovery within the MIG.

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