Brittanny 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 requested a reconsideration of a Licence Appeal Tribunal decision that found it lacked jurisdiction to consider her removal from the Minor Injury Guideline (MIG) as a standalone issue and denied her claims for an income replacement benefit, an award, and interest.

The applicant, who was self-represented, raised several grounds for reconsideration, including alleged jurisdictional errors, procedural unfairness, and disagreements with the Tribunal's assessment of the medical evidence.

The Vice-Chair dismissed the request, finding that the applicant was attempting to re-litigate the original decision and failed to establish any errors of law or fact, or a material breach of procedural fairness under Rule 18.2.

The applicant's requests for costs against the respondent and the Tribunal were also denied.

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 non-earner benefits following a motor vehicle accident.

The applicant did not provide medical evidence of entitlement but argued the respondent failed to provide a proper denial notice under section 36 of the Schedule.

The Tribunal found that the respondent provided sufficient denial notices, explaining that there was no medical documentation supporting a complete inability to carry on a normal life and requesting a section 44 assessment.

The claim for non-earner benefits, interest, and an award was dismissed.

The applicant sought accident benefits for a psychological assessment and psychological services following a motor vehicle accident.

The respondent denied the treatment plans and raised a preliminary issue regarding the two-year limitation period.

The Tribunal found the application was commenced within the limitation period, factoring in mailing delivery standards.

On the substantive issues, the Tribunal dismissed the claims, finding the applicant failed to demonstrate the treatment plans were reasonable and necessary.

The Tribunal noted a lack of contemporaneous evidence of psychological complaints and found the applicant's pre-accident medical history contradicted her reports to the assessors.

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 payment of $2,260.00 for a file review summary proposed in a treatment plan following a motor vehicle accident.

The respondent denied the expense on the basis that it was duplicative, as a file review is included in the cost of each approved assessment.

The Tribunal agreed, finding that a file review is a necessary component of an assessment and not an independently billable task under s. 25(5) of the Schedule.

The Tribunal also found the respondent's denial letter complied with s. 38(8) by providing a clear non-medical reason for the denial.

The application was 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, who was catastrophically impaired in a motor vehicle accident, sought medical benefits to cover the monthly fees of her long-term care facility, in addition to the maximum attendant care benefits she was already receiving.

The Licence Appeal Tribunal found that the facility fees were for services consistent with attendant care, not medical or hospital expenses under section 15 of the Statutory Accident Benefits Schedule.

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 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 requested a reconsideration of a Licence Appeal Tribunal decision that included income/losses from one of his properties in the calculation of his Income Replacement Benefits.

The applicant argued the adjudicator erred in law by classifying the property as employment income rather than investment income and by focusing on his level of activity.

The adjudicator dismissed the request, finding that the applicant was attempting to relitigate the original hearing and had failed to identify a significant error of fact or law.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits from the respondent insurer.

The applicant was removed from the Minor Injury Guideline for psychological reasons.

The Tribunal found that only one chiropractic treatment plan, proposed shortly after the applicant began treatment, was reasonable and necessary.

The remaining treatment plans for chiropractic care, psychological services, a functional cognitive assessment, and a chronic pain assessment were denied due to a lack of compelling medical evidence and the applicant's failure to meet the evidentiary burden.

The applicant was awarded the cost of the approved treatment plan plus interest.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident, claiming catastrophic impairment due to mental/behavioural disorders and physical impairments.

The Licence Appeal Tribunal found the applicant was not catastrophically impaired, as her psychological symptoms and knee osteoarthritis were pre-existing and not caused by the accident.

Claims for a non-earner benefit and various assessments were dismissed.

However, the Tribunal granted a treatment plan for chiropractic services, finding the applicant sustained permanent back injuries in the accident.

A claim for an award under Regulation 664 was dismissed, but interest was awarded on the overdue chiropractic benefits.