Tami Cogan

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

The Tribunal denied the non-earner benefit, finding the applicant failed to prove a complete inability to carry on a normal life.

The Tribunal approved two physiotherapy treatment plans and a psychotherapy treatment plan, finding them reasonable and necessary based on the medical evidence.

A chronic pain treatment plan was denied as the applicant did not meet the criteria for chronic pain with functional limitations.

The Tribunal also ordered a 15% award under s. 10 of Regulation 664, finding the insurer unreasonably withheld benefits by ignoring its own assessor's diagnosis and inflexibly dismissing a treatment plan over a signature issue.

The applicant sought statutory accident benefits following a 2013 motor vehicle accident.

The respondent brought a preliminary motion to dismiss the application as an abuse of process, arguing the applicant had withdrawn an identical application and refiled it to avoid an evidentiary ruling.

The adjudicator dismissed the motion, finding no legislative restriction on withdrawing and refiling an application before a decision is rendered.

On the substantive issues, the adjudicator denied the applicant's claims for a physiotherapy treatment plan and catastrophic impairment assessments, finding the medical evidence did not support that the treatments and assessments were reasonable and necessary as a result of the accident.

The adjudicator ordered the respondent to refund $1,000 in costs the applicant had paid under a previously cancelled motion order.

The applicant sought statutory accident benefits following a 2012 motor vehicle accident, claiming a catastrophic impairment due to a mental or behavioural disorder under Criterion 8 of the Schedule.

The respondent denied the claim.

The Licence Appeal Tribunal found the applicant's expert evidence unpersuasive, noting inconsistencies in the applicant's self-reporting regarding his work history, social activities, and medical history.

Preferring the respondent's multidisciplinary assessments, the Tribunal concluded the applicant suffered only mild to moderate impairments and did not meet the threshold for catastrophic impairment.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits, various medical and rehabilitation assessments, and reimbursement for damaged items.

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal found the applicant failed to prove a substantial inability to perform the essential tasks of his employment for the pre-104 week period, and failed to provide requested documentation for the post-104 week period.

The Tribunal also found the applicant failed to prove the disputed treatment plans and assessments were reasonable and necessary, as they were either duplicative, unsupported by medical evidence, or previously approved.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming catastrophic impairment due to a subdural hematoma, as well as entitlement to attendant care benefits, non-earner benefits, and various treatment plans outside the Minor Injury Guideline (MIG).

The Tribunal found that the subdural hematoma was a spontaneous occurrence unrelated to the accident.

The Tribunal further held that the applicant's injuries were predominantly minor, keeping her subject to the MIG limits.

Consequently, the claims for attendant care benefits, non-earner benefits, and treatment plans exceeding the MIG were dismissed.

The applicant sought a determination that she sustained a catastrophic impairment under Criterion 8 of the Statutory Accident Benefits Schedule due to mental or behavioural disorders following a motor vehicle accident.

The Tribunal reviewed expert evidence and the applicant's self-reported activities, including maintaining sobriety, driving long distances, and regaining custody of her children.

The Tribunal preferred the respondent's experts, finding that the applicant's impairments in social functioning, concentration, persistence and pace, and adaptation did not reach the marked (Class 4) level required for a catastrophic impairment designation.

The application was dismissed.

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

The applicant passed away intestate before the Tribunal application was filed by his counsel.

The respondent argued the application should be dismissed as no Estate Trustee had been appointed to instruct counsel or commence the proceeding.

The Tribunal agreed, finding that without a legally recognized representative, counsel had no authority to file the application.

The application was dismissed as it was not properly commenced.

The applicant requested a reconsideration of a decision finding his injuries were predominantly minor and subject to the Minor Injury Guideline limit.

The applicant sought to introduce new medical evidence under Rule 18.2(c) of the Licence Appeal Tribunal Rules.

The Tribunal dismissed the request, finding that some of the evidence was already before the Tribunal at the original hearing and excluded as late-filed, while the applicant failed to establish why the remaining evidence could not have been obtained previously.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident, claiming she sustained a catastrophic impairment due to a mental or behavioural disorder.

The Licence Appeal Tribunal found that the applicant's impairments were compatible with some useful functioning and did not reach the marked impairment threshold in three of four spheres of function.

The Tribunal also dismissed claims for attendant care benefits, finding the provider did not qualify as a professional under the Schedule and no economic loss was proven.

Claims for various treatment plans and a section 10 award for unreasonable delay were also dismissed.

The applicant sought a determination that they sustained a catastrophic impairment due to a mental or behavioural disorder following a motor vehicle accident.

