Alexander V. Dos Reis

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The respondent denied several treatment plans for chiropractic and psychological services.

The Tribunal found that the chiropractic treatment plans were reasonable and necessary to address the applicant's chronic pain, relying on the clinical notes of the applicant's family physician.

However, the Tribunal denied the psychological treatment plans because the applicant failed to provide evidence justifying the proposed hourly rates and the costs of the psychological materials.

The Tribunal also dismissed the applicant's claim for a special award, finding no evidence that the respondent unreasonably withheld or delayed benefits.

The applicant sought entitlement to various medical benefits and assessments, including a chronic pain assessment and an orthopaedic assessment, following a motor vehicle accident.

The respondent denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that the proposed treatments were not reasonable and necessary.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to meet his burden of proof.

The Tribunal held that the initial treatment plan was properly denied under section 38(5) of the Schedule, transportation expenses were not payable as the applicant did not suffer a catastrophic impairment, and the medical evidence did not support a finding of chronic pain or the need for further facility-based treatment.

The appellant appealed a decision of the Licence Appeal Tribunal to the Divisional Court while a request for reconsideration of that decision was still pending before the Tribunal.

The respondent raised a preliminary objection that the court lacked jurisdiction because the decision was not final.

The Divisional Court agreed, holding that it has no jurisdiction to hear an appeal from an interlocutory decision of the Tribunal, and that the time for appeal runs from the date of the final order on the reconsideration request.

The appeal was dismissed for want of jurisdiction.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The insurer denied a treatment plan for physiotherapy and a claim for income replacement benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The adjudicator found that the applicant's physical and psychological injuries were predominantly minor, preferring the insurer's expert reports over the applicant's treating physicians due to gaps in treatment and lack of causal connection.

The adjudicator also concluded that the applicant did not suffer a substantial inability to perform the essential tasks of her pre-accident employment as a restaurant manager.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought $1,230.92 for an attendant care assessment, along with interest and a special award.

The insurer denied the benefit on the basis that it was not reasonable and necessary.

The Tribunal found that the applicant failed to demonstrate the assessment was reasonable and necessary, noting a lack of contemporaneous objective evidence and preferring the insurer's section 44 multidisciplinary reports.

As no benefits were overdue, the claims for interest and a special award were also dismissed.

The applicant sought non-earner benefits and attendant care benefits following a motor vehicle accident and subsequent knee surgery.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove a complete inability to carry on a normal life for the claimed period, as contemporaneous medical evidence indicated excellent recovery.

The Tribunal also found that the applicant no longer required attendant care services during the disputed period and failed to prove the expenses were incurred.

The respondent insurer sought reconsideration of a preliminary issue decision which found that the applicant was not statute-barred from proceeding with her claim for income replacement benefits.

The adjudicator dismissed the request for reconsideration.

Under Rule 18.1 of the Common Rules of Practice and Procedure, the Tribunal will only reconsider a decision that finally disposes of an appeal.

Because the applicant was successful on the preliminary issue, her appeal was not finally disposed of, rendering the decision interlocutory and ineligible for reconsideration.