Tanjoyt Deol

The applicant sought various statutory accident benefits following a motor vehicle accident, including treatment plans for physiotherapy, chiropractic and massage services, and several assessments (orthopaedic, attendant care, neuropsychological, neurological, and a SPECT scan).

The respondent denied the benefits.

The Tribunal found that the respondent's denial notices complied with section 38(8) of the Schedule.

On the merits, the Tribunal concluded that only the attendant care assessment was reasonable and necessary, given the applicant's consistent reporting of difficulties with housekeeping and personal care tasks due to chronic pain.

The remaining treatment plans and assessments were denied for lack of contemporaneous medical evidence or failure to establish reasonableness and necessity.

The applicant was awarded interest on the attendant care assessment, but her claims for a special award and costs were dismissed.

The applicant was injured in a motor vehicle accident and sought post-104 income replacement benefits (IRBs) and the cost of an attendant care assessment.

The respondent denied the benefits and sought to exclude late-served s. 44 catastrophic impairment reports.

The Tribunal admitted the reports, finding no prejudice to the respondent.

On the merits, the Tribunal found the accident was a necessary cause of the applicant's back pain and surgeries.

Relying on both the applicant's and the respondent's medical experts, the Tribunal concluded the applicant suffered significant psychological impairments, including a marked to extreme impairment in adaptation to work settings, rendering her completely unable to engage in suitable employment.

The Tribunal awarded the post-104 IRBs but denied the attendant care assessment cost due to insufficient evidence.

The applicant sought housekeeping and home maintenance (HH) benefits and a special award following a catastrophic motor vehicle accident.

The Tribunal found that the applicant's traumatic brain injury and physical impairments resulted in a substantial inability to perform his pre-accident HH tasks, rejecting the insurer's reliance on surveillance footage and an Examination Under Oath.

However, the Tribunal denied payment of the HH benefits because the applicant failed to prove the expenses were incurred under section 3(7)(e) of the Schedule.

The claim for a section 10 award was dismissed as the insurer's conduct was not excessive or imprudent.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that partially denied a treatment plan for home modifications, including the location of a new garage, new flooring, electrical rewiring, and a therapy room addition.

The applicant argued the adjudicator made errors of law and fact, specifically regarding the Tribunal's jurisdiction to consider municipal encroachment for the garage location and the assessment of tripping hazards.

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

The adjudicator confirmed the Tribunal lacks jurisdiction under section 280 of the Insurance Act to determine municipal encroachment issues and held that the applicant was attempting to re-litigate findings of fact and raise new arguments not presented at the initial hearing.

The applicant sought payment for a catastrophic impairment assessment and an ENT assessment under the Statutory Accident Benefits Schedule.

The respondent denied the treatment plans.

The applicant argued the denials were non-compliant with s. 38(8) for failing to provide medical reasons.

The Tribunal found the denials were compliant as they were based on non-medical reasons (duplication of services and inclusive fees), applying the Court of Appeal's reasoning in Varriano.

The Tribunal further found the applicant failed to establish the assessments were reasonable and necessary.

The application was dismissed.

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

The insurer denied income replacement benefits (IRBs) and took the position that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant was statute-barred from pursuing his IRB claim because he failed to dispute the insurer's clear and unequivocal denial within the two-year limitation period under s. 56 of the Schedule.

The Tribunal also held that the applicant failed to adduce compelling medical evidence of pre-existing conditions, chronic pain, or psychological impairments to warrant removal from the MIG.

The disputed assessment plans were denied, and no award for unreasonable delay was granted.

The insurer applied to the Licence Appeal Tribunal, arguing the respondent was not involved in a motor vehicle accident and had wilfully misrepresented material facts to obtain statutory accident benefits.

Relying on an expert engineer's report, the Tribunal found the vehicle damage was inconsistent with the respondent's claim of a rear-end collision and was instead caused by deliberate impacts with metal tubing and a stationary object.

