Andrea L. Bandow

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

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

The applicant argued the injuries fell outside the MIG and that the respondent failed to provide proper notice of denial.

The Tribunal found that while the respondent provided late notice for two treatment plans, it cured the non-compliance before expenses were incurred.

The Tribunal concluded the applicant did not meet the burden of proving his injuries fell outside the MIG and that the disputed treatment plans were not reasonable and necessary.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought $2,230.64 for a chiropractic treatment plan under the Statutory Accident Benefits Schedule.

The respondent insurer denied the claim.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment was reasonable and necessary.

The Tribunal relied on the insurer's expert medical examination, which concluded the applicant suffered only minor soft-tissue injuries and would not benefit from the proposed treatment.

The applicant's medical evidence, consisting primarily of clinical notes from his family physician, was insufficient to establish entitlement.

The application was dismissed.

The applicant sought post-104 week income replacement benefits following a motor vehicle accident.

The insurer denied the benefits, arguing the applicant did not meet the complete inability test.

The Tribunal found that the applicant failed to establish on a balance of probabilities that she suffered a complete inability to engage in any employment or self-employment for which she was reasonably suited.

The Tribunal noted the applicant's pre-existing health issues and failure to address causation regarding a subsequent accident.

The medical evidence provided did not sufficiently address the complete inability test.

The application was dismissed.

The applicant sought entitlement to a Non-Earner Benefit and two treatment plans following a motor vehicle accident.

The adjudicator found that the applicant failed to demonstrate a complete inability to carry on a normal life, as his pain did not practically prevent him from engaging in his pre-accident activities.

The adjudicator also denied the treatment plans, noting the applicant failed to produce the plans in evidence or demonstrate they were reasonable and necessary.

The application was dismissed.

The applicant requested a reconsideration of a decision denying medical and rehabilitation benefits, specifically a chronic pain assessment.

The applicant argued that new IE reports from Dr. Khan and Dr. Kanagaratnam, received after the written submissions deadline but before the decision was rendered, constituted new evidence.

The Tribunal dismissed the request, finding that the reports were available seven months before the decision was issued and thus were not new evidence.

Furthermore, the Tribunal held that the reports would not have changed the original findings regarding the chronic pain assessment.

The applicant sought an income replacement benefit (IRB) of $400 per week following a motor vehicle accident, claiming psychological and physical impairments prevented him from performing his essential tasks as an AutoCAD technician.

The respondent denied the claim, arguing the applicant returned to work immediately, was terminated for being a poor fit, and lacked objective medical evidence of disability.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to provide contemporaneous, objective medical evidence demonstrating a substantial inability to perform his pre-accident employment tasks during the disputed period.

As no benefits were payable, the claim for interest was also dismissed.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming a substantial inability to perform the essential tasks of his self-employment as a general contractor.

The Tribunal found that the applicant's right rotator cuff tear was a pre-existing condition, not caused by the accident.

Due to significant inconsistencies in the applicant's evidence regarding his return to work and prior medical history, the Tribunal found his self-reports lacked credibility.

The Tribunal concluded the applicant failed to prove on a balance of probabilities that he suffered a substantial inability to perform his essential tasks, and dismissed the application for IRBs and interest.

The applicant sought various statutory accident benefits following a motor vehicle accident, including treatment plans for assistive devices, psychological services, hydrotherapy, chiropractic services, and catastrophic impairment assessments.

The insurer denied the benefits, arguing the applicant's ongoing issues were related to a significant pre-existing back condition and opioid dependence, not the accident.

The adjudicator dismissed the application, finding the applicant failed to provide sufficient medical evidence to prove the treatments were reasonable and necessary, and preferred the insurer's medical assessors who concluded the accident did not exacerbate the pre-existing condition.

The applicant sought statutory accident benefits following a motor vehicle accident, including treatment plans for physiotherapy, a psychological pre-screening, and a chronic pain assessment.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to meet her burden of proving the disputed treatment plans were reasonable and necessary, noting a lack of persuasive medical evidence and reliance on reports that did not support the requested treatments.

The claims for the disputed treatment plans and interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming two treatment plans for physiotherapy (Pilates and massage therapy) and one for an occupational therapy assessment.

The adjudicator found the physiotherapy treatment plans reasonable and necessary to alleviate pain and improve function, preferring the evidence of the applicant's treating and assessing practitioners over the insurer's examination assessor.

However, the hourly rate for the Pilates instructor was reduced to the unregulated provider rate, and the second plan was subject to deduction for available collateral benefits.

The claim for an occupational therapy assessment was dismissed as the adjudicator found it was not reasonable and necessary, relying on a recent comprehensive functional capacity evaluation.

The applicant sought interest and a special award under Regulation 664, alleging that the respondent unreasonably delayed the payment of a $6,000 funeral benefit following the death of her son in a motor vehicle accident.

The respondent argued that the 30-day timeline for payment did not commence until the applicant provided confirmation that no WSIB claim had been filed, as the accident occurred during the course of employment.

The Tribunal found that the application was not complete until the WSIB confirmation was received, and the respondent paid the benefit within 30 days of that date.

The claims for interest and a special award were dismissed.

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

The insurer denied a chiropractic treatment plan and requested an insurer examination (IE).

The applicant failed to attend the IE, citing travel out of the country.

The Tribunal found that the insurer made reasonable efforts to schedule the IE and provided proper medical reasons for the denial.

Because the applicant did not have a reasonable explanation for failing to attend, the Tribunal held that section 55(1)2 of the Schedule barred the application from proceeding until the applicant complied with the IE request.

The applicant sought reconsideration of a Tribunal decision that found his claim for Income Replacement Benefits was statute-barred and denied a medical benefit for physiotherapy services under the Minor Injury Guideline.

The applicant filed the reconsideration request past the 21-day deadline and sought an extension of time.

The adjudicator applied the Manuel factors and found that the applicant lacked a bona fide intention to appeal within the time limit and that the appeal lacked merit, as the applicant failed to provide sufficient medical evidence to prove his injuries fell outside the Minor Injury Guideline.

The request for an extension of time was denied, and the reconsideration request was dismissed.