Sarah Sheaves

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

The respondent insurer terminated the benefits, relying on section 44 assessments.

The Tribunal found that the applicant suffered a complete inability to carry on a normal life, as he was unable to meaningfully and consistently engage in his pre-accident activities, including school and recreational activities, due to ongoing physical and psychological impairments.

The Tribunal preferred the applicant's medical evidence over the respondent's assessors, who failed to properly apply the legal test.

The applicant was awarded non-earner benefits and interest, but his claim for a special award was dismissed as there was no evidence the insurer acted unreasonably or in bad faith.

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

The respondent insurer denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that while the applicant failed to prove his injuries fell outside the MIG, the respondent's denial notices under section 38(8) and section 44(5) of the Schedule were deficient for failing to provide adequate medical and other reasons.

Consequently, under section 38(11), the respondent was prohibited from taking the position that the MIG applied to the disputed plans, and the plans were deemed payable once incurred.

The applicant's claim for an award for unreasonable delay was dismissed, but interest on overdue payments was granted.

The applicant, who was 15 years old at the time of the motor vehicle accident, sought various medical and rehabilitation benefits.

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

The Tribunal found that the applicant sustained psychological impairments, including major depressive disorder and somatic symptom disorder, removing him from the MIG.

The Tribunal approved several treatment plans for chiropractic and physiotherapy services, finding them reasonable and necessary based on ongoing physical impairments.

However, other treatment plans, including those for psychological services, were denied due to a lack of evidence regarding their goals and costs.

The applicant's claim for a special award was dismissed, but interest was awarded on overdue payments.

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) and that the applicant failed to comply with section 33 of the Schedule by not providing requested documents.

The Tribunal found that the applicant's pre-existing and accident-related psychological conditions removed him from the MIG.

However, because the applicant failed to comply with the respondent's section 33 requests for nearly three years without a reasonable explanation, he was barred from receiving the disputed medical and rehabilitation benefits.

The claims for an award and interest were also dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for chiropractic services and a chronic pain assessment.

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

The applicant argued that a diagnosis of chronic pain warranted removal from the MIG.

The Tribunal found that the applicant failed to demonstrate that his chronic pain resulted in functional impairment or disability, noting a lack of medical evidence and a return to full-time work.

The Tribunal concluded the applicant remained within the MIG and dismissed the claims for medical and rehabilitation benefits.

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

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

The Tribunal found that the applicant suffered from psychological impairments, including somatic symptom disorder and adjustment disorder, removing him from the MIG.

The Tribunal denied the claim for physiotherapy services as the applicant failed to prove they were reasonable and necessary.

However, the Tribunal approved a psychological assessment up to the Schedule limit of $2,200.00 and a psychological treatment plan for $5,668.28, along with interest on overdue payments.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for an in-home assessment and catastrophic impairment assessments.

The insurer denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to meet her burden of proving the treatment plans were reasonable and necessary.

The applicant did not provide sufficient contemporaneous medical evidence, failed to address causation issues related to subsequent accidents, and did not submit the disputed catastrophic impairment assessment plan or explain the disputed amounts.

The application was dismissed, and claims for interest and an award were consequently denied.