40 total
Application for accident benefits dismissed; applicant failed to prove injuries warranted removal from the Minor Injury Guideline.
The applicant sought accident benefits following a motor vehicle accident, arguing his injuries warranted removal from the Minor Injury Guideline (MIG) due to pre-existing conditions, chronic pain, and psychological impairments.
The Tribunal found that the applicant's pre-existing degenerative disc disease did not preclude his recovery within the MIG.
Furthermore, the applicant failed to meet the AMA criteria for chronic pain and lacked evidence of psychological complaints to treating professionals.
As the applicant remained within the MIG and the treatment limit was exhausted, the disputed treatment plans and interest were denied.
The respondent's request for costs was also dismissed.
Catastrophic impairment and most treatment plans denied; cannabis oil expense granted with a 35% award.
The applicant sought a determination of catastrophic impairment under Criterion 8 (mental and behavioural disorders) and entitlement to various medical and rehabilitation benefits following a motor vehicle accident.
The Tribunal found that the applicant did not sustain a catastrophic impairment, placing limited weight on her experts due to her inconsistent self-reporting and failure to account for intervening events.
The Tribunal denied the disputed treatment plans for occupational therapy, physiotherapy, psychological services, and bathroom renovations, finding them not reasonable and necessary.
However, the Tribunal granted the cost of prescribed cannabis oil, noting that a treatment plan was not required for expenses under $250, and ordered a 35% award against the respondent for unreasonably withholding payment for the cannabis oil.
Application for non-earner benefits and treatment plans dismissed; applicant failed to prove complete inability to carry on normal life.
The applicant sought statutory accident benefits following a rear-end motor vehicle collision, claiming entitlement to a non-earner benefit (NEB) and several treatment plans for physiotherapy and psychological services.
The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to demonstrate a complete inability to carry on a normal life, as she continued to perform most of her pre-accident activities, albeit with some pain and modifications.
The Tribunal preferred the evidence of the insurer's assessors over the applicant's assessors, noting the latter failed to review medical records or diagnostic imaging.
The Tribunal also found the disputed treatment plans were not reasonable and necessary, and the insurer's denial notices were compliant with the Schedule.
Applicant's injuries found to be predominantly minor; claims for treatment plans beyond MIG limit dismissed.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) limit of $3,500.
The applicant argued his injuries fell outside the MIG due to psychological impairments, chronic pain, and pre-existing conditions.
The Tribunal found that the applicant sustained predominantly minor injuries (back and shoulder sprains) and failed to prove on a balance of probabilities that he suffered from an accident-related psychological impairment or chronic pain syndrome that would warrant removal from the MIG.
The Tribunal also found no compelling evidence of a pre-existing condition that would prevent maximal recovery within the MIG limit.
As the MIG limits were exhausted, the disputed treatment plans were denied, and no award for unreasonable delay was granted.
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline limits.
The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits.
The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant applied to the Licence Appeal Tribunal, arguing he should be removed from the MIG due to pre-existing conditions, chronic pain, and psychological impairments.
The Tribunal found that the applicant failed to provide compelling medical evidence that his pre-existing conditions or alleged chronic pain and psychological impairments prevented his recovery within the MIG limits.
As the $3,500 MIG limit had already been exhausted, the disputed treatment plans were not payable.
The application was dismissed.
Application for accident benefits dismissed; applicant failed to prove injuries fell outside the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that her injuries fell within the Minor Injury Guideline (MIG).
The applicant claimed her tennis elbow, neck and shoulder strains, and ongoing pain constituted non-minor injuries.
The Tribunal found that the tennis elbow predated the accident and that the applicant failed to prove her pain caused functional impairment or disability.
As the applicant did not establish a non-minor injury, she was subject to the $3,500 MIG limit, which was essentially exhausted.
The claim for $4,115.00 in chiropractic services was dismissed.
The respondent's request for costs was also denied.
Applicant removed from Minor Injury Guideline due to wrist fracture but denied non-earner benefits.
The adjudicator found the applicant was removed from the Minor Injury Guideline (MIG) because a CT scan confirmed she sustained a fractured pisiform in her left wrist.
The adjudicator approved a $1,596.00 physiotherapy treatment plan as reasonable and necessary, awarding interest on the overdue amount.
However, the claim for a non-earner benefit was dismissed because the applicant failed to submit a completed disability certificate in a timely manner and did not establish a complete inability to carry on a normal life.
Application for accident benefits dismissed as applicant failed to prove injuries warranted removal from the Minor Injury Guideline.
The applicant argued for removal from the MIG based on pre-existing conditions, chronic pain, and psychological impairments.
The Tribunal found the applicant failed to provide sufficient evidence to establish pre-existing impairments, accident-related chronic pain with functional limitations, or a psychological impairment warranting removal from the MIG.
As the $3,500 MIG limit was exhausted, the application for disputed treatment plans and interest was dismissed.
Applicant remains in the Minor Injury Guideline as evidence did not support chronic pain syndrome.
