Taivi Lobu

The applicant sought a determination that he was catastrophically impaired under Criterion 8 of the Statutory Accident Benefits Schedule due to mental and behavioral disorders resulting from a motor vehicle accident.

While the Tribunal accepted that the applicant sustained post-traumatic stress disorder, a major depressive episode, and substance use disorder as a result of the accident, it found that these impairments did not reach the threshold of a marked (Class 4) impairment in any of the four functional domains.

The Tribunal concluded that the applicant retained some useful functioning in activities of daily living and social functioning, and therefore dismissed the application.

The applicant sought $39,377.30 in statutory accident benefits for fertility treatments, arguing that adhesions from surgeries following a 2002 motor vehicle accident caused her difficulty conceiving.

The respondent denied the claim.

The Licence Appeal Tribunal found that the applicant failed to meet her burden of proving on a balance of probabilities that the need for fertility treatments was causally related to the accident.

The Tribunal declined to qualify the applicant's family physician as an expert and noted the absence of expert medical evidence linking the adhesions to the fertility issues.

The claims for the medical expenses, an award under Regulation 664, and interest were dismissed.

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

The respondent denied benefits beyond the $3,500 Minor Injury Guideline (MIG) limit and terminated income replacement benefits.

The Tribunal found that the applicant's physical injuries fell within the definition of a minor injury and that she failed to establish a pre-existing condition, chronic pain, or psychological impairment warranting removal from the MIG.

The Tribunal accepted the respondent's expert evidence, which raised significant validity concerns regarding the applicant's presentation, over the applicant's evidence.

The Tribunal also dismissed the claim for ongoing income replacement benefits, finding the applicant failed to prove a substantial inability to perform the essential tasks of her employment.

The applicant, a law student who was struck by a vehicle while riding a bicycle, sought a determination of catastrophic impairment under Criterion 8 (mental and behavioural disorders) and entitlement to various treatment plans.

The Tribunal found that the applicant did not meet the threshold for catastrophic impairment, as he did not demonstrate a marked impairment in three of four functional domains.

Despite accident-related challenges, the applicant successfully completed law school, passed the bar, and maintained employment as a lawyer.

The Tribunal also dismissed the claims for the disputed treatment plans, finding that the applicant failed to prove they were reasonable and necessary.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to an income replacement benefit (IRB), an award for unreasonable delay, and interest.

The Tribunal found that the applicant was employed as a machine operator at the time of the accident and that the accident caused pre-existing degenerative changes in his lumbar spine to become symptomatic.

The Tribunal preferred the evidence of the applicant's physiatrist over the respondent's, noting it was based on more comprehensive medical records including an MRI.

The Tribunal concluded the applicant suffered a substantial inability to perform the essential tasks of his employment and awarded IRBs at $384 per week for the first 104 weeks.

However, the applicant failed to prove a complete inability to engage in any suitable employment after 104 weeks.

The claim for a special award was dismissed, but interest on overdue benefits was granted.

The applicant sought a non-earner benefit following a 2011 motor vehicle accident.

The respondent denied the benefit in November 2013 based on an updated disability certificate completed by the applicant's treating occupational therapist, which indicated she no longer suffered a complete inability to carry on a normal life.

The applicant applied to the Tribunal in 2022, arguing the 2013 denial was invalid for failing to provide medical reasons under section 37(4) of the Schedule.

Applying Varriano, the Tribunal held the denial was valid as it relied on a non-medical ground (the disability certificate), triggering the two-year limitation period.

The application was dismissed as statute-barred.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming catastrophic impairment and entitlement to various medical assessments.

After multiple adjournments, the applicant failed to attend the scheduled videoconference hearing.

Pursuant to section 7(3) of the Statutory Powers Procedure Act, the Tribunal proceeded in her absence.

As the applicant produced no evidence, she failed to meet her burden of proof, and the application was dismissed.

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

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

The Tribunal found that while the applicant's physical and psychological injuries did not warrant removal from the MIG, her accident-related chronic pain condition caused functional impairment justifying removal.

The Tribunal awarded an income replacement benefit for the first 104 weeks post-accident, finding the applicant suffered a substantial inability to perform her duties as a personal support worker.

However, post-104 week benefits were denied as she did not demonstrate a complete inability to engage in any suitable employment.

Various treatment plans and assessments were approved in part, and interest was awarded on overdue payments.

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

The insurer denied benefits, arguing non-compliance with an examination under oath and that the injuries fell within the Minor Injury Guideline.

The Tribunal found the insurer could not rely on the examination under oath non-compliance because it improperly sought a mixed examination.

The Tribunal removed the applicant from the Minor Injury Guideline due to an accident-related chronic pain condition, approving several physical rehabilitation and pain assessment plans.

However, claims for an income replacement benefit and various psychological and cognitive assessments were dismissed for lack of supporting evidence.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, claiming entitlement to medication costs (Cialis) and a determination of catastrophic impairment based on mental and behavioural disorders (Criterion 8).

The Tribunal dismissed the application.

The claim for medication was denied because the applicant failed to prove the prescription was necessitated by the accident rather than other substances, such as hair loss medication or bodybuilding supplements.

On the catastrophic impairment issue, the Tribunal found the applicant had a marked impairment in only one domain (adaptation) and moderate impairments in the other three (activities of daily living; social functioning; concentration, persistence and pace), falling short of the threshold requiring marked impairment in three domains.

The applicant requested a reconsideration of a Tribunal decision that found he did not meet the requirements for catastrophic impairment under Criterion 8 of the Statutory Accident Benefits Schedule.

