Tanjoyt Deol

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

The Tribunal found that the applicant was not barred from proceeding with her claim for a psychological assessment because the insurer's notices of examination failed to comply with s. 44(5) of the Schedule.

On the substantive issues, the Tribunal determined that the applicant's injuries fell within the Minor Injury Guideline (MIG), as she failed to establish chronic pain or psychological impairments warranting removal.

However, because the insurer failed to provide compliant medical reasons for denying the treatment plans under s. 38(8), the Tribunal ordered the insurer to pay for the psychological and chronic pain assessments pursuant to s. 38(11).

Claims for an award and costs were dismissed.

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

The insurer denied treatment plans for a psychological assessment and physiotherapy services, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant failed to prove his injuries warranted removal from the MIG.

However, the Tribunal held that the insurer's denial notices failed to comply with s. 38(8) of the Schedule because they did not provide adequate medical reasons or identify the specific assessments being denied.

Consequently, under s. 38(11), the insurer was prohibited from relying on the MIG to deny the specific treatment plans, and the plans were ordered payable.

The applicant's claim for an award for unreasonable delay was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a chronic pain program, chiropractic treatment, and physiotherapy services.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to establish that the proposed chronic pain program and chiropractic treatments were reasonable and necessary, noting a lack of contemporaneous recommendations from her family physician and insufficient evidence of pain relief.

The Tribunal also found the physiotherapy expense was not payable as it was incurred before a treatment plan was submitted.

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

The self-represented applicant sought income replacement benefits (IRBs) following a motor vehicle accident.

The Tribunal admitted late-filed evidence from both parties, prioritizing a liberal interpretation of the rules and the consumer protection mandate of the Schedule.

While the Tribunal found that the applicant's shoulder injury caused a substantial inability to perform the essential tasks of his self-employment at a pizza restaurant, the application was ultimately dismissed.

The applicant failed to provide sufficient financial evidence or an accountant's report to prove the quantum of his accident-related income loss.

The applicant sought entitlement to a non-earner benefit and medical benefits for physiotherapy following a motor vehicle accident.

The adjudicator found that the applicant failed to provide submissions or evidence to establish entitlement to the non-earner benefit.

Furthermore, the adjudicator determined that the applicant's injuries were predominantly minor and subject to the $3,500 Minor Injury Guideline limit, as there was insufficient evidence of chronic pain or psychological impairment to warrant removal from the guideline.

Consequently, the claims for physiotherapy treatment plans and interest were dismissed.

The applicant was injured in a motor vehicle accident and sought post-104 income replacement benefits (IRBs) and funding for four treatment plans for chiropractic services.

The respondent denied the benefits.

The Tribunal found that the applicant met the test for post-104 IRBs, as her physical and psychological impairments resulted in a complete inability to engage in any employment for which she was reasonably suited.

The Tribunal also approved the four treatment plans, finding them reasonable and necessary for pain relief, and awarded interest on overdue payments.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including attendant care benefits and various treatment plans (ergonomic assessment, chiropractic services, nutritional assessment, and occupational therapy).

The respondent denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to meet his evidentiary burden to prove entitlement to attendant care benefits and failed to demonstrate that the proposed treatment plans were reasonable and necessary.

As no benefits were payable, the claim for interest was also dismissed.

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 pre-existing osteoarthritis, chronic pain, and psychological impairments.

The Tribunal found that the applicant failed to prove her pre-existing condition prevented maximal recovery within the MIG.

Furthermore, the Tribunal gave little weight to the applicant's medical evidence regarding chronic pain, noting she had failed to disclose five prior and subsequent workplace injuries to her assessors.

The Tribunal concluded the injuries were predominantly minor, dismissed the claims for the treatment plans, and found the respondent's denial notices compliant with the Schedule.

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

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove she suffered a complete inability to carry on a normal life.

The adjudicator noted that the applicant had returned to her pre-accident employment as a practical nurse, increased her hours to full-time, and failed to provide sufficient particulars regarding her pre-accident activities and how her pain practically prevented her from engaging in them.

As no benefits were payable, the claim for interest was also dismissed.

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

The applicant argued that her pre-existing psychological conditions, chronic pain, and accident-related psychological impairments warranted removal from the MIG.

The Tribunal found the medical evidence insufficient to establish that her pre-existing conditions precluded recovery within the MIG, or that she suffered from chronic pain or accident-related psychological impairments.

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.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries fell outside the Minor Injury Guideline (MIG) due to psychological impairments and chronic pain.

The Licence Appeal Tribunal found the applicant failed to prove a psychological impairment, preferring the respondent's psychological assessment which aligned with the family physician's records.

The Tribunal also found the applicant did not establish chronic pain with functional limitations, noting he met at most one of the six criteria under the AMA Guides.

