5 total
Application for income replacement benefits dismissed; applicant ordered to repay $557.50 overpayment to insurer.
The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming she was unable to work as a self-employed aesthetician.
The respondent insurer denied the benefits based on section 44 assessments and sought repayment of a $557.50 overpayment.
The Tribunal found the applicant failed to provide contemporaneous medical evidence proving a substantial or complete inability to perform the essential tasks of her employment.
The applicant's claim for IRBs, interest, and a special award was dismissed.
The respondent's request for repayment was granted, as the overpayment was an error and timely notice was provided.
Applicant removed from Minor Injury Guideline due to chronic pain; disputed treatment plans found reasonable and necessary.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits.
The respondent insurer denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 limit.
The Tribunal found that the applicant suffered from chronic pain and psychological impairments that caused functional disability, removing him from the MIG.
The Tribunal concluded that all disputed treatment plans, including chiropractic services, psychological services, and various assessments, were reasonable and necessary.
The applicant was awarded the claimed benefits and interest on overdue payments.
Application for accident benefits dismissed as treatment plans were not reasonable and necessary.
The applicant sought payment for chiropractic and psychological treatment plans following a motor vehicle accident.
The respondent insurer argued it was not liable due to the applicant's failure to provide requested medical records under s. 33 of the Schedule.
The Tribunal found the requested information was not reasonably required, as the insurer had already denied the claims on their merits.
However, on the substantive issues, the Tribunal dismissed the application, finding that neither treatment plan was reasonable and necessary given the preponderance of medical evidence, including multiple insurer examinations indicating no further need for treatment and a lengthy gap in seeking treatment.
The respondent's request for costs was also denied.
Plaintiff ordered to attend defence psychiatric assessment to ensure trial fairness after serving late expert report.
The defendant brought a motion to compel the plaintiff to attend a defence psychiatric assessment after the action had been set down for trial.
The plaintiff had served a new psychiatric expert report after the matter was set down, prompting the defendant's request to obtain a responding report.
The court granted leave under Rule 48.04 to bring the motion, finding it just in the circumstances.
The court ordered the plaintiff to attend the psychiatric assessment, emphasizing trial fairness and the defendant's right to respond to the plaintiff's new expert evidence with an expert of their choosing.
Minor Injury Guideline applied; insurer obtained summary judgment dismissing accident benefits claim.
The insurer moved for summary judgment dismissing the accident benefits claim on the basis that the claimant's impairments fell within the Minor Injury Guidelines under the statutory accident benefits regime.
The court held that the responding party failed to put forward admissible evidence showing chronic pain, psychological impairment, or any injury taking the claim outside predominantly minor sprains and strains.
Applying the summary judgment framework, the court found there was no genuine issue requiring a trial and that the record was sufficient for final disposition.
Summary judgment was granted dismissing the action against the insurer, with costs fixed at $3,500 inclusive of disbursements and HST.