Ulana Pahuta

The applicant sought a determination of catastrophic impairment (CAT) under criterion 8 of the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent denied the CAT designation, arguing the applicant's impairments were caused by pre-existing conditions and prior accidents.

The Tribunal applied the "but for" test and found the accident caused the applicant's psychological impairments, including somatic symptom disorder.

The Tribunal concluded the applicant suffered a marked impairment in activities of daily living, concentration, persistence and pace, and adaptation, thereby meeting the CAT threshold.

However, the applicant's claims for travel expenses for his daughter's flight and out-of-town CAT assessments were dismissed for lack of evidence establishing they were reasonable and necessary.

The claim for an award under s. 10 of Regulation 664 was also dismissed.

The applicant sought a special award under s. 10 of Regulation 664 and interest, alleging the respondent unreasonably delayed removing her from the Minor Injury Guideline and approving treatment plans following a motor vehicle accident.

The adjudicator dismissed the application, finding the respondent's actions were not unreasonable because the applicant failed to provide requested pre-accident and updated clinical notes and records in a timely manner.

Without these records, the respondent could not properly assess whether the applicant's psychological impairments were caused by the accident or pre-existing marital issues.

The applicant requested a reconsideration of a prior decision denying a chiropractic treatment plan.

The applicant argued the adjudicator erred in law by improperly conflating sections 38(8) and 44(5) of the Schedule, failing to properly evaluate the medical reasons in the Notice of Examination, and improperly considering the respondent's insurer's examination reports.

The Tribunal found no significant error of law or fact, noting the applicant was attempting to re-litigate issues or raise new arguments not presented at the initial hearing.

The request for reconsideration was dismissed.

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

The Tribunal declined to rule on income replacement benefits as they were not currently in dispute.

The Tribunal denied a 2019 treatment plan for chiropractic and physiotherapy services, finding it was not reasonable and necessary at the time.

However, the Tribunal approved a 2020 treatment plan for chiropractic and physiotherapy services, a functional abilities evaluation, and a functional cognitive assessment, finding them reasonable and necessary based on the medical evidence.

Interest was awarded on the approved treatment plans.

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

The respondent insurer denied benefits and scheduled insurer's examinations, which the applicant failed to attend.

The respondent argued the applicant was barred from proceeding to a hearing under section 55 of the Schedule.

The Tribunal found that the respondent's notices of examination did not comply with section 44(5) because they failed to provide sufficient medical reasons, relying only on the passage of time and an unspecified impairment.

As the notices were deficient, the applicant was not barred from proceeding with her application.

The applicant sought statutory accident benefits following a motor vehicle accident but was denied by the insurer.

The insurer raised a preliminary issue that the applicant was barred from proceeding to a hearing under section 55 of the Schedule due to her failure to attend multiple section 44 insurer's examinations.

The Tribunal found that the applicant had recently attended two rescheduled examinations and indicated her intention to attend the remaining two.

Denying the applicant the ability to adjudicate her claim would be unduly prejudicial and contrary to procedural fairness.

The Tribunal ordered that the applicant may proceed with her application.

The applicant sought entitlement to multiple treatment plans for chiropractic services, various assessments (psychological, neurological, cognitive, chronic pain, FAE, attendant care), and assistive devices following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to meet her burden of proving the proposed treatments and assessments were reasonable and necessary.

The Tribunal noted a lack of objective medical evidence, reliance on self-reports, and failure to provide clinic treatment records or progress reports to justify the ongoing identical treatment plans.

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

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

The adjudicator found the applicant failed to establish chronic pain or psychological impairments warranting removal from the MIG, preferring the respondent's expert evidence.

However, the adjudicator ordered the respondent to pay for a chronic pain assessment and psychological treatment because the respondent's denial notices failed to comply with s. 38 of the Schedule by not explicitly stating that the MIG applied.

Claims for an award and costs were dismissed.

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) and the $3,500 limit had been exhausted.

The applicant argued for removal from the MIG due to chronic pain and psychological impairments.

The Tribunal found the applicant failed to provide compelling medical evidence to support removal from the MIG, noting illegible clinical notes and a lack of corroborating evidence beyond self-reports.

The application was dismissed as the MIG limit was exhausted.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) from the respondent insurer.

The respondent subsequently discovered the applicant was concurrently receiving long-term disability benefits, which reduced the IRB quantum to zero.

The respondent sought repayment of $54,552.79 in overpaid IRBs.

