Brittanny K. Tinslay

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to three chiropractic treatment plans and arguing he should be removed from the Minor Injury Guideline (MIG) due to chronic knee pain.

The Tribunal found the applicant failed to prove his injuries fell outside the MIG, noting his medical records showed a pre-existing history of knee issues and did not link his current pain to the accident.

The Tribunal also rejected the applicant's argument that the insurer failed to provide valid medical reasons for denying the treatment plans under s. 38(8) of the Schedule.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought payment for three treatment plans (physiotherapy and chiropractic services) under the Statutory Accident Benefits Schedule.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the first two treatment plans were reasonable and necessary based on documented improvements in range of motion.

However, the third plan was denied as it was duplicative of a previously submitted plan.

The applicant was also awarded interest on overdue benefits.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, including an income replacement benefit (IRB) and a determination that her injuries fell outside the Minor Injury Guideline (MIG).

The Tribunal held it lacked jurisdiction to determine the MIG issue as a standalone dispute without a related claim for medical or rehabilitation benefits.

The Tribunal dismissed the claim for an IRB, finding the applicant failed to prove she suffered a substantial inability to perform the essential tasks of her employment within 104 weeks of the accident, noting she had stopped working for unrelated reasons prior to the accident and did not seek medical treatment for accident-related injuries until over four years later.

Claims for an award and interest were also dismissed.

The applicant, who was a minor at the time of the motor vehicle accident, sought accident benefits which were denied by the insurer.

The insurer raised a preliminary issue that the application was statute-barred under the two-year limitation period in section 56 of the Statutory Accident Benefits Schedule.

The Tribunal held that the term 'court' in section 2 of the Limitations Act, 2002 includes the Licence Appeal Tribunal, meaning the limitation period was suspended under section 6 of the Limitations Act while the applicant was a minor without a litigation guardian.

As the applicant was not represented by a litigation guardian for the accident benefits claim, the application was not statute-barred.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that her injuries fell within the Minor Injury Guideline (MIG) and seeking a non-earner benefit and various medical benefits.

The matter proceeded to a written hearing.

The applicant failed to file any written submissions or evidence.

Consequently, the Tribunal found that the applicant failed to meet her onus to demonstrate entitlement to the claimed benefits or removal from the MIG.

The application was dismissed.

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 sought $4,223.90 for a chiropractic treatment plan following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the proposed treatment was not reasonable and necessary.

The Tribunal accepted the respondent's medical assessment evidence, which indicated that the applicant had achieved maximum medical recovery and had normal ranges of motion, consistent with the clinical notes of the applicant's treating family physician.

Claims for interest and a special award were consequently dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to various treatment and assessment plans, including neuropsychological and neurological assessments, chiropractic services, massage therapy, acupuncture, and a functional ability assessment.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove on a balance of probabilities that the disputed plans were reasonable and necessary.

The Tribunal noted a lack of contemporaneous evidence from the applicant's treating family physician supporting the need for the requested interventions, and preferred the evidence of the respondent's section 44 assessor who found no objective evidence of residual musculoskeletal impairment.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision denying entitlement to disputed treatment plans for long-term care home expenses.

The applicant argued the Tribunal erred in characterizing the expenses as attendant care rather than rent, and failed to consider the consumer protection nature of the Schedule.

The adjudicator dismissed the request, finding no error of fact or law in the original decision, which correctly applied the legislation.

The adjudicator also declined to consider new arguments regarding rehabilitation benefits that were not raised at the original hearing.

The applicant was injured in a motor vehicle accident and sought $2,103.34 for a physiotherapy treatment plan under the Statutory Accident Benefits Schedule.

The respondent denied the claim.

The Licence Appeal Tribunal found that the applicant failed to meet her burden of proving the treatment was reasonable and necessary, noting that previous treatments had not achieved their goals and the applicant had reached maximum medical improvement.

The application was dismissed, and no interest was awarded.

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 a pre-existing condition and chronic pain.

The Tribunal found that the applicant's injuries, including degenerative changes, were predominantly minor.

The Tribunal also found insufficient evidence of chronic pain syndrome or functional impairment to warrant removal from the MIG under the AMA Guides criteria.

Consequently, the disputed treatment plans for physiotherapy and an orthopaedic assessment were deemed not reasonable and necessary, and the claims for benefits and interest were dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a chronic pain assessment in the amount of $2,460.00.