As the injuries were predominantly minor, the applicant was not entitled to the disputed treatment plans, an award, interest, or costs.

The application was dismissed.

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

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

The Tribunal found the applicant failed to prove chronic pain or psychological impairments warranting removal from the MIG, citing inconsistent self-reporting to assessors.

However, the Tribunal ordered the insurer to pay for social work, general practitioner, and psychological assessments because the insurer's denial notices contained boilerplate language and failed to comply with the medical reasons requirement under s. 38(8) of the Schedule.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident.

The Licence Appeal Tribunal found the applicant was entitled to $2,700 for social work services and various expenses for medical cannabis, preferring the evidence of her treating practitioners over the insurer's assessors.

However, the Tribunal dismissed claims for case management services and a Cefaly device for lack of supporting medical evidence.

A claim for vestibular physiotherapy was dismissed as barred by res judicata, as it had been denied in a previous Tribunal decision and the applicant's new evidence did not conclusively impeach the original result.

The applicant requested a reconsideration of a preliminary issue decision which found she was not 'involved in' an accident and thus ineligible for accident benefits.

The applicant had witnessed her boyfriend being struck and killed by a vehicle.

The Tribunal found it had erred in law by previously requiring physical contact with a vehicle to be 'involved in' an accident, and by failing to analyze whether her apprehension of being struck constituted involvement.

However, upon reconsideration, the Tribunal confirmed its original decision.

It held that merely witnessing an accident does not constitute being 'involved in' it, and the applicant's medical evidence showed her psychological injuries arose from witnessing her boyfriend's death, not from her own apprehension of being struck.

The applicant insurer sought repayment of $8,400 in Income Replacement Benefits (IRB) paid to the respondent following a motor vehicle accident.

The insurer argued the respondent was disqualified from receiving IRBs under s. 31(1)(a)(ii) of the Schedule because he was driving with a suspended license at the time of the accident.

The respondent failed to participate in the written hearing.

The Tribunal found the insurer provided proper notice under s. 52 and established the respondent's license was suspended prior to the accident for medical reasons.

The Tribunal ordered the respondent to repay the $8,400 plus applicable interest.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, which were denied by the respondent insurer on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing that chronic pain, psychological impairments, and extensive dental injuries warranted removal from the MIG.

The Tribunal found that the applicant failed to establish on a balance of probabilities that the accident was a necessary cause of his dental impairments or his left ankle impairment.

While the accident was a necessary cause of his right ankle, foot, and other soft tissue injuries, the applicant did not provide sufficient medical evidence of chronic pain or psychological impairment to warrant removal from the MIG.

The application for the disputed treatment plans and interest was dismissed.

The applicant was involved in a motor vehicle accident and subsequently moved from Ontario to British Columbia.

He submitted an application for catastrophic impairment, which the respondent denied, requesting insurer's examinations (IEs) in Ontario.

The applicant refused to attend, arguing the respondent failed to make reasonable efforts to schedule the IEs in a convenient location (British Columbia) under s. 44(9)2i of the Schedule.

The respondent had inquired about BC assessors, found none available, and offered to pay for the applicant's travel and accommodations to Ontario.

The Tribunal found the respondent made reasonable efforts and that the applicant failed to provide medical evidence demonstrating an inability to travel.

Consequently, the applicant was found non-compliant with s. 44 and is barred from proceeding with his application under s. 55 of the Schedule.

The applicant, who has pre-existing non-verbal autism, sought attendant care benefits following a motor vehicle accident, alleging the accident caused increased violent and unpredictable behaviour.

The respondent denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding that the incurred expenses were not for services outlined in the approved Form 1 and that the applicant failed to prove the accident caused the behavioural changes.

The Tribunal preferred the respondent's occupational therapy assessment, which was supported by contemporaneous medical and school records showing significant pre-existing behavioural issues, over the applicant's assessment.

The applicant sought payment for three treatment plans (OCF-18s) for chiropractic, massage, and physiotherapy services following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove the treatments were reasonable and necessary, noting a lack of contemporaneous medical records recommending the treatments and preferring the respondent's medical assessments.

The application for benefits and interest was dismissed.

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).

The applicant argued for removal from the MIG based on pre-existing conditions, chronic pain, and psychological impairments.

The Tribunal found that the applicant failed to establish that his pre-existing conditions would prevent maximal recovery within the MIG.

Furthermore, the Tribunal concluded that the applicant's left knee injury was not accident-related, he did not meet the criteria for chronic pain, and his psychological symptoms were related to interpersonal challenges rather than the accident.

As the applicant's injuries were predominantly minor, he was not entitled to the disputed treatment plans or interest, and the application was dismissed.