Teresa Walsh

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

The respondent denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG) and the applicant failed to attend scheduled insurer's examinations (IEs).

The Tribunal found the applicant was barred from proceeding with her claim for physiotherapy services due to her unexcused failure to attend two reasonably necessary IEs.

Furthermore, the Tribunal held the applicant failed to prove she sustained an accident-related psychological impairment warranting treatment outside the MIG.

The application for psychological benefits, an award, and interest was dismissed.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident.

The central issue was whether the applicant was employed or self-employed at the time of the accident, as she had been performing freelance online academic writing for a foreign company.

The Tribunal found that the applicant was self-employed, noting the lack of a formal employment relationship, her status as a contract worker, and remuneration based on word count rather than a wage.

Because the applicant reported no self-employment income in the taxation year prior to the accident, the quantum of her IRB was calculated as nil.

The claims for an award and interest were consequently dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically funding for a neuropsychological catastrophic assessment, a neurocognitive catastrophic assessment, and document support expenses.

The adjudicator found that the neuropsychological assessment was reasonable and necessary because the medical evidence raised a question regarding whether the applicant's impairments stemmed from the accident, entitling the applicant to an expert opinion on the issue.

However, the adjudicator denied funding for the neurocognitive assessment, finding it would overlap with the neuropsychological assessment, and denied the document support expenses for lack of supporting evidence.

The applicant was awarded $2,260.00 for the neuropsychological assessment and HST.

The applicant sought entitlement to statutory accident benefits for chiropractic, psychological, and occupational therapy treatment plans following a motor vehicle accident.

The Tribunal found that the applicant failed to prove the chiropractic, occupational therapy, and first psychological treatment plans were reasonable and necessary.

However, the Tribunal ordered the respondent to pay the second psychological treatment plan because its denial letter failed to comply with the notice requirements under section 38(8) of the Schedule.

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

The applicant sought attendant care benefits and payment for two treatment plans following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant's testimony lacked credibility and the medical evidence, including surveillance and family physician records, demonstrated she did not require the claimed attendant care.

The Tribunal also denied the treatment plans, noting a lack of evidence for the first and finding the second sought unreasonable duplicate fees for catastrophic impairment assessments under section 25(5) of the Schedule.

Claims for an award and interest were consequently dismissed.

The applicant, a minor injured in a motor vehicle accident, sought attendant care benefits under the Statutory Accident Benefits Schedule.

The claim was narrowed to the period between February 8, 2022, and May 5, 2022.

The Tribunal found that the applicant's mother provided the care but did not sustain an economic loss, meaning the expenses were not 'incurred' under section 3(7)(e) of the Schedule.

The Tribunal also rejected the argument that the expenses should be deemed incurred based on the Suarez decision, as that case pertained to section 38, not section 42.

The application for attendant care benefits was dismissed.

The applicant was injured in a motor vehicle accident and sought a determination of catastrophic impairment based on mental or behavioural impairments, as well as ongoing income replacement benefits and medical/rehabilitation benefits.

The Tribunal found that the applicant sustained a catastrophic impairment under Criterion 8, as the accident exacerbated her pre-existing mental health issues, resulting in marked impairments in activities of daily living, concentration, persistence and pace, and adaptation.

The Tribunal also found the applicant entitled to a post-104-week income replacement benefit, concluding she suffered a complete inability to engage in suitable employment due to her psychological impairments.

Claims for social rehabilitation counselling and a separate file review fee for a catastrophic assessment were dismissed as not reasonable and necessary.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision finding he had not sustained a catastrophic impairment.

The applicant argued the Tribunal breached procedural fairness by relying on the untested report of the respondent's psychiatric expert, who did not attend the hearing for cross-examination.

The adjudicator dismissed the request, finding no procedural unfairness because the parties knew from the outset the expert would not testify, the report was properly admitted under section 15(1)(b) of the Statutory Powers Procedure Act, and the Tribunal appropriately assigned it less weight.

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

The Tribunal found that the applicant's physical injuries fell within the Minor Injury Guideline (MIG) and that he failed to provide sufficient objective medical evidence to establish a psychological impairment warranting removal from the MIG.

The Tribunal also dismissed the applicant's claim for a non-earner benefit, finding insufficient evidence of his pre- and post-accident activities to demonstrate a complete inability to carry on a normal life.

The application was dismissed, and the respondent's request for costs was denied.

The applicant sought a determination of catastrophic impairment and entitlement to attendant care benefits and assessment costs following a motorcycle accident.

