Theresa McGee

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

The respondent denied benefits beyond the $3,500 limit, arguing the injuries fell within the Minor Injury Guideline (MIG).

The applicant contended he suffered from chronic pain and psychological impairments, and had pre-existing conditions warranting removal from the MIG.

The Tribunal found the applicant's evidence insufficient to establish chronic pain or psychological impairment exceeding the MIG, noting inconsistencies and lack of objective evidence.

The Tribunal also found no compelling evidence that pre-existing conditions would prevent maximal recovery within the MIG.

The application for medical benefits and interest was dismissed.

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

The respondent insurer determined the injuries fell within the Minor Injury Guideline (MIG) and denied treatment plans exceeding the $3,500 limit.

The applicant argued he should be removed from the MIG due to a diagnosis of chronic pain syndrome.

The Tribunal found the applicant's evidence, including an expert report diagnosing chronic pain, lacked sufficient analysis and objective support.

The Tribunal concluded the applicant sustained minor soft tissue injuries and an aggravation of pre-existing degenerative changes, which did not warrant removal from the MIG.

As the MIG limits were exhausted, the disputed treatment plans and assessment were dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic treatment and a psychological assessment.

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

The Licence Appeal Tribunal found that the applicant suffered a head injury and post-concussion syndrome, which exceed the definition of a minor injury, rendering the MIG inapplicable.

The Tribunal further held that the disputed treatment plans were reasonable and necessary to address the applicant's persistent cognitive challenges, ordering the respondent to pay the benefits with interest.

The applicant sought medical benefits and examination costs following a rear-end collision, arguing his injuries fell outside the Minor Injury Guideline due to chronic pain, psychological impairments, and a pre-existing condition.

The Licence Appeal Tribunal found the applicant failed to meet his onus.

The medical evidence showed the applicant did not seek immediate treatment, had subsequent accidents, and lacked objective evidence of functional limitations or severe psychological symptoms caused by the accident.

The Tribunal concluded the applicant's injuries were minor and dismissed the application, finding no basis for an award for delayed payment.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit and the cost of a psychological assessment.

The Licence Appeal Tribunal found that the applicant failed to demonstrate a substantial inability to perform the essential tasks of her employment, noting she returned to full-time work for several months before being laid off due to a plant relocation.

The Tribunal also found the psychological assessment was not reasonable and necessary, as her symptoms were effectively managed by her family physician and the assessment report lacked a review of her medical records.

The application was dismissed.

The applicant was struck by a vehicle in a parking lot, sustaining crush injuries to her feet.

She sought $900 for chiropractic treatment to address low back and pelvic pain, which the respondent insurer denied on the basis that the pain was caused by pre-existing arthritis rather than the accident.

The Tribunal found that the applicant's altered gait from her foot injuries caused overcompensation resulting in low back pain, satisfying the 'but for' test for causation.

The Tribunal held the treatment was reasonable and necessary, ordering the respondent to pay the $900 plus interest, but denied the applicant's request for costs.

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

The respondent denied several treatment plans for chiropractic and psychological care on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant sustained predominantly minor soft tissue injuries and failed to establish that he suffered from chronic pain or a psychological impairment that would remove him from the MIG.

As the $3,500 MIG funding limit had been exhausted, the claims for additional medical benefits were dismissed, along with claims for interest and an award for unreasonable withholding of benefits.

The applicant sought statutory accident benefits for psychological impairments sustained after observing her spouse's serious injuries in the hospital following a pedestrian-vehicle collision.

The respondent denied the claim, arguing the applicant was not involved in an 'accident' as defined in the Schedule.

The Tribunal applied the Greenhalgh test and found that the incident causing the applicant's impairment was the aftermath at the hospital, not the collision itself.

As the impairment did not arise out of the use or operation of an automobile, the applicant was not involved in an 'accident' and the application was dismissed.

The self-represented applicant sought $6.0 million in chiropractic services arising from a 2007 motor vehicle accident.

The respondent insurer brought a preliminary issue motion to dismiss the application.

The Tribunal found it lacked jurisdiction to hear the application because the applicant had not submitted a Treatment and Assessment Plan (OCF-18) as required by section 38 of the Schedule.

Without a submitted plan and a subsequent denial by the insurer, there was no 'dispute' within the meaning of section 280 of the Insurance Act.

The application was dismissed.

The applicant sought reconsideration of a Licence Appeal Tribunal decision that dismissed her claims for income replacement and medical benefits, finding her injuries fell within the Minor Injury Guideline.

