Anil Hampole

The applicant sought the unapproved balance of two treatment plans for psychological services provided by a social worker following a motor vehicle accident.

The dispute centered on whether the social worker should be paid the enhanced hourly rate of $149.61, commensurate with a psychologist or psychotherapist, rather than the $99.75 rate approved by the respondent.

The Tribunal found that the applicant failed to provide sufficient evidence that the social worker was under the active supervision of a psychologist or possessed specialized training in psychotherapy.

Consequently, the Tribunal deemed the $99.75 hourly rate reasonable and dismissed the claims for the unapproved balances, interest, and an award under s. 10 of Reg. 664.

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

The insurer denied a treatment plan for chiropractic services, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered from an accident-related psychological impairment (PTSD) that warranted removal from the MIG.

The Tribunal also found the proposed chiropractic treatment plan to be reasonable and necessary, ordering the insurer to pay the benefit with interest.

The applicant's claim for an award for unreasonable delay was dismissed.

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

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

The Tribunal found that the applicant's physical injuries were predominantly minor soft tissue injuries and that she failed to provide compelling evidence of a psychological impairment that would warrant removal from the MIG.

Consequently, the applicant was not entitled to the disputed treatment plans, interest, or an award for unreasonable delay.

The applicant sought statutory accident benefits following a 2019 motor vehicle accident, including non-earner benefits, medical benefits for chiropractic and psychological treatment, and a special award.

The Licence Appeal Tribunal dismissed the application in its entirety.

The adjudicator found the applicant failed to establish a complete inability to carry on a normal life, noting a lack of contemporaneous medical evidence and details regarding pre-accident activities.

The claims for medical benefits and assessments were also dismissed as the applicant failed to prove they were reasonable and necessary, with several claims lacking any supporting submissions or evidence.

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

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed a psychological impairment (PTSD) warranted removal from the MIG.

The Tribunal found the medical evidence did not support a psychological diagnosis, noting the family physician's records contradicted the PTSD claim.

As the applicant's injuries were minor and the MIG limit was exhausted, the claims for physiotherapy, medical services, interest, and an award for unreasonable delay were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident but was denied by the respondent insurer.

The respondent scheduled an insurer's examination under section 44 of the Schedule, which the applicant failed to attend on three separate occasions.

The Tribunal found that the notices of examination were compliant with section 44(5) and that the applicant failed to provide a reasonable explanation for his non-attendance.

Consequently, pursuant to section 55(1)2 of the Schedule, the applicant is barred from proceeding with his application to the Tribunal.

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

The Tribunal found the applicant was barred from receiving a non-earner benefit under s. 31(1)(d)(i) of the Schedule because she was convicted of a criminal offence on the day of the accident.

The Tribunal also held that the applicant's injuries were predominantly minor and subject to the $3,500 Minor Injury Guideline limit, as the medical evidence showed her psychological conditions pre-dated the accident and were not exacerbated by it.

The application for treatment plans and an award was dismissed.

The applicant sought payment for the unapproved balances of three treatment plans for psychological assessment and treatment following a motor vehicle accident.

The respondent had partially approved the plans based on the recommendations of its psychological assessor and the rates set out in the Professional Services Guideline.

The Tribunal found that the applicant failed to provide any evidence to contradict the respondent's assessor or to establish that the unapproved balances were reasonable and necessary.

The application was dismissed.

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

The insurer denied benefits and argued the applicant was barred from proceeding to a hearing because she failed to attend an insurer's examination.

The Tribunal found that the insurer's notices of examination were deficient because they relied on boilerplate language regarding the Minor Injury Guideline without explaining the applicant's specific medical conditions or why they fell within the guideline.

As the notices did not comply with the Schedule, the applicant was not barred from proceeding with her application.

The applicants sought statutory accident benefits following an alleged motor vehicle collision in a parking lot.

The respondent insurer denied the claims on the basis that the accident was staged.

Relying on forensic and biomechanical engineering evidence, as well as significant inconsistencies in the applicants' testimonies and lack of corroborating evidence, the Tribunal found that the collision did not occur as alleged.

The Tribunal concluded the incident was a staged accident and therefore did not meet the definition of an 'accident' under section 3(1) of the Schedule.

The applications were dismissed, and the respondent's request for costs was denied.