Statutory Accident Benefits Schedule matters (SABS)

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

The insurer denied a treatment plan for chiropractic services on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The Tribunal found that the applicant failed to provide compelling medical evidence to warrant removal from the MIG, noting that imaging showing a shoulder tear was conducted 16 months post-accident and was not causally linked to the collision.

As the MIG limit was exhausted, the treatment plan and claim for interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming physical and psychological impairments that warranted removal from the Minor Injury Guideline (MIG) and entitlement to a non-earner benefit, a treatment plan, and an award for unreasonable delay.

The respondent denied the benefits, relying on section 44 assessments.

The Tribunal found that the applicant's physical injuries were predominantly minor sprains and strains, and that his knee pain and psychological issues were pre-existing and not aggravated by the accident.

The Tribunal concluded the applicant did not suffer a complete inability to carry on a normal life and remained subject to the MIG.

The application was dismissed in its entirety.

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 psychological impairments and chronic pain.

The Tribunal found that the applicant failed to meet the evidentiary burden to prove a psychological impairment or chronic pain condition that would warrant treatment outside the MIG limits.

The application for disputed treatment plans and assessments was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claim for attendant care benefits for basic supervisory care and medication assistance.

The applicant argued the Tribunal made an error of fact by not allotting time for these needs.

The adjudicator found that the applicant was attempting to relitigate her claim and had not established that the Tribunal made an error of fact.

The request for reconsideration was dismissed.

The applicant sought statutory accident benefits for optometric services, an eye assessment, and speech language pathology following a 2019 motor vehicle accident.

The respondent denied the treatment plans, arguing the applicant had not proven they were reasonable and necessary.

The Tribunal found that the applicant failed to provide sufficient medical evidence to support the ongoing need for the proposed treatments years after the accident, noting her high level of functioning and lack of recent complaints in clinical records.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline (MIG) and claiming entitlement to income replacement benefits (IRBs) and a chiropractic treatment plan.

The Tribunal found that the applicant failed to provide sufficient medical evidence to warrant removal from the MIG, noting the absence of corroborating evidence for diagnoses of sciatica and bursitis.

As the $3,500 MIG limit was exhausted, the treatment plan was denied.

The Tribunal also dismissed the claim for IRBs, finding the applicant failed to prove a substantial inability to perform the essential tasks of his pre-accident employment as a barber.

The Tribunal preferred the respondent's medical examination and relied on surveillance footage showing the applicant performing barbering tasks in his garage.

The application was dismissed.

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

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

The applicant applied to the Licence Appeal Tribunal, claiming chronic pain and psychological impairments warranted removal from the MIG.

The Tribunal found the medical evidence, including clinical notes from the applicant's family doctor and treatment providers, did not support a finding of chronic pain with functional impairment or a psychological impairment.

The Tribunal concluded the applicant's injuries were predominantly minor and subject to the $3,500 MIG limit, dismissing the claims for additional treatment plans and interest.

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

The respondent denied several treatment plans for physiotherapy and a psychological assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG because the respondent's denial notices were procedurally non-compliant under s. 38(8) of the Schedule.

The Tribunal found the denial notices were compliant, clearly identifying the missing medical evidence required.

As the applicant provided no substantive medical evidence to prove her injuries fell outside the MIG, and the $3,500 limit was exhausted, the application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including six chiropractic treatment plans, an attendant care needs assessment, and an orthopaedic assessment.

The respondent denied the benefits, relying on insurer's examinations which concluded the applicant's injuries were minor and had resolved, and that her ongoing complaints stemmed from pre-existing osteoarthritis.

The Tribunal found that the chiropractic treatment plans and attendant care needs assessment were not reasonable and necessary, preferring the respondent's physiatrist's reports over the applicant's orthopaedic surgeon's report.

However, the Tribunal granted the orthopaedic assessment, finding that the family doctor's clinical notes corroborated an aggravation of the applicant's pre-existing knee condition caused by the accident.

The Tribunal also found the respondent's denial notices compliant with the Schedule and declined to order a special award.

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

The Tribunal scheduled a written hearing, but neither party filed submissions.

The applicant indicated by email that a settlement had been reached and was awaiting court approval, but no Notice of Withdrawal was filed.

Proceeding under section 7(2) of the Statutory Powers Procedure Act, the Tribunal dismissed the application because the applicant failed to meet his evidentiary burden to demonstrate entitlement to the claimed benefits.

The applicant sought non-earner benefits and various medical and rehabilitation benefits following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that proper notice was provided.

