Statutory Accident Benefits Schedule matters (SABS)

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline (MIG).

She claimed entitlement to income replacement benefits, a psychological assessment, and an award for unreasonable delay.

The Tribunal found that the applicant failed to provide sufficient medical evidence to prove her injuries, including alleged psychological impairments, fell outside the MIG.

Relying on the insurer's expert reports, the Tribunal concluded the applicant did not suffer a substantial inability to perform the essential tasks of her employment and was not entitled to income replacement benefits or the disputed treatment plan.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit, a chiropractic treatment plan, and removal from the Minor Injury Guideline (MIG) due to chronic pain and psychological impairments.

The adjudicator found that the applicant's physical injuries, including neck, back, and heel pain, were minor in nature and did not meet the criteria for chronic pain.

Furthermore, the adjudicator accepted the respondent's psychological assessment that the applicant did not meet the criteria for any mental health diagnosis.

The adjudicator also dismissed the claim for a non-earner benefit, finding insufficient evidence comparing the applicant's pre- and post-accident activities to establish a complete inability to carry on a normal life.

The application was dismissed.

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

The matter proceeded to a written hearing, but the applicant failed to file any submissions or evidence.

The Tribunal proceeded in the applicant's absence pursuant to section 7(2) of the Statutory Powers Procedure Act.

The Tribunal found that the applicant failed to meet her burden of proving entitlement to the claimed benefits and removal from the Minor Injury Guideline.

The application was dismissed.

The applicant sought $14,750.81 for a catastrophic impairment assessment following a 2019 motor vehicle accident.

The respondent denied the treatment plan and argued that the issue of the applicant's chronic pain was res judicata based on a prior Tribunal decision.

The Tribunal found that res judicata did not apply as the issues were different and the prior decision did not address the cost of a catastrophic assessment.

The Tribunal partially approved the treatment plan, finding the physiatry, psychological, and occupational therapy assessments reasonable and necessary, but denied the costs for clinic file reviews, transportation, and interpretation.

The applicant was awarded $8,400.00 plus interest, but the claim for a special award under s. 10 of Regulation 664 was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits (NEBs) and several treatment plans for physiotherapy, orthotics, and a chronic pain assessment.

The Licence Appeal Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, as her impairments were not continuous and she was able to work part-time.

The Tribunal denied the physiotherapy and orthotics treatment plans due to a lack of compelling evidence of their reasonableness and necessity.

However, the Tribunal granted the $2,200 treatment plan for a chronic pain assessment, finding that the applicant's pain was worsened by the accident and warranted further investigation.

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

The respondent denied the benefits based on section 44 assessments.

The Tribunal found that the respondent's denial letter complied with the requirement to provide medical reasons under section 37(6) of the Schedule.

On the substantive issues, the Tribunal placed little weight on the applicant's expert reports due to inaccuracies and a failure to account for the applicant's significant pre-existing health conditions and prior accidents.

The Tribunal accepted the respondent's section 44 assessors' opinions that the applicant did not suffer a complete inability to carry on a normal life and did not require attendant care.

The application was dismissed in its entirety.

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

The Tribunal scheduled a written hearing, but the applicant failed to file any submissions or evidence by the deadline.

The respondent filed a motion to dismiss the application as abandoned.

Proceeding in the absence of the applicant's participation under section 7(2) of the Statutory Powers Procedure Act, the Tribunal found the applicant failed to meet their burden of proof.

The application was dismissed, and the respondent's motion was dismissed as moot.

The applicant sought statutory accident benefits for physiotherapy, a functional ability evaluation, and neuropsychological assessments following a motor vehicle accident.

The respondent denied the benefits.

The Tribunal found that the applicant failed to comply with a production order, leading to an adverse inference.

The Tribunal dismissed the claim for neuropsychological assessments because the respondent had already paid the $2,000 maximum under s. 25(5)(a) of the Schedule for one of three identical plans.

The claims for physiotherapy and a functional ability evaluation were dismissed because the applicant failed to prove causation on a balance of probabilities, given evidence of pre-existing and subsequent injuries, and contradictory evidence regarding his work status.

The application was dismissed.

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

The matter proceeded to a written hearing.

The applicant's representative withdrew prior to the hearing, and the applicant failed to file any written submissions or evidence.

The Tribunal proceeded in the applicant's absence under s. 7(2) of the Statutory Powers Procedure Act.

Finding that the applicant failed to meet her burden of proof to demonstrate removal from the Minor Injury Guideline or entitlement to the disputed benefits, the Tribunal dismissed the application.

The respondent's request for costs was denied.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident, including a non-earner benefit and funding for orthopaedic and psychological assessments.

The Licence Appeal Tribunal dismissed the application.

The claim for a non-earner benefit was barred because the applicant failed to submit a completed OCF-3 Disability Certificate within two years of the accident, as strictly required by section 32(3) of the Schedule.

The proposed assessments were found not to be reasonable and necessary, as the medical evidence did not support the need for them years after the accident.

Claims for an award and costs were also dismissed.

The applicant was injured in a motor vehicle accident and sought $4,520.00 for catastrophic impairment assessments, representing the denied portion of a treatment plan.

