Catherine Hilary Zingg

The applicant sought payment for a psychological treatment plan following a motor vehicle accident.

The insurer partially approved the plan, reducing the hourly rate to that of a social worker, reducing session lengths to one hour, and denying travel time and extra documentation fees.

The Tribunal found the appropriate hourly rate was $100 for a social worker in private practice, but restored the session length to 1.5 hours as the insurer provided no medical basis for the reduction.

The Tribunal denied travel time and extra documentation fees due to insufficient evidence.

The applicant was awarded the $600 balance with interest, but a claim for a special award was dismissed as the insurer's reliance on the Professional Fees Guideline was not unreasonable.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB) and a treatment plan for chiropractic services.

The Tribunal found the IRB claim was statute-barred under s. 56 of the Schedule, as the application was filed more than two years after the insurer's clear and unequivocal denial.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act, noting the lack of a bona fide intention to appeal, an unexplained five-month delay, and prejudice to the respondent.

The claim for chiropractic services was also dismissed, as the applicant failed to provide expert evidence to rebut the respondent's insurer's examination report, which concluded the treatment was not reasonable and necessary.

The applicant was involved in a motor vehicle accident and sought non-earner benefits and medical benefits for chiropractic treatment under the Statutory Accident Benefits Schedule.

The respondent denied the benefits.

The Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, as she was still able to engage in substantially all of her pre-accident activities, particularly caring for her children.

The Tribunal also found that the proposed treatment plans were not reasonable and necessary, as the applicant had reached maximal recovery from her accident-related injuries and the treatments appeared to be directed at a transient ischemic attack that was not caused by the accident.

The application was dismissed.

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

The respondent insurer denied the claims, relying on an insurer's examination that concluded the injuries fell within the Minor Injury Guideline.

The Tribunal found that the applicant had been removed from the Minor Injury Guideline due to psychological injuries and that the physical therapy provided pain relief.

The Tribunal concluded the treatment plans were reasonable and necessary, ordering the respondent to pay the claimed amounts with interest.

The respondent's request for costs was denied.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic and physiotherapy treatment plans, which the respondent insurer denied.

The adjudicator found that the medical evidence, including clinical notes and psychological assessments, demonstrated the applicant continued to experience accident-related pain and physical impairments.

The respondent's reliance on a three-year-old physiatry assessment and speculation about life events causing the pain were rejected.

The Tribunal concluded the treatment plans were reasonable and necessary to provide pain relief and improve functionality, granting the application in its entirety with interest.

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

The insurer determined her injuries fell within the Minor Injury Guideline (MIG) and denied several treatment and assessment plans.

The Tribunal found that the applicant's ongoing knee and back pain were likely due to pre-existing degenerative changes, and her psychological symptoms did not rise to a level that would remove her from the MIG.

As the applicant had already exhausted the $3,500 funding limit for minor injuries, she was not entitled to the disputed plans or interest.

The applicant insurer sought repayment of an overpayment of income replacement benefits (IRBs) in the amount of $8,650.60.

The respondent insured had returned to work but failed to notify the insurer, resulting in the overpayment.

The Tribunal found that the insurer complied with all procedural requirements under section 52 of the Statutory Accident Benefits Schedule and acted diligently upon discovering the return to work through a section 44 assessment report.

The Tribunal ordered the respondent to repay the overpayment amount plus applicable interest.

The applicant requested a reconsideration of a Tribunal decision that denied his claim for Income Replacement Benefits.

The applicant argued that the Tribunal failed to fully consider medical evidence and testimony, including reports from various doctors and Service Canada findings.

The Adjudicator dismissed the request, finding that the applicant was attempting to re-weigh the evidence rather than identifying an error of law or fact.

The Tribunal had properly considered all evidence in its original decision.

The applicant sought reconsideration of a decision finding he sustained a minor injury and was not entitled to non-earner benefits.

He argued the adjudicator erred in law by allowing the respondent to file insurer's examination reports and violated procedural fairness by failing to impartially assess his evidence.

The adjudicator dismissed the request, finding no error in law or breach of procedural fairness, as the applicant failed to properly identify the evidence he sought to exclude and failed to meet his burden of proof regarding his entitlement to benefits.

The respondent insurer sought reconsideration of a Tribunal decision awarding the applicant non-earner benefits, a treatment plan for concussion management, interest, and a special award under s. 10 of O. Reg. 664.

The Vice Chair granted the reconsideration in part.

The Tribunal's award of the concussion management treatment plan was set aside because the applicant had failed to submit an OCF-18 as required by s. 38(2) of the Schedule.

The s. 10 award was also set aside, as the Tribunal had misapplied the legal test for unreasonable delay and relied on a significant factual error regarding the amount of medical benefits previously paid by the insurer.

The Tribunal's decision on non-earner benefits was upheld, but the interest calculation was varied.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a psychological assessment, physical therapy, and psychological treatment.

The respondent insurer denied portions of the treatment plans.

