Amanda Fowler

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her income replacement benefits on the basis that she was not employed at the time of the accident.

The applicant sought to introduce new evidence, including paystubs and bank statements, and argued the Tribunal erred by failing to consider she was self-employed.

The adjudicator dismissed the request, finding that the applicant was aware of the respondent's position prior to the hearing and had the opportunity to obtain the documents.

Furthermore, the adjudicator found no error in the Tribunal's failure to consider self-employment, as this argument was never raised at the initial hearing and the evidence did not support it.

The applicant insurer sought repayment of $12,731.87 in income replacement benefits (IRBs) paid to the respondent following a motor vehicle accident.

The insurer alleged that the respondent wilfully misrepresented her employment status by failing to disclose that she had returned to work.

The Tribunal found that the respondent failed to report her new employment and failed to produce a Record of Employment, leading to an adverse inference.

The Tribunal concluded that the respondent wilfully misrepresented her return to work date, entitling the insurer to full repayment of the IRBs plus interest.

The Tribunal also awarded $100 in costs to the insurer due to the respondent's bad faith conduct during the proceeding.

The applicant requested a reconsideration of a decision that denied his claim for income replacement benefits (IRB) and an award.

The applicant argued that the adjudicator made errors of law and fact, violated procedural fairness, and acted outside their jurisdiction.

The Vice Chair dismissed the request, finding no errors in the original decision's assessment of the evidence, including the applicant's return to work and medical reports.

The Vice Chair also declined to award costs to the respondent, as the applicant's conduct did not meet the threshold for a costs award.

The applicant insurer sought repayment of income replacement and medical benefits paid to the respondent, alleging he wilfully misrepresented his involvement in a motor vehicle accident.

Surveillance evidence showed the respondent working at his place of employment, contradicting his claims of inability to work.

The police report and testimony from the at-fault driver and responding officer confirmed the respondent was not a passenger in the vehicle.

The Tribunal found the respondent wilfully misrepresented his involvement in the accident and ordered repayment of $22,677.59 plus interest.

The applicant sought statutory accident benefits for a chronic pain assessment and a chronic pain program following a motor vehicle accident.

The respondent insurer denied the treatment plans, arguing a lack of medical evidence.

The Licence Appeal Tribunal found that the applicant failed to meet her burden of proving the treatment plans were reasonable and necessary, as she did not provide post-accident clinical notes and records from her treating physicians.

The expert reports relied upon by the applicant were based solely on self-reporting and pre-accident records.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits for psychological treatment and a chronic pain assessment following a motor vehicle accident.

The adjudicator denied the psychological treatment plans, finding an unexplained gap in treatment and a lack of supporting documentation.

However, the adjudicator granted the chronic pain assessment, concluding that the applicant's ongoing pain complaints and functional limitations made it reasonably possible she suffered from chronic pain syndrome.

The respondent's request for costs was denied as the applicant's conduct was not unreasonable, frivolous, vexatious, or in bad faith.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident, claiming physical and psychological impairments prevented him from working as a carpenter and security guard.

The Licence Appeal Tribunal dismissed the application, finding insufficient medical evidence to establish a substantial inability to perform the essential tasks of his pre-accident employments.

The Tribunal gave little weight to the applicant's experts because they were not informed of his second job as a security guard and relied on incomplete documentation.

The Tribunal preferred the evidence of the respondent's assessors and noted surveillance and employment records contradicted the applicant's testimony.

Claims for a special award and interest were also dismissed.

The applicant insurer sought repayment of $5,600.00 in income replacement benefits (IRBs) paid to the respondent insured, alleging the respondent wilfully misrepresented his return-to-work status.

The respondent had returned to full-time employment but continued to receive IRBs for over three months without notifying the insurer.

The respondent did not make submissions at the written hearing.

The Tribunal found that the respondent's failure to report his return to work constituted wilful misrepresentation.

The Tribunal ordered the respondent to repay the $5,600.00 overpayment plus interest.

The applicant sought a Non-Earner Benefit (NEB) following a motor vehicle accident.

The respondent insurer denied the claim, relying on independent medical examinations which concluded the applicant did not suffer a complete inability to carry on a normal life.

The Tribunal dismissed the application, finding the applicant's testimony unreliable due to numerous inconsistencies regarding her marital status, gym attendance, prior accidents, and work history.

The Tribunal accepted the respondent's unrefuted medical evidence and noted the applicant's failure to provide corroborating evidence for her claims.

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

The respondent denied the treatment plans on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant failed to provide objective evidence of functional improvement or recommendations from her family doctor to support the need for further chiropractic treatment.

