Dr. Auguste

The appellant sought an appeal and judicial review of a Licence Appeal Tribunal decision denying him income replacement benefits under the 'any occupation' test and denying an extension of time to request reconsideration.

The Divisional Court found no errors of law or procedural unfairness in the adjudicator's handling of expert evidence, cross-examination, or factual findings.

The court held the adjudicator's decision was reasonable and dismissed the appeal and judicial review application.

The applicant sought income replacement benefits following a motor vehicle accident.

The adjudicator found that the applicant failed to establish a substantial inability to perform the essential tasks of his pre-accident employment as a forklift driver.

The medical evidence, including insurer's examinations, indicated normal physical function and independence in daily activities.

Furthermore, the applicant had declared to the Canada Revenue Agency that he stopped working due to the COVID-19 pandemic and received government benefits, undermining his claim that his inability to work was accident-related.

The application was dismissed.

The applicant was struck by a vehicle while riding her bicycle and sought statutory accident benefits.

The insurer terminated her income replacement benefits (IRBs) and denied a physiotherapy treatment plan.

The Tribunal found the applicant was entitled to post-104-week IRBs, as her cognitive impairments, fatigue, and required pacing strategies rendered her completely unable to engage in any employment for which she was reasonably suited.

However, the Tribunal denied the physiotherapy treatment plan, finding no ongoing physical impairments that necessitated it.

The claim for an award for unreasonable delay was also dismissed, as the insurer reasonably relied on its assessors' medical opinions.

The applicant sought entitlement to statutory accident benefits for four treatment plans, including chiropractic services, knee braces, a psychological assessment, and a chronic pain assessment, following a motor vehicle accident.

The adjudicator found that the applicant failed to establish that any of the treatment plans were reasonable and necessary.

The medical evidence, including an insurer's examination by an orthopedic surgeon, demonstrated a lack of ongoing accident-related physical impairments, and the psychological and chronic pain claims lacked objective medical support.

The application was dismissed in its entirety, with no benefits, interest, or costs awarded.

The applicant was injured in a motor vehicle accident and sought a non-earner benefit from the respondent insurer.

The respondent denied the benefit, arguing the applicant did not suffer a complete inability to carry on a normal life.

The Tribunal compared the applicant's pre- and post-accident activities, noting his inability to perform meaningful hobbies, home maintenance, and family activities due to a right wrist fracture and ongoing pain.

Preferring the evidence of the treating orthopaedic surgeon over the insurer's assessor, the Tribunal found the applicant met the test for a non-earner benefit and ordered the respondent to pay the benefit with interest.

The applicant sought a non-earner benefit (NEB) following a motor vehicle accident in which she sustained a concussion and a fractured sacrum.

The Tribunal applied the Heath test to compare her pre- and post-accident activities.

Finding the applicant credible and her limitations corroborated by her family doctor, the Tribunal concluded she suffered a complete inability to carry on a normal life for the first ten months post-accident.

The insurer's medical examinations, conducted at the 23-month mark, were deemed unhelpful for assessing the earlier period.

The applicant was awarded the NEB from March 14, 2018, to December 31, 2018, along with interest on overdue payments, but denied benefits for the remainder of the claimed period due to a lack of medical evidence supporting ongoing impairment.

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

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

The Tribunal found that the applicant suffered predominantly minor soft-tissue injuries and failed to provide compelling medical evidence of chronic pain or psychological impairments warranting removal from the MIG.

Furthermore, the applicant did not establish a complete inability to carry on a normal life, as she continued to engage in most pre-accident activities, and was therefore not entitled to a non-earner benefit.

The application was dismissed.

The applicant sought income replacement benefits (IRB) and attendant care benefits (ACB) following a motor vehicle accident.

The Tribunal found that while the accident exacerbated the applicant's pre-existing psychological impairments, she did not suffer a substantial inability to perform the essential tasks of her employment.

The Tribunal preferred the respondent's medical evidence, which showed no acute physical changes and stable psychological conditions post-accident.

The applicant also failed to meet the post-104 weeks complete inability test for IRB and did not establish that the claimed ACB was reasonable and necessary.

The application was dismissed.

The applicant sought an income replacement benefit (IRB) of $400 per week following a motor vehicle accident, claiming psychological and physical impairments prevented him from performing his essential tasks as an AutoCAD technician.

The respondent denied the claim, arguing the applicant returned to work immediately, was terminated for being a poor fit, and lacked objective medical evidence of disability.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to provide contemporaneous, objective medical evidence demonstrating a substantial inability to perform his pre-accident employment tasks during the disputed period.

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

The applicant sought reconsideration of a Licence Appeal Tribunal decision that denied her claims for medical benefits, interest, and an award following a motor vehicle accident.

The applicant alleged the adjudicator made errors of fact regarding the medical evidence, the cause of her right knee pain, the receipt of a denial letter, and her request for an award.

The adjudicator dismissed the request for reconsideration, finding no errors of fact were made.

The adjudicator noted that the applicant failed to properly introduce medical evidence at the initial hearing, failed to rebut the legal presumption of mail receipt for the denial letter, and was not entitled to an award because no benefits were unreasonably withheld.

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

The insurer denied certain benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that while the applicant did not establish a psychological impairment, she did prove on a balance of probabilities that she suffered from chronic pain as a result of the accident, which removed her from the MIG.

Consequently, the Tribunal approved a disputed physiotherapy treatment plan as reasonable and necessary, but denied a psychological assessment.

Interest was awarded on overdue payments.

The applicant was injured in a motor vehicle accident and sought medical benefits and income replacement benefits (IRB) from the respondent insurer.

The adjudicator found that the applicant's physical and psychological injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 funding limit, as the applicant failed to prove pre-existing conditions or psychological injuries that would exempt him.

Consequently, the disputed treatment plans were denied.

The adjudicator also dismissed the claim for IRB, finding the applicant did not provide sufficient medical evidence to prove a substantial inability to perform the essential tasks of his employment as a taxi driver.