The Licence Appeal Tribunal found that the applicant did not meet the threshold for catastrophic impairment under either criterion 7 or 8, preferring the evidence of the respondent's experts over the applicant's expert, whose conclusions relied heavily on inconsistent self-reporting.

The Tribunal also dismissed the claims for attendant care benefits and assessment costs due to a lack of evidence demonstrating incurred expenses or reasonable necessity.

The applicant was injured in a motor vehicle accident and sought payment for three medical assessments (neurological, chronic pain, and physiatry) under the Statutory Accident Benefits Schedule.

The respondent denied the benefits on the basis that they were not reasonable and necessary.

The Tribunal found that the applicant failed to meet his burden of establishing that the assessments were reasonable and necessary, noting a lack of objective medical evidence and inconsistencies in the applicant's self-reported functionality compared to pre-accident records and independent assessments.

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

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 he was not entitled to an income replacement benefit (IRB) due to failing to submit a disability certificate and continuing to work.

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

The Tribunal also dismissed the IRB claim because the applicant did not submit the required disability certificate and failed to establish any substantial inability to perform his employment tasks or any actual income loss.

The applicant requested a reconsideration of a Tribunal decision that found she was not involved in an 'accident' under s. 3(1) of the Schedule when her pre-existing spinal AVM or aneurysm ruptured, causing paraplegia.

The applicant argued the Tribunal breached procedural fairness by allowing the respondent's expert to provide new opinion evidence at the hearing and erred in its causation analysis.

The adjudicator dismissed the request, finding no procedural unfairness as the expert's hearing evidence flowed from his reports and was subject to cross-examination.

The adjudicator also found no errors of fact or law in the Tribunal's intervening act and dominant feature analyses, concluding the pre-existing condition, not the vehicle, was the dominant feature of the injury.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant procedurally disentitled due to his failure to comply with section 33 of the Schedule and document production orders regarding his financial and employment records.

Furthermore, the Tribunal found the applicant failed to substantively establish a substantial inability to perform the essential tasks of his employment within 104 weeks of the accident, or a complete inability to engage in suitable employment thereafter.

Claims for an award and interest were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing that her chronic pain and psychological impairments warranted removal from the Minor Injury Guideline (MIG).

The adjudicator found that the applicant failed to meet her burden of proof, as her chronic pain claims lacked objective medical corroboration and her psychological claims were inconsistent with her self-reported functionality to other assessors.

The adjudicator concluded that the applicant's injuries were predominantly minor and subject to the MIG limits.

Because the MIG limits were already exhausted, the disputed treatment plans were not considered, and claims for an award and interest were dismissed.

The applicant sought statutory accident benefits after suffering lower limb paraplegia following a car ride where the driver engaged in aggressive driving to avoid a group of motorcyclists.

The applicant argued the stress of the incident caused a blood pressure spike that ruptured a spinal aneurysm.

The Tribunal found that the applicant was not involved in an 'accident' under s. 3(1) of the Schedule.

Preferring the respondent's medical evidence, the Tribunal concluded that the applicant's congenital spinal arteriovenous malformation (AVM) likely ruptured spontaneously, making the AVM the dominant feature and 'but for' cause of the impairment, with the vehicle merely being the location of the injury.

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

The respondent denied the benefits on the basis that the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal for resolution.

The Tribunal found that the applicant failed to meet his burden of proving that his injuries fell outside the MIG, as the medical evidence did not support ongoing, non-minor injuries or a pre-existing condition precluding recovery.

Because the MIG limits were already exhausted, the Tribunal did not need to determine the reasonableness and necessity of the disputed treatment plans.

The application was dismissed, and claims for a section 10 award and costs were also denied.

The applicant sought payment for the unapproved balances of three treatment plans for psychological assessment and treatment following a motor vehicle accident.

The respondent had partially approved the plans based on the recommendations of its psychological assessor and the rates set out in the Professional Services Guideline.

The Tribunal found that the applicant failed to provide any evidence to contradict the respondent's assessor or to establish that the unapproved balances were reasonable and necessary.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought payment for various medical and rehabilitation benefits, including chiropractic, physiotherapy, occupational therapy, a brain SPECT scan, an EMG assessment, and cognitive devices.

The respondent insurer denied the treatment plans on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to meet his burden of proof.

The Tribunal afforded little weight to the applicant's medical experts due to factual inaccuracies in their reports and relied on the respondent's assessors, who concluded the applicant had reached maximum medical improvement and that the proposed treatments were not medically justified.

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

The respondent 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 chronic back and neck pain and psychological impairments.

The Tribunal found insufficient objective medical evidence to support chronic pain or psychological impairment caused by the accident, noting that the psychological reports relied heavily on subjective complaints and contained copied sections.

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