Dr. Alfonse Marchie

The applicant sought statutory accident benefits following a motor vehicle accident, arguing he should be removed from the Minor Injury Guideline (MIG) due to chronic pain and psychological injury.

The Tribunal found the applicant did not meet his burden of proof, preferring the respondent's medical evidence which showed the applicant did not meet the AMA criteria for chronic pain and that his psychological testing indicated symptom over-endorsement.

As the applicant was held to the MIG, his claims for treatment plans, assessments, interest, and an award were dismissed.

The applicant requested reconsideration of a Licence Appeal Tribunal decision that denied certain physiotherapy and chiropractic treatment plans following a motor vehicle accident.

The applicant argued that his post-hearing decision to undergo shoulder surgery constituted new evidence that would have affected the outcome.

The Tribunal found that while the decision to have surgery was new evidence, it would not have changed the original decision.

The original denial was based on the lack of clinical justification for extended passive treatment and a factual finding that the applicant did not sustain a concussion, neither of which were altered by the subsequent surgery.

The request for reconsideration was dismissed.

The applicant sought various statutory accident benefits following a motor vehicle accident, including attendant care benefits, multiple treatment plans, and an award for unreasonable delay.

The Licence Appeal Tribunal found the applicant entitled to attendant care benefits of $1,372.21 and $1,297.46 per month, preferring the applicant's occupational therapy assessments over the insurer's examination.

The Tribunal also approved assessments for concussion and chronic pain.

However, claims for extended physiotherapy, chiropractic care, and other assessments were denied as not reasonable and necessary.

The Tribunal held that outstanding invoices were payable only after collateral benefits were exhausted, and declined to order a section 10 award, finding the insurer's conduct was not unreasonable.

The applicant sought income replacement benefits (IRBs) and payment for various physiotherapy and psychological treatment plans following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application in its entirety.

The adjudicator found the applicant failed to prove a substantial inability to perform his pre-accident employment tasks or a complete inability to engage in suitable employment post-104 weeks, noting he had returned to work.

The treatment plans were deemed not reasonable and necessary, as medical evidence indicated the applicant's psychological issues stemmed from pre-existing conditions and subsequent accidents, and he had reached maximum medical recovery for his soft tissue injuries.

Claims for an award and interest were consequently dismissed.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule, which the respondent insurer denied.

The Licence Appeal Tribunal found the applicant was entitled to two treatment plans for chiropractic services, as the medical evidence supported her ongoing symptoms from an ankle fracture, and the insurer's expert reports were given little weight.

The Tribunal also approved the unapproved balance of two psychological treatment plans, preferring the treating psychologist's recommendation for 1.5-hour sessions over the insurer's expert's 1.0-hour recommendation.

However, the Tribunal denied a third psychological treatment plan because the applicant failed to attend a scheduled insurer's examination, barring her claim under s. 55(1)(2) of the Schedule.

Claims for travel expenses and an occupational therapy assessment were also dismissed due to insufficient evidence.

The Tribunal declined to order a special award under s. 10 of Reg. 664, finding the insurer's reliance on its expert reports was not unreasonable.

The applicant sought entitlement to several treatment plans for physiotherapy, chiropractic, and psychological services following a motor vehicle accident, as well as an award for unreasonable delay.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the treatment plans were reasonable and necessary.

The Tribunal preferred the respondent's medical evidence, which indicated that further physical therapy would not provide lasting relief and that the applicant's psychological symptoms did not warrant the requested interventions.

Claims for interest and a special award were also dismissed.

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

The respondent denied the benefits, arguing the injuries were minor.

The Licence Appeal Tribunal found that the applicant failed to meet her burden of proving she suffered a concussion, chronic pain, or a psychological impairment as a result of the accident.

The Tribunal accepted the respondent's medical assessments, which concluded the applicant sustained only soft tissue injuries.

Consequently, the applicant's injuries were deemed predominantly minor, and her claims for psychological and physiotherapy services, as well as interest, were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits and two treatment plans for chiropractic services.

The Licence Appeal Tribunal found that the applicant failed to prove a complete inability to carry on a normal life, relying on insurer evaluations that showed the applicant continued to perform daily activities.

The Tribunal approved the first treatment plan for chiropractic services, finding it reasonable and necessary based on the applicant's positive response to prior chiropractic care and support from his general practitioner.

The second treatment plan was denied because it was not submitted into evidence.

The applicant sought statutory accident benefits following a November 2017 motor vehicle accident.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The respondent also argued the application should be dismissed based on res judicata, as a prior Tribunal decision had already determined the applicant suffered minor injuries.

