28 total
Application for accident benefits dismissed; injuries fell within Minor Injury Guideline and denial notices were compliant.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant argued for removal from the MIG due to a concussion, psychological impairment, and chronic pain.
The Tribunal found insufficient medical evidence to support these diagnoses, concluding the applicant's injuries were predominantly minor.
The Tribunal also found the respondent's denial notices complied with section 38(8) of the Schedule.
As the applicant was subject to the MIG and the limit was exhausted, the treatment plans were not payable.
Claims for interest and a section 10 award were dismissed.
Application for non-earner benefits dismissed as applicant failed to prove complete inability to carry on normal life.
The applicant sought a non-earner benefit (NEB) following a motor vehicle accident.
The Tribunal found that the applicant failed to establish a complete inability to carry on a normal life, noting he returned to work shortly after the accident.
The applicant also argued the respondent failed to comply with the notice provisions under sections 35 and 36 of the Schedule.
The Tribunal held that the respondent's denial of the NEB on the basis that the applicant qualified for an income replacement benefit was valid and compliant with section 36(4).
The application was dismissed, and claims for interest and an award were denied.
Applicant not statute-barred from proceeding to hearing after providing reasonable explanation for missing insurer's examination.
The applicant sought statutory accident benefits following a motor vehicle accident and was denied by the respondent.
The respondent raised a preliminary issue, arguing the applicant was statute-barred from proceeding to a hearing for failing to attend a scheduled insurer's examination.
The Tribunal found that the applicant had provided a reasonable explanation for her non-attendance, having notified the respondent of a scheduling conflict prior to the examination and requested a rescheduled date, to which the respondent did not reply.
The applicant was permitted to proceed to a substantive hearing.
The applicant's request for costs was denied due to a lack of supporting submissions or evidence.
Application for accident benefits dismissed; injuries remain within the Minor Injury Guideline.
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 psychological condition and chronic pain.
The Tribunal found that the medical evidence, including the clinical notes and records of the family doctor, did not support a psychological impairment or chronic pain with functional impairment.
The Tribunal concluded the applicant's injuries remained within the MIG, dismissing the claims for treatment plans, interest, and an award.
Insurer ordered to pay 25 per cent award for unreasonable 686-day delay in reinstating income replacement benefits.
The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRB).
The respondent insurer suspended the IRB based on section 44 assessments but reinstated the benefits just five days before the hearing, after a 686-day delay.
The sole issue at the hearing was whether the respondent was liable for an award under section 10 of Regulation 664 for unreasonably withholding or delaying payments.
The Tribunal found that the respondent failed to adjust the file as new information became available, specifically section 25 rebuttal reports, and that its conduct was inflexible.
The Tribunal ordered the respondent to pay a 25 per cent award on the total IRB payable during the delay period.
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline limits.
The respondent insurer denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant argued for removal from the MIG due to paresthesia, chronic pain, and psychological impairments.
The adjudicator found insufficient medical evidence linking the paresthesia or imaging results to the accident.
Furthermore, the adjudicator concluded the applicant failed to establish chronic pain with functional impairment or a psychological impairment, noting inconsistencies between the applicant's self-reporting to different medical practitioners.
The application was dismissed, and the applicant was held to the MIG limits.
Application for psychological treatment plans dismissed as applicant failed to prove accident-related psychological impairment.
The applicant sought payment for three psychological treatment plans, a special award, and interest following a motor vehicle accident.
The respondent denied the benefits.
The Tribunal found that the applicant failed to prove the psychological issues were caused by the accident, noting that the treating psychologist's reports focused on family issues and lack of employment.
Relying on the respondent's section 44 assessment, which found insufficient objective evidence of an accident-related psychological impairment, the Tribunal concluded the treatment plans were not reasonable and necessary.
The application was dismissed in its entirety.
Applicant remains in MIG, but defective denial notice renders physiotherapy treatment plan payable.
The respondent denied treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from a psychological condition, chronic pain with functional impairment, or a pre-existing condition that would warrant removal from the MIG.
However, the Tribunal found that the respondent's denial of a $4,675.12 physiotherapy treatment plan did not comply with the notice requirements under s. 38(8) of the Schedule, rendering it payable despite the MIG limits being exhausted.
The denial of a psychological assessment was found to be compliant and was dismissed.
The applicant's claim for a special award under s. 10 of Reg. 664 was denied.
Reconsideration request dismissed; no errors of law, fact, or procedural fairness found in original decision.
The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found his injuries fell within the Minor Injury Guideline and denied his claims for income replacement benefits and treatment plans.
The applicant argued the Tribunal breached procedural fairness, made errors of law and fact, and failed to properly consider evidence.
The adjudicator dismissed the request, finding no breach of procedural fairness, no errors of law or fact, and no new evidence that would justify a reconsideration.
Application for statutory accident benefits dismissed as treatment plans were not proven reasonable and necessary.
The applicant was involved in a motor vehicle accident and sought statutory accident benefits, which were denied by the respondent insurer.
The applicant applied to the Licence Appeal Tribunal for entitlement to various treatment plans, an attendant care assessment, and the cost of an accounting report for an income replacement benefit calculation.
The Tribunal found that the applicant failed to prove on a balance of probabilities that the treatment plans and assessments were reasonable and necessary, noting a lack of supporting medical evidence and reliance on an insurer's examination that concluded the applicant had reached maximum medical recovery.