The applicant argued the Tribunal failed to properly adjudicate the evidence, relied too heavily on expert reports, and failed to consider his impairments on a biopsychosocial basis.

The Tribunal dismissed the request, finding no error of law or fact.

The Tribunal held that it had properly weighed the evidence, including the applicant's own expert who found only a moderate impairment in concentration, persistence, and pace, and that the reconsideration process is not an opportunity to reweigh evidence.

The applicant failed to appear for a scheduled four-day video conference hearing and served a notice of withdrawal shortly after the hearing was set to begin.

The respondent sought costs under Rule 19 of the Tribunal's Common Rules.

The Tribunal found the applicant's failure to provide timely notice of the withdrawal and failure to respond to communications to be unreasonable and disrespectful, causing an unnecessary expenditure of resources.

Costs of $400 were awarded to the respondent to deter future unreasonable conduct.

The applicant sought statutory accident benefits for a physiotherapy treatment plan following a motor vehicle accident.

The respondent insurer denied the plan and required the applicant to attend insurer examinations.

The Tribunal found that the respondent's notices denying the plan and requiring the examinations did not comply with the requirements of sections 38(8) and 44(5) of the Schedule, as they failed to provide meaningful medical and other reasons.

Consequently, the applicant was not required to attend the examinations, and the treatment plan became payable under section 38(11)2 upon proof that the expenses were incurred.

The Tribunal also awarded interest and a 10 percent award under section 10 of O. Reg. 664, finding the respondent's prolonged failure to provide meaningful reasons to be stubborn and unyielding.

The applicant sought accident benefits following a motor vehicle accident, arguing his injuries warranted removal from the Minor Injury Guideline (MIG) due to a pre-existing condition, psychological impairment, and chronic pain.

The Tribunal found the applicant failed to provide compelling evidence of a pre-existing condition that precluded recovery within the MIG.

The Tribunal preferred the respondent's psychiatric and physiatry evidence, concluding the applicant did not suffer from an accident-related psychological impairment or chronic pain syndrome.

As the applicant's injuries were predominantly minor and the MIG limits were exhausted, the claims for treatment plans, an award, and interest were dismissed.

The respondent's request for costs was also denied.

The applicant insurer sought repayment of $33,264.00 in income replacement benefits (IRBs) paid to the respondent, alleging she wilfully misrepresented her employment at her husband's bakery.

The Tribunal found the respondent's evidence regarding her employment to be inconsistent and not credible, noting discrepancies in start dates, hours, and pay, as well as a lack of corroborating banking or tax records.

Concluding that the IRBs were paid as a result of wilful misrepresentation, the Tribunal ordered the respondent to repay the full amount with interest, plus $50.00 in costs for unreasonable conduct during the proceeding.

The applicant was injured in a motor vehicle accident and sought a determination that she sustained a catastrophic impairment under Criterion 8 (mental or behavioural disorder) of the Statutory Accident Benefits Schedule.

The respondent denied the claim, relying on its psychiatric assessor who found only mild to moderate impairments.

The Tribunal preferred the evidence of the applicant's assessors, noting that they appropriately included pain-related impairments and relied on functional occupational therapy assessments which demonstrated the applicant's significant deterioration when challenged by tasks.

The Tribunal concluded the applicant suffered marked impairments in three of four functional domains and declared her catastrophically impaired.

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

The respondent denied the benefit and brought a motion to dismiss the claim for failure to comply with a notice of examination.

The Tribunal proceeded with the hearing and found that the applicant failed to meet her burden of proof, as she provided no medical or documentary evidence to support her claim of a complete inability to carry on a normal life.

The application was dismissed.

The applicant requested a reconsideration of a Tribunal decision which found that his injuries were predominantly minor and subject to the Minor Injury Guideline limit, and that a specific physiotherapy treatment plan was reasonable and necessary.

The applicant argued that he was denied procedural fairness, that the Tribunal made errors of fact and law, and that new evidence regarding collateral health benefits should be considered.

The Tribunal dismissed the request, finding that the applicant had adequate notice and opportunity to present his case, that any factual errors in the original decision were not material to the outcome, and that the new evidence would not have affected the result.

The applicant was injured in a motor vehicle accident and sought post-104 week income replacement benefits (IRBs) and a physiotherapy treatment plan.

The respondent terminated IRBs based on insurer examinations concluding her physical injuries had resolved.

The Tribunal found that the accident was a necessary cause of the applicant's chronic pain syndrome, which rendered her completely unable to engage in suitable employment.

The Tribunal awarded ongoing IRBs and interest.

The physiotherapy treatment plan was denied as the applicant had reached maximum medical recovery.

The Tribunal also ordered a $2,800 award against the respondent under Regulation 664 for unreasonably failing to provide the applicant's chronic pain assessment report to its own medical examiners, which prejudiced the assessment process.

The applicant, who suffered severe physical injuries in a motorcycle accident, sought a catastrophic impairment designation under Criterion 8 of the Statutory Accident Benefits Schedule based on mental and behavioural disorders.

The Licence Appeal Tribunal found that the applicant failed to demonstrate a marked impairment in three of four functional domains or an extreme impairment in one domain.

The Tribunal gave limited weight to the applicant's psychiatric expert due to conclusory analysis and reliance on outdated occupational therapy reports, preferring the respondent's occupational therapy assessment and surveillance evidence showing the applicant retained useful functioning.

As the applicant was not catastrophically impaired and had exhausted his standard medical and rehabilitation limits, his claims for an occupational therapy treatment plan and an award for unreasonable delay were dismissed.