The Tribunal found that the respondent's denial notices complied with the Schedule's requirements.

The applicant failed to prove entitlement to non-earner benefits or that his injuries warranted removal from the MIG.

As the MIG limits were exhausted, the treatment plans were denied.

The application was dismissed.

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

The respondent insurer raised a preliminary issue, arguing the applicant was barred from proceeding because she failed to notify the insurer within seven days of the accident, as required by section 32(1) of the Schedule.

The Tribunal found that the applicant's husband had reported the accident to the insurer's property damage line on the day it occurred.

Following recent Divisional Court binding authority, the Tribunal held that reporting the accident itself constitutes sufficient notice under section 32(1), triggering the insurer's obligation to inquire about injuries and provide benefit application forms.

The applicant was therefore not barred from proceeding.

The applicant sought statutory accident benefits after fracturing his foot while disembarking from a parked shuttle van onto uneven pavement.

The respondent insurer denied benefits, arguing the incident did not meet the definition of an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal applied the purpose and causation tests, finding that disembarking is an ordinary use of a vehicle and that the use of the vehicle was a direct cause of the injuries, despite the uneven surface being a contributing factor.

The Tribunal concluded the applicant was involved in an accident.

The respondent insurer requested a reconsideration of a Tribunal decision which found that the applicant was involved in an 'accident' after being struck by a wheel loader.

The respondent argued that the Tribunal breached procedural fairness and erred in law and fact by misapplying the 'ordinary parlance' test from Adams and improperly weighing evidence regarding a police accident report.

The Tribunal dismissed the request, finding that the respondent had the opportunity to make submissions on the Adams test at the hearing and was improperly attempting to re-litigate the case and reweigh evidence.

The request for reconsideration was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found he did not sustain a catastrophic impairment.

The applicant argued that the Tribunal breached procedural fairness and made errors of law by excluding his written submissions, relying on the respondent's section 44 assessment reports without the assessors testifying, and ignoring his expert evidence.

The Tribunal dismissed the reconsideration request, finding that case law is not new evidence under Rule 18.2(c), the exclusion of written submissions in a videoconference hearing was proper, the applicant had the opportunity to summons the section 44 assessors but failed to do so, and the Tribunal is not required to comment on every piece of evidence in its decision.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, which the respondent insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing for removal from the MIG due to a pre-existing condition, chronic pain, and a psychological impairment.

The Tribunal found that the applicant failed to provide sufficient evidence of a pre-existing condition preventing recovery, and preferred the insurer's medical examinations over the applicant's self-reports and expert evidence regarding chronic pain and psychological impairments.

Consequently, the Tribunal held that the applicant's injuries were predominantly minor, and dismissed the claims for four treatment plans and interest, as the plans exceeded the MIG limit and were not proven reasonable and necessary.

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

He failed to notify the insurer of his intention to claim benefits within the seven-day period prescribed by section 32(1) of the Schedule, instead notifying them approximately three months later.

The Tribunal found that the applicant's ignorance of the law and lack of experience with the claims process did not constitute a reasonable explanation for the delay, especially since he had retained counsel within a month of the accident.

The application was dismissed pursuant to section 55(1) of the Schedule.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident.

In a previous 2020 decision, the Tribunal found the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant brought a second application seeking removal from the MIG based on alleged new medical evidence and claiming entitlement to additional treatment plans.

The Tribunal held that the doctrine of res judicata barred the applicant from relitigating the MIG issue, as the new medical reports did not constitute fresh evidence that would conclusively impeach the original result.

The Tribunal also found the respondent provided proper notice of denial for the disputed treatment plans.

The application was dismissed.

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 warranted removal from the MIG and sought funding for a psychological assessment.

The Tribunal found no compelling evidence of an accident-related psychological impairment, noting the applicant only consulted his family doctor once by phone post-accident with no psychological complaints reported.

The Tribunal held the applicant remains within the MIG and dismissed the claims for the assessment, interest, and an award.

The respondent insurer raised a preliminary issue arguing that the applicant was barred from proceeding with her claim for statutory accident benefits due to res judicata and failure to attend section 44 insurer's examinations.

The Tribunal found that issue estoppel did not apply because the current application disputed different treatment plans than those addressed in a prior Tribunal decision.

Furthermore, the Tribunal held that the applicant was not non-compliant with section 44, as the insurer had never actually requested examinations for the specific treatment plans currently in dispute.

The applicant was permitted to proceed to a hearing on the substantive issues.