The Tribunal found that the applicant failed to prove the disputed costs for the psychological assessment and treatment were reasonable and necessary, as the insurer's examiners had found the proposed costs excessive or partially unnecessary.

However, the Tribunal awarded the cost of the physical therapy based on the recommendation of the applicant's family doctor, which the insurer failed to rebut with medical evidence.

The applicant was injured in a motor vehicle accident and sought a medical benefit of $2,902.55 for physiotherapy, which the respondent insurer denied.

The applicant argued the accident aggravated pre-existing conditions, while the respondent contended the applicant's current complaints were caused by a subsequent cancer diagnosis and spinal surgery.

The Tribunal found that the applicant failed to prove on a balance of probabilities that the treatment plan was reasonable and necessary as a result of the accident, noting the medical evidence linked his severe back and leg pain to his cancer rather than the collision.

The application for benefits, interest, and an award was dismissed.

The applicant sought income replacement benefits (IRBs) beyond the 104-week post-accident mark, claiming a complete inability to engage in reasonably suited employment due to physical and psychological impairments from a motor vehicle accident.

The Licence Appeal Tribunal reviewed the medical evidence and the applicant's employment history, determining that reasonably suited employment included light-to-medium manual labour.

The Tribunal found that the applicant did not suffer a complete inability to engage in such employment, as objective medical assessments indicated he retained the physical, psychological, and cognitive capacity to perform light-to-medium work.

The application for IRBs and interest was dismissed.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, arguing his injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain, pre-existing injuries, and psychological issues.

The Licence Appeal Tribunal found that the applicant failed to meet the burden of proving his injuries fell outside the MIG.

The medical evidence did not support a finding of chronic pain under the AMA criteria, nor did it establish a significant psychological impairment or that a pre-existing condition prevented maximal recovery.

Consequently, the claims for a psychological assessment, interest, and a special award were dismissed.

The applicant sought an increased Income Replacement Benefit (IRB) following a motor vehicle accident, arguing the insurer failed to include income from self-employment and a short-term job.

The Tribunal found the applicant failed to report this income under the Income Tax Act, meaning it could not be used to calculate the IRB pursuant to s. 4(5) of the Schedule.

The Tribunal also found that while the insurer breached the 10-day response timeline under s. 36(4), it cured the breach by paying the full IRB owed for the period in dispute.

The application for increased IRB, interest, and an award was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including non-earner benefits, medical/rehabilitation treatments, and various assessments.

The insurer denied many of the benefits based on reports from its assessors.

The Licence Appeal Tribunal found that the applicant met the test for a complete inability to carry on a normal life and awarded non-earner benefits for the 104-week post-accident period.

The Tribunal also approved the disputed treatment plans and assessments, subject to the $2,000 statutory cap per assessment.

Furthermore, the Tribunal ordered the insurer to pay interest on overdue benefits and a special award of 33% under O. Reg. 664, finding that the insurer unreasonably delayed approving treatments that its own experts had recommended.

The applicant sought Non-Earner Benefits (NEBs) and Attendant Care Benefits (ACBs) following a motor vehicle accident.

The Tribunal dismissed the claim for NEBs, finding the applicant failed to prove a complete inability to carry on a normal life, noting surveillance evidence showing she could still drive, perform personal care, and shop.

The Tribunal also dismissed the claim for ACBs, finding the requested 90 hours per month was not reasonable or necessary given her demonstrated functionality, and the expenses were not incurred.

Claims for an award and interest were also dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including non-earner benefits and treatment beyond the Minor Injury Guideline (MIG) limit.

The respondent denied the claims, arguing the injuries were minor.

The Tribunal found that the applicant's physical and psychological injuries fell within the MIG, preferring the respondent's psychological assessment over the applicant's.

The Tribunal also dismissed the claim for non-earner benefits, finding insufficient evidence that the applicant suffered a complete inability to carry on a normal life, noting inconsistencies in the applicant's self-reporting and a lack of supporting medical evidence.

The applicant sought income replacement benefits following a motor vehicle accident, claiming physical and psychological impairments prevented him from working as a machine operator.

The Licence Appeal Tribunal reviewed medical evidence, including insurer examinations, which indicated the applicant's soft tissue injuries had resolved and his adjustment disorder did not cause a substantial inability to perform his light-duty work.

The Tribunal dismissed the application, finding the applicant did not suffer a substantial inability to perform the essential tasks of his employment during the disputed period.

The applicant sought reconsideration of a Tribunal decision dismissing his claims for statutory accident benefits, including an Income Replacement Benefit, a Work Site Assessment, and a Functional Abilities Evaluation.

The applicant argued the Tribunal violated natural justice by issuing the decision before receiving his written submissions, misused surveillance evidence, applied the wrong legal test, and misinterpreted medical evidence.

The adjudicator dismissed the request, finding no violation of procedural fairness as the applicant failed to submit written submissions in a timely manner, and concluding there were no significant errors of law or fact in the original decision.