The respondent insurer denied the treatment plan based on an insurer's examination report which concluded the applicant suffered only minor soft tissue injuries.

The Licence Appeal Tribunal found the insurer's medical report failed to adequately consider the clinical notes and records of the applicant's family physicians, which included a chronic pain diagnosis.

Relying on the applicant's psychological assessments and the AMA Guides criteria for chronic pain, the Tribunal concluded the chronic pain assessment was reasonable and necessary.

The Tribunal ordered the respondent to pay for the assessment and interest on the overdue payment, but dismissed the applicant's claim for a special award under section 10 of O. Reg. 664, finding the insurer's conduct did not meet the threshold of being excessive or imprudent.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit.

A three-day videoconference hearing was scheduled, but the applicant failed to attend despite receiving notice.

The Tribunal proceeded in the applicant's absence pursuant to s. 7(3) of the Statutory Powers Procedure Act.

As the applicant tendered no evidence and made no submissions, he failed to meet his onus of proof.

The application was dismissed.

The applicant sought statutory accident benefits after sustaining injuries during an altercation that began when he was sitting in his running rental vehicle.

The respondent denied the claim on the basis that the incident was an assault, not an 'accident' under the Statutory Accident Benefits Schedule.

The Tribunal found that the dominant feature of the incident was an unprovoked assault, which constituted an intervening act that broke the chain of causation.

The application was dismissed as the incident did not meet the definition of an accident.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy, psychological treatment, clinical notes, and a chronic pain assessment.

The respondent insurer denied the treatment plans.

The Licence Appeal Tribunal found that the insurer's initial denials for the physiotherapy and psychological treatment plans were non-compliant with section 38 of the Schedule, but subsequent denials cured the defects.

On the merits, the Tribunal held that the psychological treatment and chronic pain assessment were reasonable and necessary, relying on the applicant's ongoing symptoms and the reports of his treating practitioners.

The claims for physiotherapy and clinical notes were dismissed.

Interest was awarded on the overdue payments for the approved plans.

The applicant sought statutory accident benefits for aquatic therapy, physiotherapy, and a chronic pain assessment following a motor vehicle accident.

The respondent denied the treatment plans, arguing they were not reasonable and necessary, and that the claims for physiotherapy and chronic pain treatment were barred by res judicata due to a previous Tribunal decision.

The Tribunal agreed that res judicata applied to the physiotherapy and chronic pain claims, as they had been previously adjudicated on the merits with no new objective evidence of deterioration.

The Tribunal also found the aquatic therapy plan unreasonable given the availability of a much cheaper aquafit program.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought payment for a chronic pain assessment and a neurological assessment under the Statutory Accident Benefits Schedule.

The insurer denied the treatment plans.

The Licence Appeal Tribunal found that the applicant failed to establish that either assessment was reasonable and necessary.

The applicant did not meet the AMA Guides criteria for chronic pain and lacked objective medical evidence supporting the need for a neurological assessment.

The application was dismissed.

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

The insurer denied the claim for non-earner benefits and income replacement benefits in a clear and unequivocal explanation of benefits.

The applicant filed an application with the Licence Appeal Tribunal regarding income replacement benefits only, but later sought to change the issue to non-earner benefits after the two-year limitation period had expired.

The Tribunal found the application for non-earner benefits was statute-barred under s. 56 of the Statutory Accident Benefits Schedule.

The Tribunal declined to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act, finding no bona fide intention to appeal within the time limit, excessive delay, prejudice to the insurer, and lack of merit to the claim.

The application was dismissed.

The applicant sought medical benefits for injuries sustained in a motor vehicle accident.

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

The applicant contended that chronic pain and psychological impairments removed her from the MIG.

The Tribunal found insufficient evidence of chronic pain or pre-existing conditions, noting a prolonged absence of treatment.

The Tribunal also found the psychological assessment unpersuasive due to reliance on self-reporting and inconsistencies.

The application was dismissed, and the injuries were deemed subject to the MIG limit.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to three treatment plans for chiropractic services and a chronic pain assessment.

The respondent denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline and that he had recovered through a home-based exercise program.

The Licence Appeal Tribunal dismissed the application, finding that the chiropractic treatments were not reasonable and necessary as they provided minimal improvement compared to the home exercise program.

The Tribunal also denied the chronic pain assessment, preferring the respondent's expert evidence that the applicant lacked objective markers of chronic pain syndrome over the applicant's expert, whose opinion relied on subjective reports contradicted by contemporaneous medical records.