25 total
Insurer ordered to fund treatment plans as applicant's head injury exceeded the Minor Injury Guideline.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic treatment and a psychological assessment.
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 a head injury and post-concussion syndrome, which exceed the definition of a minor injury, rendering the MIG inapplicable.
The Tribunal further held that the disputed treatment plans were reasonable and necessary to address the applicant's persistent cognitive challenges, ordering the respondent to pay the benefits with interest.
Physiotherapy treatment plan denied as applicant's injuries fell within the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident, specifically a $1,988.96 physiotherapy treatment plan.
The insurer denied the plan on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the treatment was not reasonable and necessary.
The Licence Appeal Tribunal found that the applicant failed to prove his injuries warranted treatment beyond the MIG limit.
Furthermore, relying on an Insurer's Examination and the lack of supporting medical evidence from the applicant, the Tribunal concluded the treatment plan was not reasonable and necessary.
Claims for interest and a bad faith award under Regulation 664 were also dismissed.
The Court of Appeal upheld a nil judgment and costs award where a jury verdict was entirely offset by a statutory deductible and an advance payment.
The appellant, a passenger injured in a motor vehicle collision, appealed a trial judgment that resulted in a nil award after the jury verdict of $50,000 in non-pecuniary damages was reduced by a statutory deductible and an advance payment made by the defendants.
The appellant challenged the trial judge's qualification of expert witnesses, aspects of the jury charge, and the costs award.
The Court of Appeal dismissed the appeal on the merits and the costs appeal, finding that the trial judge properly admitted non-party expert evidence, provided a balanced jury charge, and correctly applied the costs rules given the nil judgment.
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline.
The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits.
The respondent insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant argued that pre-existing injuries from a prior accident and chronic pain exempted him from the MIG.
The Tribunal found that the applicant's prior injuries had resolved before the subject accident and that he did not suffer from chronic pain causing functional impairment.
Consequently, the applicant failed to meet the onus of proving his injuries fell outside the MIG, and the application for benefits was dismissed.
Applicant awarded income replacement benefits as accident impairments prevented him from working pre-accident hours.
The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) beyond the date the insurer terminated them.
The adjudicator found that the applicant suffered a substantial inability to perform the essential tasks of his pre-accident employment as a gas station owner/operator, as his accident-related impairments prevented him from working the required hours.
The applicant was awarded IRBs for the disputed period, subject to a deduction of 70% of his post-accident employment income.
The insurer was entitled to a repayment of overpaid IRBs based on this deduction, and the applicant was awarded interest on overdue payments.