Aimee Draper

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

The respondent partially denied several treatment plans, arguing that psychotherapists are not entitled to the higher hourly rate of psychologists under the Professional Services Guideline.

The Tribunal found that the applicant failed to establish that the higher rate was reasonable and necessary.

However, the Tribunal found that one of the respondent's denial letters violated s. 38(8) of the Schedule by failing to provide reasons for the partial denial, entitling the applicant to $637.07 for that plan.

The remaining claims were dismissed, including two that were barred by the two-year limitation period.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for various assessments and treatments.

The respondent insurer denied the treatment plans.

The applicant argued the treatment plans were payable under s. 38(11) of the Schedule because the respondent's denial notices failed to comply with the strict medical and other reasons requirements of s. 38(8).

The Tribunal agreed with the applicant for four of the five treatment plans, finding the denial notices lacked sufficient detail for an unsophisticated person to make an informed decision.

The Tribunal ordered the respondent to pay for the psychotherapy, chronic pain, hyperbaric oxygen, and social work assessments, plus interest, but dismissed the claim for an orthopaedic assessment and a special award.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for psychological services and an attendant care assessment.

The respondent partially denied the psychological services and fully denied the attendant care assessment.

The Licence Appeal Tribunal found the applicant was entitled to 90-minute psychological sessions but not the higher hourly rate requested for a psychotherapist.

The Tribunal also granted the attendant care assessment based on the applicant's ongoing vertigo symptoms.

The applicant's request for a section 10 award for unreasonable delay was dismissed.

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

Prior to the hearing, the respondent conceded the applicant's catastrophic impairment designation and agreed to pay the disputed benefits.

The only remaining issue was the applicant's request for costs, arguing the respondent unreasonably delayed serving a psychiatric addendum report, causing unnecessary legal expense.

The Tribunal dismissed the costs request, finding the respondent acted diligently in following up with the assessment facility and served the report within the ten-day statutory timeline under s. 45(5) of the Schedule.

The applicant sought payment for unapproved amounts related to psychological services, an attendant care assessment, and catastrophic impairment assessments following a motor vehicle accident.

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

Specifically, the applicant did not justify paying a social worker at a psychologist's rate, failed to make submissions on the attendant care assessment, and did not establish that the denied catastrophic assessment fees were not a duplication of services.

The applicant sought statutory accident benefits following a slip and fall in a restaurant parking lot, which was previously determined to be an accident under the Schedule.

The Tribunal found the applicant was entitled to income replacement benefits for a closed period until he returned to work.

Claims for attendant care benefits were dismissed as the applicant failed to prove the expenses were incurred.

The Tribunal awarded funding for an attendant care assessment, physiotherapy, and partial occupational therapy, finding them reasonable and necessary.

The applicant's request for a special award under s. 10 of O. Reg. 664 was denied, as the insurer's initial denial based on the definition of an accident was not unreasonable.

The applicant sought a non-earner benefit and various medical and rehabilitation benefits following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant had not suffered a complete inability to carry on a normal life, as she continued to engage in her pre-accident activities of daily living.

The Tribunal also denied the disputed treatment plans for chiropractic, physiotherapy, and social work services, relying on the clinical notes of the applicant's family doctor and the respondent's section 44 insurer examinations, which indicated the treatments were not reasonable and necessary.

Claims for interest and a special award were consequently dismissed.

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

The Licence Appeal Tribunal denied the applicant's claims for physiotherapy, chiropractic, and psychotherapy treatment plans, as well as medication expenses, finding insufficient medical evidence and a failure to attend a required insurer examination.

However, the Tribunal found that the insurer unreasonably delayed approving a psychological assessment after the applicant was removed from the Minor Injury Guideline.

The Tribunal ordered the insurer to pay a $440 special award and interest on the delayed assessment.

The applicant sought statutory accident benefits for physiotherapy services and a catastrophic impairment assessment following a motor vehicle accident.

The insurer denied the benefits, arguing the applicant had reached maximum medical recovery and had not shown a change in condition to warrant a second catastrophic assessment.

The Tribunal agreed with the insurer, finding that the applicant's large gaps in treatment and the medical evidence indicated maximum medical recovery.

The Tribunal also found no evidence of a worsened condition to justify an additional catastrophic impairment assessment.

The application was dismissed.

The applicant sought various statutory accident benefits following a 2018 motor vehicle accident, including attendant care benefits, post-104 income replacement benefits, and several treatment plans.

The Tribunal dismissed the claims for attendant care and income replacement benefits, finding the applicant was independent with personal care and did not suffer a complete inability to engage in suitable employment.

