Tyler Moore

The applicant, a pedestrian struck by a vehicle, sought a determination of catastrophic impairment under criteria 7 and 8 of the Statutory Accident Benefits Schedule, along with various medical, rehabilitation, and attendant care benefits.

The Licence Appeal Tribunal found the applicant's expert evidence regarding her physical and mental/behavioural whole person impairment (WPI) ratings to be unreliable, preferring the respondent's experts who correctly applied the AMA Guides.

The Tribunal concluded the applicant did not meet the 55% WPI threshold under criterion 7, nor did she demonstrate marked impairments in three functional domains under criterion 8.

As the applicant's non-catastrophic benefit limits were exhausted, all claims for disputed benefits, awards, and interest were dismissed.

The applicant sought a determination of catastrophic impairment under criterion 8 of the Schedule following a motor vehicle accident.

The respondent conceded the applicant was catastrophically impaired but argued the impairments pre-dated the accident.

Applying the 'but for' test for causation, the Tribunal found that while the applicant had pre-existing physical limitations and transient depression, he maintained a high level of mental and behavioural functioning and worked full-time prior to the accident.

The Tribunal preferred the evidence of the applicant's treating physician and assessing psychiatrist, concluding the accident triggered a significant decline in function.

The Tribunal held the applicant sustained a catastrophic impairment as a result of the accident.

The applicant sought Non-Earner Benefits (NEBs) following a motor vehicle accident, claiming a complete inability to carry on a normal life.

The Tribunal applied the Heath test and found that while the applicant was less able to live her life, she continued to engage in substantially all of her pre-accident activities, such as caring for pets, doing laundry, and preparing meals, albeit to a lesser extent.

The Tribunal concluded the applicant did not suffer a complete inability to carry on a normal life and dismissed the claims for NEBs, interest, and a section 10 award.

The applicant was injured in a bicycle accident when struck by a tow-truck and sought non-earner benefits and medical benefits for chiropractic and massage therapy services.

The respondent denied the benefits.

The Tribunal found that the applicant failed to prove she suffered a complete inability to carry on a normal life, as medical evidence showed she could perform most activities of daily living.

The Tribunal also found the proposed treatment plans were not reasonable and necessary, as there was no objective evidence of improvement and independent medical examinations concluded she had reached maximum medical recovery.

The application was dismissed.

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

The respondent argued that the applicant was actively magnifying her symptoms and that her actual functional limitations were minor.

The Tribunal found that the applicant's symptom magnification was itself a symptom of her somatic symptom disorder and pre-existing mental health vulnerabilities.

The Tribunal concluded that the applicant sustained a marked impairment in the domain of adaptation, thereby meeting the definition of catastrophic impairment under the Schedule.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits, income replacement benefits (IRBs), and a treatment plan for chiropractic and physiotherapy services.

The Licence Appeal Tribunal dismissed the claim for attendant care benefits because the applicant failed to prove the expenses were incurred and failed to comply with the insurer's requests for information under s. 33 of the Schedule.

The Tribunal found the applicant was entitled to IRBs for a closed period, but after deducting post-accident employment income (including Employment Insurance benefits), the payable amount was reduced to zero.

The claim for the treatment plan was dismissed as the applicant failed to establish it was reasonable and necessary, given a 19-month gap in treatment and lack of corroborating medical evidence.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits for various treatment plans and a chronic pain assessment.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plans for chiropractic and physical therapy were reasonable and necessary, as they were proposed years after the accident with little evidence of functional improvement.

However, the Tribunal approved the $2,000 chronic pain assessment, finding that the applicant's ongoing physical and psychological symptoms warranted a holistic, multi-disciplinary assessment.

The applicants requested a reconsideration of a decision denying them non-earner benefits, housekeeping benefits, and other awards.

They alleged violations of procedural fairness, errors of fact and law, and the admission of false evidence under Rule 18.2 of the Tribunal's Common Rules of Practice and Procedure.

The Vice-Chair dismissed the request, finding no procedural unfairness in the exclusion of late documents or the handling of witnesses, and no errors of fact or law that would have changed the outcome.

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

After multiple adjournments to allow the applicant to retain legal counsel, a videoconference hearing was scheduled.

The applicant failed to attend the hearing despite receiving proper notice.

As the applicant failed to adduce any evidence to support his claims for income replacement benefits, medical benefits, and other relief, the Tribunal dismissed the applications for failing to meet the burden of proof.

The applicants sought statutory accident benefits following a motor vehicle accident, claiming entitlement to non-earner benefits, housekeeping and home maintenance benefits, and various treatment plans.

The Licence Appeal Tribunal dismissed the claims, finding that the applicants failed to establish a complete inability to carry on a normal life to qualify for non-earner benefits and failed to prove they had purchased optional coverage for housekeeping benefits.

The Tribunal also noted the applicants failed to attend multiple examinations under oath without valid reasons.

The disputed treatment plans had already been approved by the respondent.

The Tribunal awarded $500 in costs to the respondent because the applicants misstated their whereabouts to obtain an adjournment of the hearing.

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

The respondent insurer denied a treatment plan for chiropractic services, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and its $3,500 funding limit.

The Tribunal found that the applicant's pre-existing fibromyalgia and osteoarthritis warranted removal from the MIG, as these conditions prevented her from reaching maximum medical recovery within the MIG limits.

The Tribunal ordered the respondent to pay the disputed $873.72 for chiropractic services, finding the treatment reasonable and necessary, along with interest on the overdue payment.

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

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

The Tribunal found that the applicant failed to meet her burden of proving her injuries warranted treatment beyond the MIG, noting the lack of specialist evidence other than a neurologist who diagnosed a predominantly minor injury.

The application for the treatment plan, interest, and an award for unreasonable delay 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 claimed chronic pain and psychological impairments warranted removal from the MIG and sought funding for chiropractic treatment and a psychological assessment.

The Tribunal found the applicant's evidence lacked credibility due to inconsistencies between his self-reports and the medical records.

Relying on hospital records, treating physician notes, and the respondent's independent medical examinations, the Tribunal concluded the applicant sustained predominantly minor injuries.

As the $3,500 MIG limit was already exhausted, the disputed treatment plans were denied.

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

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

The Tribunal found that the applicant failed to meet her burden of proving her injuries warranted treatment beyond the MIG, noting the lack of medical evidence supporting a more serious impairment.

The application for the treatment plan, interest, and an award was dismissed.