The Tribunal also denied the cost of the accounting report because the applicant had not submitted the required disability certificate to establish entitlement to income replacement benefits.
The application was dismissed.
Tribunal awards limited benefits due to insurer's non-compliant denial notices despite injuries falling within MIG.
The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that the dispute for certain treatment plans was time-barred.
The Tribunal found the limitation period was not triggered because the respondent's denial notices were procedurally non-compliant.
While the applicant failed to prove her injuries warranted removal from the MIG, the Tribunal awarded two physiotherapy treatment plans and a limited period of non-earner benefits solely due to the respondent's failure to provide compliant notices under the Schedule.
Claims for an award and remaining benefits were dismissed.
Application for accident benefits dismissed; injuries fell within the Minor Injury Guideline and IRB denied.
The respondent denied various benefits, asserting the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found the applicant failed to prove his physical or psychological injuries warranted removal from the MIG.
The Tribunal also dismissed the claim for income replacement benefits, finding the applicant did not suffer a substantial inability to perform the essential tasks of his self-employment in construction.
As the MIG limit was exhausted, the disputed chiropractic treatment plans were denied.
Claims for interest and an award for unreasonable delay were also dismissed.
Plaintiff's counsel ordered to personally pay mistrial costs for undisclosed conflict of interest.
The defendants sought costs personally against the plaintiff's counsel following a mistrial.
The mistrial was declared due to the plaintiff's counsel's failure to disclose a conflict of interest involving her husband's medical assessment company, which retained the plaintiff's expert witnesses and significantly marked up their invoices.
The court found that the counsel's conduct frustrated and interfered with the administration of justice, noting her lack of candour and failure to adhere to representations previously made to the Law Society.
The court ordered the plaintiff's counsel to personally pay the costs of the mistrial.
Insurer ordered to fund treatment plans despite MIG limit due to defective denial notices.
The Tribunal found that the applicant failed to establish her injuries fell outside the MIG.
However, the Tribunal held that the respondent's denial notices for most of the treatment plans were defective under s. 38(8) of the Schedule because they failed to provide sufficient medical reasons.
As a result, the defective notices did not trigger the two-year limitation period, and the respondent was required to fund the disputed treatment plans once incurred, pursuant to s. 38(11).
Claims for an award and interest were dismissed.
Application for accident benefits dismissed; applicant failed to prove injuries warranted removal from the Minor Injury Guideline.
The applicant sought removal from the Minor Injury Guideline (MIG) and payment for a psychological assessment and a functional abilities evaluation following a motor vehicle accident.
The applicant argued that psychological impairments and chronic pain warranted removal from the MIG.
The Tribunal found that the applicant failed to provide sufficient evidence of a psychological impairment or chronic pain syndrome, preferring the respondent's section 44 insurer examination reports which concluded the applicant suffered only minor sprains and strains.
The application was dismissed, and the applicant was held to the $3,500 MIG limit.
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline limit.
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 Licence Appeal Tribunal found that the applicant failed to provide objective medical evidence to prove his injuries warranted removal from the MIG.
Relying on the insurer's physiatry assessment, the Tribunal concluded the applicant sustained soft tissue injuries that were predominantly minor.
As the applicant remained within the MIG and had exhausted the $3,500 limit, his claims for additional treatment plans, interest, and an award were dismissed.
Application for removal from Minor Injury Guideline and income replacement benefits dismissed.
The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain, psychological impairments, and TMJ disorders.
He also claimed income replacement benefits (IRB) and various treatment plans.
The Licence Appeal Tribunal found the applicant failed to prove his injuries fell outside the MIG, noting a lack of supporting medical evidence for chronic pain or psychological impairment.
The Tribunal also dismissed the IRB claim, finding the applicant's unemployment was due to the end of a seasonal contract rather than accident-related impairments.
Mistrial declared due to plaintiff counsel's undisclosed conflict of interest involving an expert assessment company.
In a personal injury trial arising from a motor vehicle accident, the plaintiff sought leave to adduce a late-served loss of income expert report.
The court denied leave under Rule 53.08, finding no reasonable explanation for the delay and prejudice to the defendants.
During the trial, a voir dire revealed that the plaintiff's law firm had retained medical experts through an assessment company owned by the spouse of the firm's principal lawyer.
The assessment company had also significantly marked up the expert's invoice.
Finding an egregious and undisclosed conflict of interest that breached the duty of loyalty, the court declared a mistrial.
Application for accident benefits dismissed after self-represented applicant failed to file submissions or evidence.
The matter proceeded to a written hearing, but the self-represented applicant failed to file any submissions or evidence despite being granted an extension of time.
The Tribunal found that it had met its reasonable notice obligations under the Statutory Powers Procedure Act and proceeded in the applicant's absence.
The application was dismissed as the applicant failed to meet his evidentiary burden to prove entitlement to the claimed benefits or removal from the Minor Injury Guideline.
Application for accident benefits beyond the Minor Injury Guideline dismissed due to insufficient medical evidence.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming physical and psychological injuries that warranted removal from the Minor Injury Guideline (MIG).
The respondent denied the benefits, arguing the injuries fell within the MIG.
The Tribunal found that the applicant failed to meet her evidentiary burden to prove her injuries warranted removal from the MIG.
The Tribunal preferred the respondent's medical evidence, which included in-person assessments, over the applicant's virtual assessments and uncorroborated claims.
The application was dismissed, and the disputed treatment plans, interest, and award were denied.
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