The Tribunal granted the treatment plans for a SPECT scan and occupational therapy, finding them reasonable and necessary to address the applicant's traumatic brain injury and ongoing impairments.

Claims for other assessments, physiotherapy, speech-language therapy, and a special award were dismissed.

The applicant sought non-earner benefits and various medical and rehabilitation benefits following a motor vehicle accident.

The Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, as her extensive pre-accident medical records indicated she experienced the same level of chronic pain and functional limitation before and after the accident.

The Tribunal also dismissed the claims for the disputed treatment plans, finding a lack of objective medical evidence that they were reasonable and necessary to treat accident-related impairments.

The application was dismissed in its entirety.

The applicant sought entitlement to statutory accident benefits for chiropractic, massage, psychotherapy, and catastrophic determination assessments following a 2017 motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to meet her evidentiary burden to prove the treatment and assessment plans were reasonable and necessary.

The Tribunal preferred the respondent's more current section 44 assessment reports over the applicant's outdated section 25 reports and noted the lack of consistent recommendations from treating physicians.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for psychological services and an accountant's report.

The insurer denied the benefits.

The Tribunal found the psychological services were reasonable and necessary to treat the applicant's adjustment disorder and specific phobia, noting the treating psychologist's recommendations and the applicant's progress.

However, the Tribunal denied the cost of the accountant's report because the applicant failed to prove he was applying for an income replacement benefit or that the report was reasonable and necessary.

The applicant was awarded the cost of the psychological services with interest.

The applicant sought statutory accident benefits after slipping and falling on snow and ice while walking towards his remotely started vehicle in a restaurant parking lot.

The respondent denied benefits on the basis that the incident was not an 'accident' under section 3(1) of the Schedule.

The Tribunal applied the purpose and causation tests, finding that while the purpose test was met, the causation test failed because the snow and ice constituted an intervening act that broke the chain of causation.

The application was dismissed.

The applicant sought accident benefits following a 2016 motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed entitlement to a $3,281.98 chiropractic treatment plan.

The Tribunal found that the applicant failed to provide medical documentation to support removal from the MIG or to prove the treatment plan was reasonable and necessary.

Relying on the respondent's insurer's examination report, the Tribunal concluded the applicant's injuries were minor and dismissed the application in its entirety.

The applicant, a pedestrian struck by a vehicle, sought statutory accident benefits for physiotherapy services and an orthopaedic assessment.

The respondent insurer denied the benefits and argued that the claims for two of the treatment plans were statute-barred under the two-year limitation period.

The Tribunal found that the respondent's denial notices contained boilerplate language and failed to provide valid medical reasons, meaning they did not trigger the limitation period.

On the substantive issues, the Tribunal found that the proposed treatment plans and the orthopaedic assessment were reasonable and necessary to address the applicant's ongoing pain and promote a return to normal activities.

The applicant was awarded the claimed benefits and interest on overdue payments.

The applicant sought entitlement to various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident, including a functional abilities evaluation, chiropractic services, physiotherapy, massage therapy, and occupational therapy.

The respondent insurer denied the benefits.

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

The Tribunal relied on the respondent's section 44 medical assessments, which indicated the applicant had returned to work and was functional in her activities of daily living, and noted a lack of objective medical evidence from the applicant to support the need for ongoing passive facility-based treatment.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a physiatry assessment and chiropractic services.

The respondent insurer denied the treatment plans based on insurer's examinations indicating the applicant had reached maximum medical recovery and that his shoulder issues stemmed from a pre-existing hockey injury.

The Tribunal applied the 'but for' test for causation and accepted the medical evidence that the applicant's ongoing impairments were not caused by the accident.

The Tribunal found the proposed treatment plans were neither reasonable nor necessary.

The application was dismissed.

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

The Licence Appeal Tribunal found the applicant was entitled to funding for psychotherapy, a neuropsychological assessment, and a COGMED assessment/treatment, as these were reasonable and necessary given objective evidence of a traumatic brain injury and ongoing psychological symptoms.

Claims for chiropractic services and a driver evaluation were dismissed.

The Tribunal also held the applicant was barred from pursuing a neurological assessment due to his failure to attend scheduled insurer's examinations without a reasonable explanation.

A claim for a special award under s. 10 of O. Reg. 664 was dismissed, but interest was awarded on the approved treatment plans.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and the balance of a psychological assessment.

The Licence Appeal Tribunal dismissed the application.

The Tribunal found the insurer's denial notices were valid and compliant with the Schedule.

The applicant failed to prove a complete inability to carry on a normal life, as there was insufficient evidence comparing her pre- and post-accident activities.

The claim for the psychological assessment balance was denied because it related to transportation expenses under 50 kilometres.

Claims for interest and an award were also dismissed.