Arash Sasani

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to chiropractic treatments, an in-home assessment, and in-home treatments.

The Licence Appeal Tribunal dismissed the application, finding that the applicant had achieved maximal recovery and functional range of motion.

The Tribunal preferred the respondent's insurer's examinations, noting the applicant had returned to full-time employment as a nurse and was able to participate in activities such as hiking, cycling, and yoga.

As no benefits were payable, the claim for interest was also dismissed.

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

The Tribunal found the applicant sustained a catastrophic impairment under Criterion 7, reaching a 57% whole-person impairment rating.

The Tribunal also found the applicant met the test for post-104 income replacement benefits due to a complete inability to engage in suitable employment, but denied payment because the applicant failed to file income tax returns as required by section 4(5) of the Schedule.

Finally, the Tribunal determined the applicant was entitled to attendant care benefits of $889.21 per month, but denied payment because the expenses were not incurred.

The applicant, who sustained a catastrophic brain injury in a 1997 motor vehicle accident, applied for retroactive attendant care benefits (ACBs) in 2021.

The respondent insurer denied the retroactive claim.

The Tribunal found that the applicant was entitled to retroactive ACBs for the period after his discharge from the hospital, as well as for two weekends spent at home during his hospital stay, because the services were reasonably necessary and quantifiable.

The Tribunal also held that interest on the overdue benefits began to accrue 10 business days after the 2021 application was submitted.

Finally, the Tribunal granted a special award of $42,000 under s. 10 of Regulation 664, finding that the respondent unreasonably withheld benefits by failing to adequately inform the applicant of his potential entitlement to ACBs shortly after the accident.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB) and two treatment plans for devices and nutritional counseling.

The Tribunal found the applicant was not entitled to IRBs as he returned to full-time work for three months post-accident and failed to prove a substantial inability to perform the essential tasks of his employment.

The treatment plans were also denied as the applicant did not demonstrate they were reasonable and necessary, with the Tribunal preferring the insurer's medical examination which concluded the injuries were minor.

The Tribunal also found the insurer's denial notices complied with section 38 of the Schedule.

The application was dismissed.

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

The Tribunal found the applicant was barred from claiming a non-earner benefit because she ought reasonably to have known her vehicle was uninsured at the time of the accident.

Claims for attendant care benefits and most treatment plans were denied, as medical and surveillance evidence demonstrated her injuries had healed and her presentation was exaggerated.

The Tribunal ordered the applicant to repay $3,000 in attendant care benefits, finding she wilfully misrepresented the extent of services received from personal support workers.

The applicant was awarded $80 for the outstanding balance of an assistive devices treatment plan.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for an occupational therapy device, specifically the repair of a heated car seat, costing $927.60.

The respondent denied the treatment plan, relying on an insurer's examination that concluded the device was not reasonable and necessary.

The Tribunal found that the applicant met her burden of proving the device was reasonable and necessary to manage her chronic pain while driving in winter months, supported by her occupational therapist's report.

The Tribunal ordered the respondent to pay for the treatment plan with interest, but declined to order a special award as there was no evidence of unreasonable delay or ill intention.

The applicant sought non-earner benefits and attendant care benefits following a motor vehicle accident.

The respondent denied the benefits based on section 44 assessments.

The Tribunal found that the respondent's denial letter complied with the requirement to provide medical reasons under section 37(6) of the Schedule.

On the substantive issues, the Tribunal placed little weight on the applicant's expert reports due to inaccuracies and a failure to account for the applicant's significant pre-existing health conditions and prior accidents.

The Tribunal accepted the respondent's section 44 assessors' opinions that the applicant did not suffer a complete inability to carry on a normal life and did not require attendant care.

The application was dismissed in its entirety.

The applicant sought various statutory accident benefits following a motor vehicle accident, including multiple treatment plans for physiotherapy and psychological services, attendant care benefits, and the cost of an accounting report for income replacement benefits.

The Tribunal dismissed the application in its entirety.

The Tribunal found the applicant failed to prove the treatment plans were reasonable and necessary, noting inconsistencies in self-reported improvement and accepting medical evidence that the applicant required a multi-disciplinary chronic pain program rather than further facility-based physical therapy.

The Tribunal also denied the cost of the accounting report, finding the applicant's income calculation was straightforward and did not require an accountant's expertise.

Claims for attendant care benefits, interest, and a special award were similarly dismissed.

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 applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits, medical benefits for PRP therapy, and attendant care benefits.

The Tribunal found that the applicant's physical impairments, specifically severe osteoarthritis in his hips, and his psychological impairments were not caused by the accident but were pre-existing or related to his termination from employment.

The Tribunal preferred the evidence of the respondent's insurer examination assessors over the applicant's experts, noting the applicant's lack of credibility and his experts' failure to review pre-accident medical records.

The application was dismissed in its entirety.