Ulana Pahuta

The applicant sought statutory accident benefits for chiropractic services, prescriptions, and catastrophic impairment assessments following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove the proposed physical treatments were reasonable and necessary, as her limitations were primarily driven by psychological pain avoidance behaviours rather than physical impairments.

The claim for prescriptions was denied for lack of supporting documentation linking them to the accident.

The claim for additional catastrophic assessment fees was denied because file reviews are included in the $2,000 statutory cap per assessment.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to treatment plans for temporomandibular joint (TMJ) treatment, a TMJ assessment, and psychological services.

The adjudicator dismissed the claims for TMJ treatment and assessment, finding the applicant failed to prove the dental injuries were caused by the subject accident rather than a prior collision.

The adjudicator partially granted the claim for psychological services, awarding $2,000.00 based on an appropriate hourly rate for a social worker, plus interest on the overdue amount.

The applicant's claim for an award under Regulation 664 for unreasonably withheld payments was dismissed, as the insurer's conduct was not found to be excessive or imprudent.

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

The respondent denied the benefits, arguing the impairments were not accident-related but due to pre-existing degenerative changes.

The Tribunal found that while the accident exacerbated the applicant's left shoulder and left knee conditions, the applicant failed to prove the proposed treatment plans were reasonable and necessary.

The medical evidence did not support the need for further physical therapy or the diagnosis of chronic pain syndrome.

The application was dismissed, and no award or interest was payable.

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

The respondent insurer denied the plans on the basis that the applicant had reached maximum medical improvement and the proposed treatment was not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant suffered soft tissue injuries and a thumb ligament strain, but failed to establish that the ongoing facility-based treatment was effective or necessary.

The Tribunal noted that the applicant did not follow specific treatment recommendations from a specialist for his thumb injury, and that clinical records did not support ongoing debilitating chronic pain.

The application was dismissed, and no interest was payable.

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.

A written hearing was scheduled, but the applicant failed to file any submissions or evidence.

As the applicant bore the onus of proving his entitlement on a balance of probabilities, the Tribunal dismissed the application due to a lack of evidence.

The respondent's request for costs was denied, as the applicant's failure to file submissions did not meet the high threshold of acting unreasonably, frivolously, vexatiously, or in bad faith.

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

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

The Licence Appeal Tribunal found that while the applicant failed to establish chronic pain, she provided uncontested psychological evidence diagnosing her with Major Depressive Disorder and a travel phobia, removing her from the MIG.

The Tribunal awarded the cost of a psychological assessment and an outstanding balance for chiropractic treatment, with interest, but denied further chiropractic and physiotherapy treatment plans for lack of objective medical evidence establishing ongoing physical impairments.

The applicant sought statutory accident benefits for psychological treatment following a motor vehicle accident.

The insurer denied two treatment plans for psychological services, relying on an insurer's examination which concluded that the applicant's symptoms were resolving and only a limited number of additional sessions were required.

The Tribunal found that the applicant failed to prove the disputed treatment plans were reasonable and necessary, noting that the applicant had already returned to normal activities and the proposed plans did not reflect his apparent improvements.

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

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

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

The applicant contended that chronic pain and psychological impairments removed him from the MIG.

The Tribunal found that the applicant failed to provide sufficient objective medical evidence to establish chronic pain or a psychological impairment caused by the accident.

The Tribunal preferred the respondent's expert evidence, which found no significant physical or psychological impairments beyond minor sprains and strains.

As the applicant's injuries were predominantly minor and the $3,500 MIG limit was exhausted, the disputed treatment and assessment plans were not payable.