Eluxmeenah Rishihesan

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

The respondent denied certain treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered a concussion, removing her from the MIG, and approved a treatment plan for physiotherapy services.

However, a claim for an outstanding balance on chiropractic services was denied due to insufficient evidence.

The Tribunal also dismissed the applicant's claim for an award for unreasonable delay, finding the respondent reasonably relied on its medical assessor's reports, but granted interest on overdue benefits.

An adverse inference was drawn against the respondent for failing to provide reasons for redactions in adjuster log notes as previously ordered.

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 she should be removed from the MIG due to pre-existing right knee and psychological conditions, as well as accident-related psychological impairments.

The Tribunal found the applicant failed to prove her pre-existing conditions precluded recovery within the MIG or that she suffered an accident-related psychological impairment, noting a lack of corroborating clinical notes from her family doctor.

The application was dismissed.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's chronic pain and left elbow arthrofibrosis warranted removal from the MIG.

However, the Tribunal denied the applicant's claim for a $7,520.00 elbow flexion and extension unit because the applicant failed to submit the required OCF-18 treatment plan.

Claims for interest and an award for unreasonable delay were also 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 on the basis of chronic pain.

The Tribunal found the applicant failed to provide sufficient medical evidence demonstrating functional impairment or disability to support a chronic pain diagnosis.

Consequently, the applicant's injuries were deemed predominantly minor, and the claims for a $1,908.72 chiropractic treatment plan, an award, and interest were dismissed.

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

The respondent denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant suffered an accident-related psychological impairment, warranting removal from the MIG.

The Tribunal approved a $2,200 psychological assessment as reasonable and necessary.

However, claims for a $6,447.13 psychological counselling plan and a $3,770.16 physiotherapy plan were dismissed due to insufficient evidence of how treatment goals would be met and a documented lack of therapeutic effectiveness, respectively.

Interest was awarded on the approved assessment plan.

The applicant requested a reconsideration of a previous Tribunal decision that held him to the Minor Injury Guideline (MIG) and denied his treatment plans.

The Vice-Chair found that the original decision contained a factual error regarding the interpretation of a CT scan report, which did not rule out a concussion as previously concluded.

Upon re-hearing the matter, the Vice-Chair determined that the applicant's consistent neurological symptoms supported a concussion diagnosis, removing him from the MIG.

The applicant was awarded funding for physiotherapy, massage, and occupational therapy (excluding travel time), plus interest.

The claim for a special award was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her injuries, including a shoulder impingement and chronic pain, warranted removal from the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor and subject to the $3,500 MIG limit, as she failed to provide sufficient medical evidence of functional impairment or chronic pain.

Consequently, her claims for two physiotherapy treatment plans, interest, and an award for unreasonable delay were dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found his accident-related impairments fell within the Minor Injury Guideline (MIG).

The applicant argued the Tribunal erred in its assessment of his pre-existing conditions, psychological impairments, and chronic pain.

The Vice-Chair dismissed the request, finding that the applicant was attempting to re-litigate the original decision and re-weigh the evidence, which is not permitted on reconsideration.

The Tribunal found no material error of law or fact that would have changed the outcome.

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

The respondent denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered from chronic pain with functional impairment, warranting removal from the MIG.

The Tribunal also approved a treatment plan for an occupational therapy assessment as reasonable and necessary, and awarded interest on overdue payments.

The applicant's request for a special award under s. 10 of O. Reg. 664 was dismissed, as there was no evidence of unreasonable withholding or delay by the respondent.

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 she should be removed from the MIG due to a concussion and chronic pain.

The Tribunal found insufficient medical evidence to support a concussion diagnosis or a chronic pain condition causing functional impairment.

The Tribunal concluded the applicant's injuries were predominantly minor, subject to the $3,500 MIG limit, and dismissed the claims for the disputed treatment plans.

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 low back condition, psychological impairments, chronic pain, and a concussion.

The Tribunal found the applicant failed to meet the burden of proof for removal from the MIG, preferring the respondent's section 44 assessments over the applicant's evidence, which lacked corroboration from the family doctor's clinical notes.

As the applicant remained within the MIG, the disputed treatment plans were not considered, and claims for interest and a special award were dismissed.

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

The respondent insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant suffered from a chronic pain condition with functional impairment, warranting removal from the MIG.

The Tribunal further held that the disputed treatment plans for chiropractic services were reasonable and necessary to alleviate the applicant's ongoing pain.

The applicant was awarded the treatment plans plus interest on the overdue payments.

The applicant sought a determination that she sustained a catastrophic impairment under Criterion 8 (mental and behavioural disorders) following a 2018 motor vehicle accident.

The respondent insurer denied the claim, arguing her impairments were largely due to a pre-existing 2011 slip and fall injury.

The Tribunal applied the 'but for' test and found the accident was a necessary cause of her current impairments.

Preferring the applicant's expert evidence, the Tribunal concluded the applicant suffered marked (Class 4) impairments in three domains: social functioning, concentration, persistence and pace, and adaptation.

The applicant was deemed catastrophically impaired.

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

The respondent denied various chiropractic and psychological treatment plans, arguing 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 pre-existing condition, a psychological impairment, or chronic pain that would warrant removal from the MIG.

The Tribunal preferred the respondent's psychological and physical assessments, noting a lack of psychological symptoms in the treating practitioners' records and no evidence of functional impairment.

The application for the disputed treatment plans, interest, and an award was dismissed.

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

The matter proceeded to a written hearing, but the applicant failed to file any submissions or evidence.

As the applicant bore the onus of proving entitlement to the disputed benefits and removal from the Minor Injury Guideline, the Tribunal dismissed the application in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, including funding for dentures and assistive devices.

The matter proceeded to a written hearing, but the applicant failed to file any submissions or evidence despite receiving notice.

The Licence Appeal Tribunal found that the applicant failed to meet her onus of demonstrating entitlement to the disputed benefits.

The application was dismissed.

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

The Licence Appeal Tribunal found the applicant was entitled to treatment plans for physiotherapy and concussion therapy, as they were supported by contemporaneous medical evidence and treating practitioners' records, which outweighed the insurer's examination reports.

However, the Tribunal denied entitlement to occupational therapy and the balance of a psychological assessment due to insufficient evidence.

The applicant's request for an award for unreasonable delay under s. 10 of Reg. 664 was also dismissed, as the insurer reasonably relied on its assessors' opinions.

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

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 psychological impairment.

The Tribunal found that the applicant did not demonstrate a psychological condition warranting removal from the MIG, noting a lack of psychological complaints until a year after the accident and relying on an insurer's examination report.

As the applicant remained in the MIG, the disputed treatment plans were not payable.

Claims for an award and interest were also dismissed.

The applicant sought a non-earner benefit, interest, and an award under s. 10 of Reg. 664 following a motor vehicle accident.

The Tribunal applied the Heath test and found the applicant failed to prove a complete inability to carry on a normal life, noting his pre-accident baseline involved minimal activity due to prior health issues and there was substantially little change post-accident.

The Tribunal placed little weight on the applicant's physiotherapist certificate as it lacked detail and included psychological diagnoses outside the practitioner's scope.

The application was dismissed in its entirety.

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

The matter proceeded to a written hearing, but the applicant failed to file any submissions or evidence.

The Tribunal proceeded with the hearing under s. 7(2) of the Statutory Powers Procedure Act.

As the applicant bore the onus of proof and provided no evidence, the Tribunal found the applicant remained within the Minor Injury Guideline and dismissed the claims for a chronic pain assessment, an award, and interest.