Amanda Faulkner

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

The respondent denied benefits and closed the file after the applicant failed to submit a completed OCF-1 application within 30 days of receiving the forms.

The applicant submitted the OCF-1 over nine months late, citing language barriers and his daughter's personal issues as reasons for the delay.

The Tribunal found the explanation unreasonable, noting the applicant's prior experience with accident benefits and the daughter's ongoing communication with the adjuster.

The application was dismissed as statute-barred under section 55(1)1 of the Schedule.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

The respondent denied benefits because the applicant failed to submit an application for benefits (OCF-1) within the 30-day time limit prescribed by section 32(5) of the Schedule.

The applicant submitted the form over nine months late, arguing that language barriers and family issues provided a reasonable explanation for the delay.

The Tribunal applied the Horvath test and found the explanation unreasonable, noting the applicant's daughter had communicated with the insurer multiple times and the applicant was familiar with the process from a prior accident.

The Tribunal concluded the applicant was statute-barred under section 55(1)1 of the Schedule and dismissed the application.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her injuries, including a concussion and headaches, fell outside the Minor Injury Guideline (MIG).

As a preliminary issue, the adjudicator excluded the respondent's surveillance evidence due to late service, finding it prejudiced the applicant's ability to respond.

On the substantive issues, the adjudicator found insufficient medical evidence to support the concussion or persistent headache claims, concluding the injuries were predominantly minor.

Because the disputed treatment plans exceeded the $3,500 MIG limit, they were denied, and the application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including removal from the Minor Injury Guideline (MIG), a Non-Earner Benefit (NEB), and funding for a psychological assessment.

The Tribunal found that the applicant's chronic pain warranted removal from the MIG and approved the psychological assessment as reasonable and necessary to investigate the pain symptomology.

However, the claim for an NEB was dismissed because the medical evidence and the applicant's post-accident activities, including returning to part-time work, did not demonstrate a complete inability to carry on a normal life.

The applicant sought statutory accident benefits following a motor vehicle accident where he was allegedly struck as a pedestrian.

The insurer determined his injuries fell within the Minor Injury Guideline (MIG) and denied further treatment plans and Income Replacement Benefits (IRBs).

The Tribunal found that the applicant failed to prove his injuries fell outside the MIG, rejecting his claims of chronic pain and psychological injuries due to inconsistent medical evidence and uncompelling expert reports.

The Tribunal also dismissed the claim for IRBs, finding no credible link between the accident and the applicant's inability to work, as the medical evidence showed functional range of motion and no substantial impairment.

All claims were dismissed.

The applicant was injured in a motor vehicle accident and sought $2,212 for a chiropractic treatment plan, which the respondent denied.

The Tribunal found that the treatment plan was reasonable and necessary to treat the applicant's ongoing pain, despite the applicant's delay in providing updated medical records.

The applicant was awarded the cost of the treatment plan upon proof of it being incurred, plus applicable interest.

However, the Tribunal declined to order an award for unreasonable delay under Regulation 664 because the applicant failed to provide the respondent with updated clinical notes in a timely manner.

The applicant sought various medical and rehabilitation benefits following a 2015 motor vehicle accident.

The Licence Appeal Tribunal reviewed treatment plans for psychological services, an audiometric assessment, an optometric assessment, and a driving assessment.

The Tribunal found that the applicant failed to prove the psychological, audiometric, and optometric plans were reasonable and necessary, largely relying on the respondent's section 44 medical examination reports.

However, the Tribunal approved the driving assessment, finding it reasonable and necessary to address the applicant's well-documented driving anxiety.

The applicant sought statutory accident benefits following a rear-end motor vehicle accident, including ongoing income replacement benefits (IRBs) and various treatment plans.

The Licence Appeal Tribunal dismissed the application, preferring the respondent's insurer examination reports which found no physical, neurological, or psychological impairments preventing the applicant from working.

The Tribunal also noted the applicant's family doctor refused to complete IRB forms due to a lack of ongoing symptoms.

The claims for medical assessments and treatment plans were denied as they were not reasonable and necessary, and had not been incurred.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including treatment plans for massage therapy, physiotherapy, psychological services, and an in-home attendant care assessment.

The respondent denied the treatment plans.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that the disputed treatment plans were reasonable and necessary, noting a lack of objective medical evidence supporting the requests.

The Tribunal awarded interest on two previously approved and incurred expenses but declined to deem other approved but unincurred expenses as incurred under s. 3(8) of the Schedule, finding the respondent did not unreasonably withhold payment.

The applicant's claims for a special award and costs were dismissed.

The applicant sought statutory accident benefits following a 2015 motor vehicle accident, including attendant care benefits and funding for three medical assessments.

The Tribunal dismissed the claim for attendant care benefits because the applicant was not catastrophically impaired and the 104-week post-accident period had expired.

The claims for an orthopedic and home site assessment were dismissed due to a lack of supporting medical evidence.