The Tribunal applied the AMA Guides 4th Edition to assess the applicant's functioning in four spheres.

Relying on surveillance evidence, social media posts, and the respondent's medical experts, the Tribunal found the applicant's self-reported limitations were inconsistent with their actual activities, which included home renovations, driving, and running a business.

The Tribunal concluded the applicant did not suffer a marked impairment in any of the four spheres and dismissed the application.

The applicant sought statutory accident benefits following a motor vehicle accident but failed to attend the videoconference hearing or file any evidence.

The respondent moved to dismiss the application as abandoned and sought costs.

The Tribunal denied the motion to dismiss as abandoned, opting to proceed on the merits.

Because the applicant provided no evidence, the Tribunal found he failed to meet his evidentiary burden and dismissed the claims for benefits.

The Tribunal also denied the respondent's request for costs, finding that the applicant's failure to attend did not amount to unreasonable, frivolous, or vexatious conduct warranting a costs award.

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 due to a pre-existing wrist condition, chronic pain, and psychological impairment.

The Tribunal found insufficient evidence to support removal from the MIG, noting the pre-existing condition did not prevent maximal recovery and the applicant failed to meet the criteria for chronic pain or psychological impairment.

The disputed treatment plans were approved only up to the remaining $3,500 MIG limit, and the claim for a special award under s. 10 of Regulation 664 was dismissed.

The Applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs), attendant care benefits (ACBs), and various medical and rehabilitation treatment plans.

The Licence Appeal Tribunal found the Applicant was not entitled to IRBs because he failed to provide the insurer with requested information, and was not entitled to ACBs because they were neither reasonable and necessary nor incurred.

However, the Tribunal approved the treatment plans for chiropractic and psychological services, preferring the evidence of the Applicant's treating practitioners over the insurer's paper-review assessors.

Claims for occupational therapy and a special award under s. 10 of Regulation 664 were dismissed.

The applicant insurer sought repayment of $7,585.00 in non-earner benefits paid to the respondent, alleging the respondent wilfully misrepresented material facts when applying for automobile insurance.

The respondent failed to attend the hearing.

The Tribunal found that the respondent wilfully misrepresented that he owned the insured vehicle, that it was not financed, and that it would not be used for commercial purposes.

However, because the applicant's notice of repayment only specified $2,035.00, the Tribunal limited the repayment order to that amount.

The respondent was ordered to repay $2,035.00 plus interest.

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

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

The Tribunal found that the respondent's notices for insurer's examinations were insufficient, so the applicant was not barred from proceeding.

However, the Tribunal concluded that the applicant failed to prove he suffered from chronic pain with functional impairment or a psychological impairment.

Therefore, the applicant's injuries remained subject to the $3,500 MIG limit, and the application for treatment plans beyond that limit was dismissed.

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

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

The applicant applied to the Licence Appeal Tribunal, claiming removal from the MIG due to psychological impairment, chronic pain, and pre-existing conditions.

The Tribunal found insufficient medical evidence to support a psychological injury, chronic pain with functional limitations, or a pre-existing condition that would preclude recovery within the MIG.

The Tribunal held that the applicant remains subject to the $3,500 MIG limit.

The disputed treatment plans were deemed reasonable and necessary up to the remaining MIG limit, provided they are incurred.

The claim for an award for unreasonable delay was dismissed.

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 claimed psychological impairments, chronic pain, and a pre-existing osteoarthritis condition warranted removal from the MIG.

The Tribunal found insufficient evidence of psychological impairment or chronic pain caused by the accident, and no evidence that his pre-existing condition prevented maximal recovery within the MIG.

The Tribunal also dismissed the claim for non-earner benefits, finding the applicant was not continuously prevented from engaging in substantially all of his pre-accident activities.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including funding for physiotherapy, an in-home attendant care assessment, and an in-home occupational therapy assessment.

The respondent denied the treatment plans.

The Licence Appeal Tribunal found that the applicant failed to establish that the proposed treatment plans were reasonable and necessary as a result of the accident, noting a lack of compelling medical evidence linking the impairments to the index accident rather than a subsequent accident.

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

The applicant sought accident benefits following a 2016 motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed entitlement to a $3,281.98 chiropractic treatment plan.

The Tribunal found that the applicant failed to provide medical documentation to support removal from the MIG or to prove the treatment plan was reasonable and necessary.

Relying on the respondent's insurer's examination report, the Tribunal concluded the applicant's injuries were minor and dismissed the application in its entirety.