The Tribunal concluded the respondent failed to prove she was in an 'accident' under section 3(1) of the Schedule and held the insurer was entitled to terminate benefits under section 53 due to wilful misrepresentation.

The insurer's request for costs was dismissed.

The applicant insurer sought a determination that the respondent was not involved in an 'accident' under s. 3(1) of the Schedule and sought repayment of benefits paid due to wilful misrepresentation.

The respondent did not participate in the written hearing.

Relying on an engineering assessment report, the Tribunal found that the damage to the respondent's vehicle was inconsistent with her reported version of events and was likely caused by multiple separate impacts with metal tubing.

The Tribunal concluded the respondent was not involved in an accident and had wilfully misrepresented material facts.

The applicant was entitled to terminate benefits and was awarded a repayment of $200.00 for an OCF-3, but its request for repayment of medical record costs and its request for costs of the proceeding were denied.

The applicant insurer applied to the Licence Appeal Tribunal seeking a declaration that the respondent was not involved in an accident, termination of benefits for wilful misrepresentation, and repayment of benefits.

The respondent did not participate in the written hearing.

Relying on an expert engineering report, the adjudicator found that the damage to the respondent's vehicle was inconsistent with his report of a rear-end collision and was instead caused by multiple impacts with metal tubing and a low-speed sideswipe.

The adjudicator concluded the respondent failed to prove he was in an accident under s. 3(1) of the Schedule and found he wilfully misrepresented material facts.

The insurer was entitled to terminate benefits and recover $200 paid for an OCF-3, plus interest, but not $100 for employment records.

The insurer's request for costs was dismissed.

The insurer applied to the Licence Appeal Tribunal, arguing the respondent was not involved in a motor vehicle accident and had wilfully misrepresented material facts to obtain accident benefits.

The Tribunal preferred the insurer's engineering expert evidence, which concluded the vehicle damage was caused by metal tubing and a stationary sideswipe, over the respondent's uncorroborated account of a hit-and-run collision.

The Tribunal found the respondent failed to prove she was in an 'accident' under section 3(1) of the Schedule and held she committed wilful misrepresentation.

The insurer was entitled to terminate benefits and recover a $200 repayment for an OCF-3, plus interest, but its claim for $35 in medical record costs and $1,000 in proceeding costs was dismissed.

The applicant insurer sought a determination that the respondent was not involved in an "accident" as defined in s. 3(1) of the Statutory Accident Benefits Schedule, and sought repayment of benefits paid due to wilful misrepresentation.

The respondent did not participate in the written hearing.

Relying on an engineering assessment that concluded the vehicle damage was inconsistent with the respondent's reported rear-end collision and was instead caused by multiple impacts with metal tubing, the adjudicator found the respondent failed to prove she was in an accident.

The adjudicator held the applicant was entitled to terminate benefits under s. 53 for wilful misrepresentation and ordered the respondent to repay $200 for an OCF-3, plus interest.

The applicant's request for costs was denied.

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

The respondent denied various treatment plans for chiropractic and massage services.

As preliminary issues, the respondent argued the applicant was barred from proceeding due to non-attendance at insurer's examinations and an examination under oath.

The adjudicator found the applicant was barred from proceeding with one treatment plan due to an unexcused failure to attend a properly noticed insurer's examination, but not barred for the others.

The adjudicator also held that failure to attend an examination under oath is not a bar to proceeding to a hearing.

On the substantive issues, the adjudicator dismissed the claims for the remaining treatment plans, finding the applicant failed to establish they were reasonable and necessary.

Claims for interest and an award were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits (NEBs), medical benefits for physiotherapy, and removal from the Minor Injury Guideline (MIG).

The Tribunal found the applicant failed to establish a complete inability to carry on a normal life, as evidence showed a return to work, school, and daily activities.

The Tribunal also held the applicant's injuries were predominantly minor, rejecting arguments for removal from the MIG based on pre-existing conditions, an alleged lumbar fracture, chronic pain, and psychological impairments.

The respondent's denial of the treatment plan was found compliant with the Schedule's notice requirements.