The Tribunal waived res judicata because the applicant submitted fresh medical evidence.

However, upon reviewing the new evidence, the Tribunal found the applicant failed to prove on a balance of probabilities that she suffered from chronic pain with functional impairment or a psychological impairment that would warrant removal from the MIG.

Consequently, the claims for a physiotherapy treatment plan, physiotherapy expenses, clinical notes and records, and interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of treatment plans for physiotherapy, psychological services, and chiropractic services.

The Tribunal found the applicant failed to prove the physiotherapy and psychological services were reasonable and necessary, preferring the evidence of the respondent's section 44 assessors over the applicant's medical records.

However, the Tribunal ordered the respondent to pay the incurred expenses for the chiropractic treatment plan because the respondent's denial letter failed to provide specific medical reasons, violating the notice requirements under section 38(8) of the Schedule.

The claim for a section 10 award was dismissed as the respondent's conduct was not unreasonable.

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.

The applicant sought non-earner benefits and funding for two chiropractic treatment plans following a motor vehicle accident.

The Tribunal found the applicant did not meet the test for non-earner benefits, as medical assessments demonstrated her daily routine remained largely unchanged and her impairments were largely attributable to pre-existing musculoskeletal conditions.

The Tribunal lacked jurisdiction over the first treatment plan because it was not properly submitted or denied.

The second treatment plan was denied because the applicant failed to provide objective medical evidence that the treatment was reasonable and necessary for accident-related injuries.

The application was dismissed.

The applicant sought non-earner benefits following a motor vehicle accident, claiming a complete inability to carry on a normal life due to physical and psychological impairments.

The Tribunal dismissed the application, preferring the respondent's in-person medical assessments which demonstrated the applicant continued to engage in the vast majority of his pre-accident activities, including household chores and personal care.

The applicant's claims for interest and a special award were consequently dismissed as no benefits were payable.

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

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.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to physiotherapy and psychological treatment plans outside the $3,500 Minor Injury Guideline (MIG) limit.

The applicant argued that chronic pain and psychological impairments warranted removal from the MIG.

The Tribunal found insufficient medical evidence to establish chronic pain with functional impairment or a psychological impairment caused by the accident, preferring the respondent's insurer's examinations.

As the applicant remained within the MIG and the limits were exhausted, the disputed treatment plans and interest were denied.

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

The Tribunal found the applicant was barred from receiving a non-earner benefit under s. 31(1)(d)(i) of the Schedule because she was convicted of a criminal offence on the day of the accident.

The Tribunal also held that the applicant's injuries were predominantly minor and subject to the $3,500 Minor Injury Guideline limit, as the medical evidence showed her psychological conditions pre-dated the accident and were not exacerbated by it.

The application for treatment plans and an award was dismissed.

The applicant sought income replacement benefits (IRB) following a motor vehicle accident, claiming that physical and psychological injuries prevented him from working as a self-employed electrician.

The Tribunal found that the applicant failed to meet his burden of proving a substantial inability to perform the essential tasks of his employment.

The applicant's medical evidence was given little weight as it lacked objective support and did not address his ability to work.

Conversely, the respondent's medical assessments and video surveillance evidence, which showed the applicant performing work-related tasks without apparent difficulty, were accepted.

The application for IRB and interest was dismissed.

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 Licence Appeal Tribunal found that the applicant failed to prove his injuries warranted removal from the MIG, preferring the respondent's insurer examination reports over the applicant's limited medical evidence.

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

Claims for a section 10 award, interest, and costs were also dismissed.

The applicant sought statutory accident benefits following a 2019 motor vehicle accident.

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

The Tribunal found that the applicant's physical injuries were predominantly minor and that he failed to prove an accident-related psychological impairment or a pre-existing condition that would preclude recovery within the MIG.

As the applicant remained subject to the $3,500 MIG limit, the disputed treatment plans, interest, and an award for unreasonable delay were denied.

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

The respondent denied the treatment plans 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 that an ACL tear, which occurred after a subsequent slip and fall on ice, was directly caused by the motor vehicle accident, and that he suffered psychological impairments.

The Tribunal found that the applicant failed to establish a direct causal link between the motor vehicle accident and the ACL tear, noting that the slip and fall broke the chain of causation.

The Tribunal also found insufficient evidence of a psychological impairment.

As the applicant's injuries were predominantly minor and the MIG limit was exhausted, the application for the disputed treatment plans, interest, and an award was dismissed.