Duha Sikander

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent denied benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG due to an accident-related psychological injury.

The Tribunal found the applicant failed to establish a psychological injury warranting removal from the MIG, placing little weight on her psychological reports due to lack of objective testing and inconsistencies.

The application for benefits and interest was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing she should be removed from the Minor Injury Guideline (MIG) due to a psychological impairment.

The Tribunal found the applicant's psychological assessment unpersuasive, noting ambiguities about the supervising psychological associate's involvement and unexplained contradictions regarding the applicant's pre-existing mental health history.

As the applicant failed to prove on a balance of probabilities that she sustained a psychological condition warranting removal from the MIG, her claim for a psychological assessment and interest was dismissed.

The applicant requested reconsideration of a Licence Appeal Tribunal decision that denied payment for a chiropractic treatment plan.

The Tribunal originally found the insurer complied with the 10-day notice requirement under s. 38(8) of the Schedule by uploading its denial to the Health Claims for Auto Insurance (HCAI) platform.

On reconsideration, the Vice-Chair found this was an error of law, as uploading a denial to a system inaccessible to the insured person does not constitute 'giving' notice.

The decision was varied to find the treatment plan payable for any services incurred between the 11th business day and the date the applicant actually received the denial.

The defendant insurer, Pembridge, moved to compel the production of transcribed statements given by a co-defendant and a non-party to their insurer following a fatal motor vehicle collision.

Pembridge argued that the co-defendant's poor memory at discovery overcame litigation privilege.

The court dismissed the motion, finding that Pembridge failed to establish that there was no reasonable alternative form of evidence, as it had not questioned the co-defendant at discovery or attempted to examine the non-party.

The court also noted that summaries of the statements had already been provided.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent 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 chronic pain syndrome.

The adjudicator found that the applicant failed to establish chronic pain with functional impairment, preferring the respondent's s. 44 assessment over the applicant's s. 25 assessment, which relied heavily on uncorroborated self-reporting.

Consequently, the applicant remained in the MIG, and most disputed treatment plans were not payable.

However, a psychological assessment plan was deemed payable under s. 38(11) of the Schedule because the respondent's explanation of benefits failed to provide proper medical or other reasons for denial.