Argita Shehaj

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to a physiotherapy treatment plan for a vertigo assessment and a chronic pain assessment.

The respondent insurer denied the benefits.

The Tribunal found that the applicant failed to prove on a balance of probabilities that the proposed treatment plans were reasonable and necessary.

The evidence indicated that the applicant's vertigo symptoms were resolved or managed with medication, and the chronic pain diagnosis was not corroborated by the clinical notes and records of her treating physicians.

The Tribunal also dismissed the claims for an award for unreasonable delay and interest, finding the insurer's conduct was reasonable.

The applicant appealed a Licence Appeal Tribunal decision finding she was not catastrophically impaired following a motor vehicle accident.

At the hearing, the Tribunal admitted the respondent insurer's expert psychiatric reports but refused to issue a summons to compel the expert's attendance for cross-examination due to non-compliance with procedural rules.

The Divisional Court allowed the appeal, holding that the Tribunal's strict application of its rules and refusal to facilitate the cross-examination of a key expert witness on a critical issue breached the applicant's right to procedural fairness.

The matter was remitted to the Tribunal for a new hearing.

Both the applicant and the respondent requested reconsideration of a Licence Appeal Tribunal decision regarding statutory accident benefits.

The respondent argued the adjudicator erred in law by not including language about post-accident income deductions in the income replacement benefit order.

The applicant argued the adjudicator breached procedural fairness and erred in law by admitting a medical report without the author being available for cross-examination, refusing to issue summonses, and failing to provide adequate reasons regarding catastrophic impairment.

The Tribunal dismissed both requests, finding no errors of law, fact, or breaches of procedural fairness that would have changed the outcome.

The respondent's request for costs was also dismissed.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident.

The central issue was whether the applicant, a personal support worker who had recently registered a business at the behest of a staffing agency, was 'employed' or 'self-employed' under the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant suffered a substantial inability to perform the essential tasks of her employment for a closed period.

However, applying the Schedule's definitions, the Tribunal determined she was solely self-employed at the time of the accident.

Because her business reported no income in the prior fiscal year, and she could not rely on her previous employment income, the quantum of her IRBs was calculated as nil.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a catastrophic impairment due to psychological issues.

The Tribunal found the applicant was not catastrophically impaired, preferring the respondent's psychiatric expert who concluded her limitations were primarily physical rather than psychological.

The Tribunal granted the applicant's claim for an income replacement benefit for the period up to 104 weeks post-accident, finding she suffered a substantial inability to perform the essential tasks of her pre-accident employment on an assembly line.

Claims for attendant care, housekeeping, and physiotherapy were dismissed as the applicant's non-catastrophic funding limits were exhausted.

The Tribunal also denied the applicant's request for an award, finding the insurer's conduct was not unreasonable.