The Vice-Chair granted the reconsideration, finding that the original adjudicator misapprehended key evidence from the applicant's family physician and occupational therapist, and provided inadequate reasons that failed to meet the standards of justification, transparency, and intelligibility set out in Vavilov.

The matter was referred back to the original adjudicator for a redetermination on the existing record.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits, attendant care benefits, medical benefits, and the cost of various assessments.

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal found that the applicant's ongoing physical and psychological impairments were caused by pre-existing conditions and intervening injuries, including a slip and fall and a groin injury sustained during home exercises, rather than the accident.

Consequently, the applicant failed to establish that the claimed benefits and assessments were reasonable and necessary as a result of the accident.

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

The insurer denied funding for physical therapy and a chronic pain assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained only minor soft tissue injuries and gave no weight to the applicant's expert reports diagnosing chronic pain and post-concussion syndrome due to outdated criteria and lack of qualifications.

The application was dismissed as the $3,500 MIG funding limit had been exhausted.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that awarded the applicant a non-earner benefit.

The insurer argued the Tribunal erred in law by awarding the benefit beyond the 104-week statutory maximum, misapplied the Heath test by not requiring quantitative evidence of the applicant's activities, and erred in fact by relying on the applicant's self-reports.

The Tribunal granted the reconsideration in part, amending the order to limit the non-earner benefit to 104 weeks after the accident.

The Tribunal dismissed the remaining grounds, finding no error in its qualitative application of the Heath test or its weighing of the evidentiary record.

The applicant sought medical benefits for chronic pain assessments and programs following a rear-end motor vehicle accident.

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

The Licence Appeal Tribunal found that the applicant's physical injuries were predominantly minor soft tissue injuries and that she failed to establish that her chronic pain or pre-existing psychological condition warranted removal from the MIG.

As the requested treatment plans exceeded the remaining MIG funding limit, they were not payable, and the application was dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought a Chronic Pain Assessment outside the Minor Injury Guideline.

The respondent insurer denied the benefit, arguing the applicant's ongoing pain was related to pre-existing conditions and post-accident activities rather than the collision.

The Tribunal found that the accident caused a significant exacerbation of the applicant's pre-existing back pain, satisfying the 'but for' test for causation.

The Tribunal concluded the Chronic Pain Assessment was reasonable and necessary, ordering the respondent to pay the $2,314.26 cost plus interest.

The applicant sought statutory accident benefits for chiropractic services and a psychological assessment following a motor vehicle accident.

The respondent denied the benefits and requested insurer's examinations.

The Tribunal found that the applicant failed to establish the reasonableness and necessity of the disputed treatment plans, noting a lack of objective medical evidence and significant credibility issues with a pre-screen psychological assessment report that appeared to be copied from another patient.

The application was dismissed.

The Tribunal awarded $100 in costs to the respondent, finding that the applicant engaged in vexatious and bad faith conduct by misrepresenting evidence and submitting a questionable medical report.

The applicant sought accident benefits following a motor vehicle accident.

The respondent denied a $2,200 psychological assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's injuries, which included a torn meniscus and an exacerbation of pre-existing persistent depressive disorder, were not predominantly minor.

The Tribunal also found that the applicant's pre-existing psychological condition would prevent maximal recovery if subject to the MIG.

The Tribunal ordered the respondent to pay for the psychological assessment and interest on the overdue amount.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming for dietician services, rehabilitation support worker services, and physiotherapy.

The insurer denied the benefits based on an insurer's examination concluding the applicant had reached maximum medical improvement.

The Licence Appeal Tribunal found the insurer's medical evidence flawed and accepted the applicant's evidence that accident-related weight gain was a barrier to recovery, granting the dietician and physiotherapy claims.

The claim for a rehabilitation support worker was dismissed as the proposed services were not clearly linked to the expert's recommendations.

The applicant, who was 11 years old at the time of the motor vehicle accident, sought various medical and rehabilitation benefits outside the Minor Injury Guideline.

The adjudicator found that the applicant established entitlement to a treatment plan for physiotherapy and chiropractic services, as they were reasonable and necessary as a result of the accident.

However, the remaining benefits for occupational therapy and psychological assessments were denied because they either exceeded the maximum amount payable for an assessment or were not supported by objective medical evidence from qualified practitioners.

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

The respondent denied a treatment plan for a Functional Abilities Evaluation on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been exhausted.

The Tribunal found that the applicant's injuries were predominantly minor soft tissue injuries and that he failed to provide compelling evidence that pre-existing conditions prevented his maximal recovery within the MIG.

As the MIG limit was exhausted, the disputed benefits and interest were denied, and the application was dismissed.