The Tribunal also dismissed the applicant's argument that the respondent failed to comply with the timelines in s. 38 of the Schedule, finding insufficient evidence of non-compliance.

The application was dismissed.

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

The Tribunal found that the applicant was not employed at the time of the accident and therefore did not qualify for IRBs.

The Tribunal also dismissed the claims for an orthopedic mattress, chiropractic treatment, and psychological treatment, finding that the impairments were either pre-existing or the treatments were not proven to be reasonable and necessary.

The application was dismissed in its entirety.

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

The respondent denied two chiropractic treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the treatment was not reasonable and necessary.

The Tribunal found that the applicant's injuries were predominantly minor and that he had not established a pre-existing condition or chronic pain that would remove him from the MIG.

The Tribunal also found that the treatment plans were not reasonable and necessary.

Although the respondent failed to comply with the notice requirements under s. 38(8) of the Schedule for a brief period, no treatment costs were incurred during that time.

The application was dismissed.

The applicant sought a non-earner benefit under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove a complete inability to carry on a normal life.

Medical evidence and surveillance demonstrated that the applicant had substantially returned to his pre-accident routine, including working as a plumber and engaging in social and leisure activities.

Claims for interest and a special award were consequently dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied his claims for an income replacement benefit (IRB), an award, and interest.

The applicant argued that the Tribunal acted outside its jurisdiction, violated procedural fairness due to a past discipline issue of the adjudicator, and made significant errors of law and fact regarding the assessment of his disability and medical evidence.

The adjudicator dismissed the request, finding that the Tribunal acted within its jurisdiction, applied the correct legal tests under the Statutory Accident Benefits Schedule, and made no significant errors of fact or law that would have changed the outcome.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident.

The insurer suspended the IRB after eight months based on insurer's examinations.

The Licence Appeal Tribunal dismissed the application, finding the applicant did not suffer a substantial inability to perform the essential tasks of his pre-accident employment.

The Tribunal preferred the evidence of the insurer's medical assessors, noting significant symptom magnification, a lack of objective physical findings, and surveillance footage showing the applicant working at another job.

The applicant sought income replacement benefits following a motor vehicle accident, claiming chronic pain prevented him from returning to his pre-accident work as a supervisor and interior finisher.

The respondent insurer terminated benefits after 104 weeks.

The Tribunal found that the applicant did not suffer a substantial inability to perform his pre-accident employment, relying on surveillance evidence showing him performing physical work and medical reports indicating normal functioning.

The Tribunal dismissed the application for income replacement benefits, an award for unreasonable withholding, and interest.

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

The respondent insurer denied a treatment plan for $1,252.55, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued she suffered from chronic pain, which would remove her from the MIG.

The Tribunal found the applicant failed to prove she sustained a chronic pain condition as a result of the accident, noting a lack of medical evidence linking her complaints to the accident and evidence of her returning to normal activities.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits.

The respondent insurer denied the claim, arguing the applicant was excluded from coverage under paragraph 31(1)(b) of the Statutory Accident Benefits Schedule for making a material misrepresentation or intentionally failing to notify the insurer of a material risk, as he was driving a vehicle he did not own or insure.

The Tribunal found that the applicant was in the process of purchasing the vehicle and did not intentionally fail to notify the insurer.

The Tribunal concluded the exclusion did not apply and ordered the respondent to pay the income replacement benefits with interest.

The applicant's request for an award was denied as the insurer's initial denial was not unreasonable.

The applicant sought $2,200 for a chronic pain assessment following a motor vehicle accident.

The respondent insurer denied the benefit.

At the hearing, the respondent brought a preliminary motion to exclude late-filed medical evidence submitted by the applicant.

The adjudicator admitted the evidence but ordered the applicant to pay $300 in costs for breaching the case conference order.

On the substantive issue, the adjudicator found that the applicant failed to prove the chronic pain assessment was reasonable and necessary, noting a pre-existing history of back pain and relying on the respondent's independent medical examination which concluded the applicant did not have chronic pain syndrome.

The application was dismissed.

The appellant sought payment for a physical rehabilitation treatment plan and a lump sum award for a chronic pain assessment under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The adjudicator found that the appellant failed to prove the physical rehabilitation treatment was reasonable and necessary, noting a lack of evidence showing prior treatments were beneficial.

The request for a lump sum award was also denied, as the insurer had provided proper medical reasons for denying the chronic pain assessment before the expense was incurred, and thus did not unreasonably withhold or delay payment.

The application was dismissed.