9 total
Application for accident benefits dismissed; applicant failed to prove injuries warranted removal from Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that his injuries fell within the Minor Injury Guideline (MIG).
The applicant argued for removal from the MIG based on diagnoses including radiculopathy and chronic headaches, relying on letters from his chiropractor.
The Tribunal found that the applicant failed to provide compelling medical evidence of functional impairment that would warrant removal from the MIG.
Preferring the respondent's physiatry assessments, which concluded the injuries were minor sprains and strains, the Tribunal held the applicant remained subject to the $3,500 MIG limit.
Consequently, the disputed treatment plan for chiropractic services and the claim for interest were dismissed.
Application for accident benefits dismissed as res judicata; new medical evidence insufficient to waive doctrine.
The applicant sought statutory accident benefits following a 2016 motor vehicle accident.
In a prior Tribunal decision, it was determined that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant filed a second application seeking to remove herself from the MIG based on new medical reports.
The Tribunal dismissed the application, finding that the issue was barred by res judicata.
The Tribunal held that the new medical evidence did not conclusively impeach the original results, as the experts relied heavily on self-reporting and one expert lacked the appropriate orthopaedic qualifications.
The respondent's request for costs was denied.
Accident benefits denied; would-be rescuer who attended scene after collision was not involved in an accident.
The applicant sought statutory accident benefits for psychological impairments sustained after rushing to the scene of a fatal motor vehicle accident to assist a pedestrian who had been struck.
The respondent denied the claim on the basis that the applicant was not an 'insured' who was 'involved' in an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.
The Licence Appeal Tribunal dismissed the application, finding that the applicant was not involved in the accident, as he was sitting on a nearby patio when the collision occurred and only attended the scene after the use or operation of the vehicle had ceased.
The Tribunal rejected the applicant's argument that tort principles regarding rescuers should expand the definition of an accident under the Schedule.
Applicant's injuries found to be within the Minor Injury Guideline; claims for additional benefits dismissed.
The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits.
The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant argued that she suffered from chronic pain and had pre-existing conditions that warranted removal from the MIG.
The Tribunal found that the applicant failed to provide compelling medical evidence or a diagnosis of chronic pain from a qualified expert.
Furthermore, the applicant did not provide compelling evidence that her pre-existing conditions would prevent maximal recovery within the MIG limits.
The Tribunal concluded the applicant's injuries were predominantly minor and subject to the MIG.
As the MIG limits were exhausted, the claims for additional benefits and interest were dismissed.
Applicant's injuries fall within the Minor Injury Guideline; claims for further benefits dismissed.
The applicant argued she should be removed from the MIG due to chronic pain and pre-existing conditions.
The Tribunal found that the applicant failed to provide compelling medical evidence of a chronic pain diagnosis or that her pre-existing conditions would prevent maximal recovery within the MIG limits.
As the MIG limits were exhausted, the claims for further benefits and interest were dismissed.
Motion to substitute named defendants for 'John Doe' granted despite limitation period expiry and plaintiff delay.
The plaintiffs were involved in a motor vehicle accident and commenced an action against their own insurer and 'John Doe' as the unidentified driver.
Almost two and a half years later, the plaintiffs brought a motion to substitute the proposed defendants for 'John Doe' on the basis of misnomer.
The proposed defendants argued they would suffer prejudice due to the plaintiffs' delay and lack of due diligence.
Applying the Court of Appeal's jurisprudence on misnomer, the Master granted the motion, finding that the proposed defendants' insurer was aware of the accident from the outset.
However, due to the plaintiffs' significant delay, they were denied interest on any ultimate recovery from the date of the accident until June 30, 2018.
Applicant precluded from arbitrating medical benefit dispute due to unexcused failure to attend insurer examination.
The Applicant sought arbitration for a disputed medical benefit of $820.00 following a motor vehicle accident.
The Insurer raised a preliminary issue, arguing the Applicant was precluded from proceeding because he failed to attend a scheduled section 44 insurer examination.
The Arbitrator found that the Insurer had the right to choose the assessor and that the notice provided was compliant with the Schedule.
Because the Applicant failed to attend the examination without reasonable cause, he was barred from commencing mediation under section 55 of the Schedule, and consequently precluded from arbitrating the issue under section 280(2) of the Insurance Act.
Insurer's claim of staged accident rejected; applicants found credible and not liable for repayment.
The applicants sought statutory accident benefits following a motor vehicle collision.
The insurer denied further claims and sought repayment of benefits already paid, alleging that the collision was staged and the applicants wilfully misrepresented material facts.
At a preliminary issue hearing, the arbitrator found the applicants to be credible and concluded that any inconsistencies in their evidence were due to the ordinary fragility of memory rather than a conspiracy.
The arbitrator held that the applicants did not wilfully misrepresent material facts and dismissed the insurer's claims for repayment.
Arbitrator denies request for 100 chiropractic sessions, finding it unreasonable to bypass insurer's ongoing review.
The applicant was injured in motor vehicle accidents and sought payment for 100 sessions of chiropractic and massage therapy under the Statutory Accident Benefits Schedule.
The insurer denied the treatment plans, arguing it was unreasonable to approve such extensive treatment without the ability to monitor progress.
The arbitrator found that the applicant had reached maximum medical recovery and that his ongoing need for treatment was equivalent to his pre-accident usage.
The arbitrator concluded that the requested treatment was not reasonable and necessary, as it bypassed the regulatory scheme allowing insurers to review ongoing care.