The Tribunal found the respondent provided timely notice of the overpayment within 12 months of the lump-sum payment, as required by section 52 of the Schedule.

The Tribunal rejected the applicant's argument that the insurer was restricted to recovering the overpayment via a 20% clawback from future IRBs, noting the provision is permissive and the applicant was not currently receiving IRBs.

The respondent was awarded the full repayment amount plus interest.

The applicant sought attendant care benefits and payment for assistive devices following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove she had incurred any attendant care expenses as required by section 19 of the Schedule.

The Tribunal also denied the claim for assistive devices, as the applicant provided no evidence to rebut the insurer's assessment that the ergonomic study equipment was no longer reasonable and necessary after she completed her nursing course.

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).

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

The Tribunal found the applicant failed to establish that her pre-existing degenerative changes precluded maximal recovery under the MIG.

The Tribunal also preferred the respondent's psychological assessment, finding no accident-related psychological impairment, and rejected the applicant's claim of chronic pain due to a lack of objective medical evidence and functional impairment.

As the MIG limits were exhausted, the treatment plans were denied.

Claims for an award and interest were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to a chronic pain assessment and a chronic pain management program.

The Tribunal found the chronic pain assessment was not reasonable and necessary as it duplicated a previous assessment.

However, the Tribunal found the chronic pain management program was reasonable and necessary, awarding a portion of the outstanding balance, as the evidence showed the accident exacerbated the applicant's pre-existing chronic pain.

The claim for a special award under s. 10 of Regulation 664 was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his injuries warranted removal from the Minor Injury Guideline (MIG) due to a lens displacement injury and pre-existing physical and psychological conditions.

The Tribunal found insufficient evidence linking the eye injury to the accident and concluded that the applicant's pre-existing conditions did not prevent him from achieving maximal recovery under the MIG.

As the applicant's impairments were predominantly minor, he was subject to the $3,500 funding limit, and his claims for treatment plans exceeding this limit, along with claims for interest and an award, were dismissed.

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

The applicant claimed interest on delayed income replacement benefits, attendant care benefits, a physiotherapy treatment plan, and an award for unreasonable delay.

The Tribunal found the applicant was entitled to $979.92 in interest for delayed income replacement benefits and a $244.98 award under s. 10 of Regulation 664 due to the insurer's unreasonable delay.

The claims for attendant care benefits and physiotherapy were dismissed due to a lack of evidence that the expenses were incurred or that the treatment plan was submitted.

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

The Tribunal found the applicant suffered a substantial inability to perform her pre-accident employment as a dump truck driver due to chronic pain and an exacerbated shoulder injury, establishing entitlement to pre-104 week IRBs.

However, based on the applicant's pre-accident self-employment income, the quantum of IRBs owed was calculated at nil.

Claims for post-104 week IRBs were dismissed due to a lack of evidence and surveillance showing a return to work.

The Tribunal approved treatment plans for physiotherapy and an orthopaedic assessment as reasonable and necessary, but denied claims for psychological services, medication, and post-fall chiropractic treatment.

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

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

The Tribunal found that the applicant's psychological impairments, including vehicular phobia and depressive disorder, warranted removal from the MIG.

The Tribunal approved the initial psychological assessment and the first block of psychotherapy sessions as reasonable and necessary.

However, subsequent treatment plans for additional psychotherapy were denied because the applicant had already made substantial gains and the new plans did not reflect his improved condition.

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

The Tribunal found that while the applicant established a substantial inability to perform the essential tasks of her employment for the pre-104 week period, the respondent was not liable to pay the IRBs because the applicant failed to provide reasonably required financial documentation to calculate the quantum.

The applicant's claim for post-104 week IRBs was barred due to her failure to attend a reasonably necessary vocational assessment without a reasonable explanation.

Claims for an award and interest were dismissed.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident, specifically claiming costs for a chronic pain assessment and chiropractic treatment.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the treatments were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's section 44 assessors, noting a significant gap in the applicant's reports of accident-related pain to her family physician and a lack of objective evidence demonstrating functional impairment or the efficacy of past treatments.

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

The applicant sought payment for four physiotherapy treatment plans following a motor vehicle accident.

The respondent denied the plans, arguing that further facility-based treatment was not reasonable and necessary.

The Tribunal found that the applicant failed to meet his burden of proving the treatment was reasonable and necessary, as there was insufficient evidence that the goals of treatment, particularly pain relief, were being met to a reasonable degree despite years of consistent physiotherapy.

The application was dismissed.