The respondent had approved $10,230.81 for the assessments but denied the $2,000.00 fee for each medical professional to conduct a clinical file review assessment, arguing it exceeded the $2,000.00 cap per assessment under section 25(5)(a) of the Schedule.

The Tribunal agreed with the respondent, finding that a file review is part of the assessment expense and is included within the $2,000.00 limit.

The application was dismissed, and no interest was awarded.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and two treatment plans for chiropractic services.

The Tribunal found that the applicant failed to meet her burden of proof to establish entitlement to a higher quantum of pre-104 IRBs or entitlement to post-104 IRBs, as she provided no substantive submissions on these points.

The Tribunal also rejected the applicant's arguments that the respondent's notices were non-compliant with the Schedule, finding that the respondent provided adequate medical and other reasons for its denials under s. 38(8) and properly requested an insurer's examination under s. 37(1).

As the applicant failed to establish that the proposed treatments were reasonable and necessary, the application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and chiropractic treatment plans.

The insurer denied the benefits, relying on an independent medical examination concluding the injuries were minor.

The Tribunal found the applicant was entitled to the physiotherapy treatment plan, as clinical notes showed it provided genuine benefit.

However, the Tribunal denied the chiropractic treatment plan, noting a lack of corroborating medical evidence and the applicant's prior finding that chiropractic services were ineffective.

The Tribunal also denied the applicant's request for an award for unreasonable delay, but granted interest on the overdue physiotherapy benefits.

The applicant sought various statutory accident benefits, including attendant care benefits, medical benefits, and assessments, following a 2013 motor vehicle accident.

The Licence Appeal Tribunal held a written hearing to resolve the disputes.

The Tribunal dismissed the application in its entirety, finding that the applicant's case was significantly hampered by discrepancies between her written submissions and her hearing brief, including missing evidence and failure to pinpoint relevant documents.

The applicant failed to meet her onus to prove entitlement to attendant care benefits, incurred expenses, or the reasonableness and necessity of the proposed treatment and assessment plans.

Claims for interest and a special award were also dismissed.

The applicant sought entitlement to statutory accident benefits for physiotherapy, massage therapy, and osteopathy following a motor vehicle accident.

The respondent denied the benefits based on an insurer's examination report which concluded further facility-based treatment would not provide improvement.

The Tribunal found the treatment plans reasonable and necessary, preferring the evidence of the applicant's treating practitioners who noted the treatments provided pain relief and functional maintenance.

The Tribunal granted entitlement to the treatment plans and certain incurred expenses, along with interest, but dismissed the claim for an award under s. 10 of Reg. 664, finding the respondent's reliance on its medical assessment was not unreasonable.

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

The matter proceeded to a written hearing.

The applicant's representative withdrew prior to the submission deadline, and the applicant failed to file any submissions or evidence.

The Tribunal proceeded in the applicant's absence pursuant to section 7(2) of the Statutory Powers Procedure Act.

Finding that the applicant failed to meet the burden of proof, the Tribunal dismissed the application.

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

The insurer denied three treatment plans for assessments (chronic pain, orthopaedic, and hyperbaric oxygen) and required the applicant to attend insurer's examinations.

The Tribunal found that the insurer's initial denial notices failed to provide sufficient medical reasons as required by s. 38(8) and s. 44(5)(a) of the Schedule.

The defective notices were not cured until a subsequent letter was sent months later.

Consequently, the Tribunal ordered the insurer to pay for the assessments if they were incurred during the period of non-compliance.

The applicant's claim for a special award under s. 10 of O. Reg. 664 was dismissed, as the defective notices alone did not constitute unreasonable conduct.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed entitlement to a non-earner benefit, various treatment plans, and removal from the MIG due to pre-existing conditions, psychological impairments, and chronic pain syndrome.

The Licence Appeal Tribunal found that the applicant failed to establish that her pre-existing conditions precluded recovery within the MIG, nor did she prove accident-related psychological impairments or chronic pain syndrome.

The Tribunal also dismissed the claim for a non-earner benefit, finding insufficient evidence of a complete inability to carry on a normal life.

As the applicant remained in the MIG and the limits were exhausted, the disputed treatment plans were denied.

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 argued for removal from the MIG based on pre-existing carpal tunnel syndrome, chronic pain, and psychological impairment.

The Tribunal found insufficient medical evidence to support the applicant's claims of pre-existing conditions, chronic pain, or psychological impairment.

The application was dismissed, and the applicant was held to the MIG limits.

The applicant was injured in a motor vehicle accident and sought a determination of catastrophic impairment based on mental or behavioural impairments, as well as ongoing income replacement benefits and medical/rehabilitation benefits.

The Tribunal found that the applicant sustained a catastrophic impairment under Criterion 8, as the accident exacerbated her pre-existing mental health issues, resulting in marked impairments in activities of daily living, concentration, persistence and pace, and adaptation.

The Tribunal also found the applicant entitled to a post-104-week income replacement benefit, concluding she suffered a complete inability to engage in suitable employment due to her psychological impairments.

Claims for social rehabilitation counselling and a separate file review fee for a catastrophic assessment were dismissed as not reasonable and necessary.