The respondent conceded the neuropsychological assessment was reasonable and necessary, which the Tribunal ordered, but no interest was awarded as the expense had not been incurred.

The applicant insurer sought repayment of $36,456.00 in income replacement benefits (IRBs) paid to the respondent, alleging willful misrepresentation.

Surveillance evidence and the respondent's own admissions during an examination under oath confirmed she had returned to work at a restaurant she owned while continuing to receive IRBs and reporting to assessors that she was unemployed.

The respondent did not participate in the written hearing.

The Tribunal found that the respondent willfully misrepresented her return-to-work status and ordered her to repay the full amount of IRBs received, plus interest.

The applicant sought a non-earner benefit and a medical benefit for physiotherapy following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove a complete inability to carry on a normal life, noting a lack of evidence comparing pre- and post-accident activities and significant pre-existing medical conditions.

The Tribunal also found the physiotherapy treatment plan was not reasonable and necessary due to a lack of compelling medical evidence.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for psychological services and rehabilitative driving lessons.

The insurer denied the psychological treatment plan because it was proposed at a psychologist's hourly rate, but the treatment was to be provided by a psychotherapist under supervision, and the applicant failed to provide requested information under s. 33 of the Schedule.

The insurer partially approved the driving lessons at a standard rate but denied the premium rate sought for specialized rehabilitative instruction.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the psychological treatment would be provided by the listed practitioner or that the premium rate for driving lessons was reasonable and necessary.

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

The respondent denied several chiropractic treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that a pre-existing disc herniation should remove him from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence that his pre-existing condition would prevent him from achieving maximum medical recovery within the MIG limit.

The Tribunal accepted the respondent's insurer examination reports, which concluded the injuries were minor soft tissue injuries.

The application was dismissed as the MIG limit had been exhausted.

The applicant sought income replacement benefits (IRBs) and the cost of prescription medications following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the claim for IRBs because the applicant failed to file a 2016 income tax return, meaning his pre-accident income was deemed to be nil under section 4(5) of the Statutory Accident Benefits Schedule.

The claim for prescription medications was also dismissed as the respondent had already paid the amount.

No interest was payable.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including medical benefits and Income Replacement Benefits (IRBs).

The insurer denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG), and stopped IRBs based on insurer examinations.

The Licence Appeal Tribunal found that the applicant's median nerve neuropathy removed him from the MIG.

The Tribunal approved one treatment plan for physiotherapy and braces but denied others for lack of supporting evidence.

The Tribunal also ordered the reinstatement of IRBs up to the two-year anniversary of the accident, finding the applicant was substantially unable to perform his pre-accident employment as a warehouse worker and driver, and awarded interest on overdue payments.

The respondent insurer requested a reconsideration of a Tribunal decision that found the applicant entitled to a chronic pain assessment.

The insurer argued the Tribunal erred in law by failing to consider the proposed assessor's qualifications, by not giving significant weight to its medical doctor's paper review over the applicant's chiropractor, and by finding the insurer waived the requirement for signed treatment plans under s. 38(3) of the Schedule.

The Tribunal dismissed the request, finding no error in the original adjudicator's weighing of the medical evidence.

Furthermore, the Tribunal upheld the finding that the insurer implicitly waived the signature requirement by scheduling a s. 44 examination and responding to the unsigned OCF-18 without raising the issue until the hearing.

The applicant was injured in a motor vehicle accident and sought an income replacement benefit (IRB) and medical benefits.

The respondent denied the claims.

The applicant appealed the IRB denial more than two years after the limitation period expired.

The Tribunal declined to extend the time to appeal under s. 7 of the Licence Appeal Tribunal Act, finding no bona fide intention to appeal, excessive delay, and lack of merit.

The Tribunal also dismissed the claim for physiotherapy services, finding the applicant's injuries fell within the Minor Injury Guideline and the treatment was not reasonable and necessary.

The applicant filed a Request for Reconsideration of a Tribunal decision that denied her entitlement to non-earner benefits (NEBs), medical benefits, and interest following a motor vehicle accident.

The applicant argued the Tribunal erred in law by failing to properly apply the legal test for NEBs and erred in fact by failing to properly consider medical evidence.

The Vice Chair found that the Tribunal correctly applied the test for NEBs as set out in the Schedule and the principles from Heath and Galdamez.

The Vice Chair also found no error in the Tribunal's weighing of the medical evidence.

The Request for Reconsideration was dismissed.

The applicant, a pedestrian struck by a vehicle, sought statutory accident benefits for medical and rehabilitation treatments.

The respondent denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit was exhausted.

The Tribunal found that the applicant's physical injuries were minor and that she failed to prove a pre-existing condition or a psychological impairment that would warrant removal from the MIG.

The Tribunal preferred the respondent's comprehensive psychological assessment over the applicant's pre-screen.

As the injuries fell within the MIG and the limit was exhausted, the claims for further treatment and interest were dismissed.