The application was dismissed in its entirety.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claims for Income Replacement Benefits, two treatment plans (OCF-18s) for chiropractic services, interest, and an award.

The applicant argued that the Tribunal erred in law by finding that an OCF-18 alone is not compelling evidence and that a denial issued by a non-health practitioner (an adjuster) could be compliant with s. 38(8) of the Statutory Accident Benefits Schedule.

The adjudicator dismissed the reconsideration request, holding that an OCF-18 is a form used to apply for treatment rather than compelling medical evidence on its own, and that s. 38(8) requires the insurer—not necessarily a health practitioner—to provide the medical and other reasons for denying a treatment plan.

As no error of law or fact was established, the original decision was upheld.

The insurer applied to the Licence Appeal Tribunal for repayment of Income Replacement Benefits (IRB) paid to the respondent.

The insurer argued that the respondent received post-accident employment income that was deductible from the IRB, resulting in an overpayment of $1,428.58.

The respondent did not provide written submissions.

The Tribunal proceeded in the respondent's absence and found that the insurer was entitled to the repayment of $1,428.58, plus interest, as the respondent's gross employment income was deductible under the Schedule.

The applicant was injured in a motor vehicle accident and sought approval for multiple treatment plans (OCF-18s).

The insurer denied the plans, and the applicant challenged the denials at the Licence Appeal Tribunal.

The Tribunal found that the insurer's explanation of benefits (EOB) notices for almost all the disputed treatment plans failed to comply with the requirements of s. 38(8) of the Schedule, as they lacked adequate medical reasons for the denials.

Consequently, under s. 38(11), the insurer was ordered to pay for those treatment plans once incurred.

One treatment plan for a chronic pain assessment was properly denied with compliant notice, and the applicant failed to prove it was reasonable and necessary.

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

The Tribunal found the applicant's injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic back and neck pain.

The applicant was awarded funding for two physiotherapy treatment plans because the insurer's denial notices failed to comply with the procedural requirements of s. 38(8) of the Schedule.

However, a third physiotherapy plan was denied as not reasonable and necessary.

The Tribunal also dismissed the claim for non-earner benefits, finding the applicant failed to demonstrate a complete inability to carry on a normal life, and declined to order an award for unreasonable delay.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline (MIG) and claiming entitlement to income replacement benefits (IRBs) and a chiropractic treatment plan.

The Tribunal found that the applicant failed to provide sufficient medical evidence to warrant removal from the MIG, noting the absence of corroborating evidence for diagnoses of sciatica and bursitis.

As the $3,500 MIG limit was exhausted, the treatment plan was denied.

The Tribunal also dismissed the claim for IRBs, finding the applicant failed to prove a substantial inability to perform the essential tasks of his pre-accident employment as a barber.

The Tribunal preferred the respondent's medical examination and relied on surveillance footage showing the applicant performing barbering tasks in his garage.

The application was dismissed.

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

The respondent insurer denied the benefits 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 paresthesia, chronic pain, and psychological impairments.

The adjudicator found insufficient medical evidence linking the paresthesia or imaging results to the accident.

Furthermore, the adjudicator concluded the applicant failed to establish chronic pain with functional impairment or a psychological impairment, noting inconsistencies between the applicant's self-reporting to different medical practitioners.

The application was dismissed, and the applicant was held to the MIG limits.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and various medical and rehabilitation benefits.

The respondent denied the benefits and brought a preliminary motion to strike the applicant's reply submissions for improperly splitting her case.

The Tribunal dismissed the motion, finding the reply submissions properly responded to the respondent's arguments.

On the merits, the Tribunal found the applicant was not entitled to pre-104 or post-104 IRBs, as she failed to establish a substantial or complete inability to perform the essential tasks of her pre-accident employment as an accountant.

The Tribunal also denied the disputed treatment plans for transportation and physiotherapy services, finding the applicant failed to meet her evidentiary onus to demonstrate they were reasonable and necessary.

Claims for interest and an award for unreasonable delay were also dismissed.