Erin Neal

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her injuries, including a concussion and pre-existing spinal conditions, warranted removal from the Minor Injury Guideline (MIG).

The Tribunal found the applicant failed to provide compelling medical evidence from a qualified physician to support a concussion diagnosis or demonstrate that a pre-existing condition precluded recovery under the MIG.

The Tribunal also denied a $755.00 claim for physiotherapy services, finding the insurer's denial notice complied with the Schedule.

The application was dismissed.

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

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

The applicant sought removal from the MIG based on a pre-existing condition and chronic pain.

The Tribunal found the applicant failed to prove her injuries fell outside the MIG, as she did not provide compelling evidence that her pre-existing conditions prevented maximal recovery within the MIG, nor did she establish chronic pain with functional impairment.

As the MIG limit was exhausted, the treatment plans were denied.

Claims for interest and a special award were also dismissed.

The applicant sought various statutory accident benefits following a 2017 motor vehicle accident, including treatment plans for physiotherapy, occupational therapy, a chronic pain assessment, and catastrophic impairment assessments.

The respondent denied the benefits.

The Tribunal found that the respondent's notices of denial were compliant with the Statutory Accident Benefits Schedule.

On the merits, the Tribunal held that the applicant failed to prove the treatment plans were reasonable and necessary, noting that the applicant's cognitive impairments were pre-existing and that she had reached maximal medical recovery for her accident-related physical injuries.

The application was dismissed.

The applicant passed away prior to the commencement of an application for statutory accident benefits.

The application was commenced by counsel without an estate trustee having been appointed.

The Licence Appeal Tribunal found that the application was not properly constituted and was an irremediable nullity, as a deceased person cannot pursue accident benefits and no lawfully authorized representative was appointed.

The application was dismissed as an abuse of process, and the respondent's request for costs was denied.

The applicant sought entitlement to various treatment plans and a SPECT scan following a 2017 motor vehicle accident.

The applicant argued the treatment plans were payable because the insurer failed to provide compliant denials within 10 days under s. 38 of the Schedule.

The Tribunal found the insurer's denials were timely and compliant.

On the merits, the Tribunal held the treatment plans were not reasonable and necessary, relying on insurer examinations that found the applicant had adequate functional abilities and no ongoing cognitive impairments.

The SPECT scan was denied as it was submitted beyond the 260-week limitation period.

The application was dismissed.

The respondent insurer requested a reconsideration of a decision awarding the applicant entitlement to chiropractic and physiotherapy services, interest, and an award under the Schedule.

The respondent argued the adjudicator made errors of law and fact and breached procedural fairness by finding its denials non-compliant and penalizing its failure to obtain updated medical assessments.

The adjudicator dismissed the request, finding no significant legal or evidentiary mistakes, and held that the original decision correctly addressed the non-compliant denials and unreasonable delay in treatment.

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 Tribunal found that the applicant failed to establish that his physical or psychological impairments warranted removal from the MIG.

The Tribunal also found that the respondent was compliant with the response requirements under s. 38 of the Schedule.

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

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

The Tribunal found that the applicant was not entitled to the disputed physiotherapy, massage, and orthopaedic assessment plans, as they were not shown to be reasonable and necessary.

However, the Tribunal ordered the respondent to pay for two incurred treatment plans for chiropractic and physiotherapy services because the respondent's denial notices failed to comply with s. 38(8) of the Schedule.

The Tribunal also granted a 25% award under s. 10 of O. Reg. 664 on the incurred plans, finding the respondent's conduct in relying on an IE that did not address the disputed plans to be imprudent and inflexible.

The respondent insurer brought a motion to dismiss the applicant's claim for attendant care benefits, arguing she failed to comply with section 46.2(1) of the Statutory Accident Benefits Schedule by not providing requested information, including tax returns of her service provider.

The Tribunal found that the applicant had provided sufficient information to determine the incurred benefits, including a breakdown of services and the provider's curriculum vitae.

The Tribunal held that the requested tax returns were not relevant to proving the benefits were incurred.

The motion was dismissed, and the applicant was permitted to proceed to a hearing.

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

The respondent denied a treatment plan for $3,353.40 on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued the denial lacked sufficient medical reasons under s. 38(8) of the Schedule and that he suffered from chronic pain warranting removal from the MIG.

The Tribunal found the respondent's denial was compliant and that the applicant failed to provide sufficient evidence of chronic pain causing functional impairment.

The application was dismissed.

The applicant sought medical benefits for three chiropractic treatment plans following a motor vehicle accident.

The respondent denied the plans, relying in part on an insurer's examination report.

The Tribunal found that the respondent's denial notices failed to comply with section 38(8) of the Statutory Accident Benefits Schedule because they lacked specific medical reasons and relied on an examination report that did not address the specific treatment plans in dispute.

As a result of the defective notices, the respondent was ordered to pay for the treatment plans pursuant to section 38(11).

The Tribunal also awarded interest on the overdue benefits and a 25% special award due to the respondent's unreasonable delay and failure to properly adjust the file.

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

The parties settled the claims for $15,000 plus costs and disbursements.

They could not agree on expenses, so an expense hearing was held.

The applicant claimed $20,462.04 in legal fees.

The arbitrator found the claimed amount disproportionate and excessive, noting the insurer's early offer to settle and the applicant's delays in requesting adjournments.

The arbitrator reduced the allowable hours and awarded the applicant $6,162.57 in legal fee expenses, inclusive of HST.

An allegation of bias against the arbitrator was dismissed.