The applicant sought removal from the Minor Injury Guideline (MIG) following a motor vehicle accident, claiming chronic pain syndrome and a pre-existing condition of osteoarthritis.
The Tribunal found that the medical evidence, including normal neurological results and the applicant's reported functional abilities, did not support a diagnosis of chronic pain syndrome.
Furthermore, the applicant failed to prove that any pre-existing condition precluded maximal recovery within the MIG.
As the MIG limit was exhausted, the disputed treatment plans were denied, and no interest or award was payable.
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.
Application for accident benefits dismissed; applicant failed to prove injuries warranted removal from Minor Injury Guideline.
The applicant argued that his physical injuries, psychological injuries, and pre-existing conditions warranted removal from the MIG.
The Tribunal found that the applicant failed to provide objective medical evidence to support removal from the MIG, noting that subjective complaints of pain and unsupported theories regarding his scoliosis and psychological symptoms were insufficient.
The Tribunal also found that the disputed physiotherapy treatment plan was not reasonable and necessary, preferring the evidence of the respondent's occupational medicine specialist.
Applicant failed to prove injuries fell outside the Minor Injury Guideline; treatment plans largely denied.
The applicant sought medical and rehabilitation benefits following a rear-end motor vehicle accident.
The respondent insurer denied the treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant claimed she suffered a mild traumatic brain injury, post-concussion syndrome, and chronic pain, warranting removal from the MIG.
The Tribunal found the applicant's medical evidence, including a neurologist's report, unconvincing and unsupported by objective testing.
Preferring the respondent's multidisciplinary assessments, the Tribunal concluded the applicant's injuries were predominantly minor.
The applicant was awarded the remaining $1,278.19 of her MIG limit towards one treatment plan, but the remaining claims and interest were dismissed.
Application for accident benefits dismissed; injuries fell within the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming his injuries, including pulsatile tinnitus, warranted treatment beyond the $3,500 Minor Injury Guideline (MIG) limit.
The Licence Appeal Tribunal found insufficient medical evidence to substantiate the tinnitus or prove it was caused by the accident.
Relying on independent medical examinations, the Tribunal concluded the applicant's physical injuries were uncomplicated soft tissue injuries that fell within the MIG.
The disputed chiropractic treatment plans were deemed neither reasonable nor necessary, and the application was dismissed.
Application for medical benefits dismissed as applicant failed to prove treatment was reasonable and necessary.
The applicant sought medical benefits for two treatment plans for chiropractic services and massage therapy following a motor vehicle accident.
The Licence Appeal Tribunal found that the applicant failed to demonstrate the treatment plans were reasonable and necessary.
The Tribunal preferred the contemporaneous section 44 assessment of the respondent's medical examiner, which found no evidence of impairment.
Application for accident benefits dismissed; applicant failed to prove pre-existing condition warranted removal from Minor Injury Guideline.
The applicant was injured in a motor vehicle accident and sought medical benefits for chiropractic and physiotherapy treatments.
The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant argued she should be removed from the MIG due to a pre-existing connective tissue disease.
The Tribunal found that the applicant failed to provide compelling evidence that her pre-existing condition prevented maximal recovery within the MIG limits, noting that the diagnosis occurred after the accident and was not mentioned in the treatment plans.
Tribunal denies most accident benefits due to lack of impairment but approves neuropsychological assessment.
The applicant, a pedestrian struck by a vehicle, sought various statutory accident benefits including attendant care, physiotherapy, psychological services, and a neuropsychological assessment.
The insurer denied the benefits.
The Licence Appeal Tribunal found that the applicant suffered a fractured ankle and a mild concussion but returned to work quickly and demonstrated high functional independence.
Claims for attendant care, occupational therapy, and psychological services were dismissed as not reasonable and necessary.
Physiotherapy claims were denied for failure to exhaust collateral benefits.
The Tribunal granted the request for a neuropsychological assessment and minor medication expenses.
A claim for a special award for unreasonable withholding of benefits was dismissed.
Claims for additional medical benefits dismissed as applicant's injuries fell within the Minor Injury Guideline.
The insurer denied funding for additional chiropractic treatments and assessments beyond the $3,500 Minor Injury Guideline (MIG) limit.
The Licence Appeal Tribunal found that the applicant's physical and psychological injuries fell within the MIG.
The Tribunal preferred the evidence of the insurer's medical experts, who provided extensive reports based on testing, over the applicant's practitioners, who failed to provide details of testing or lacked appropriate accreditation.
As the applicant had already exhausted the MIG funding limit, the claims for additional medical benefits and interest were dismissed.
Insurer ordered to pay $2,200 for chronic pain assessment deemed reasonable and necessary following accident.
The applicant was injured in a motor vehicle accident and sought payment for a $2,200 chronic pain assessment.
The insurer denied the benefit, arguing the applicant's ongoing pain was related to her pre-existing Crohn's disease rather than the accident.
The Tribunal found the assessment was reasonable and necessary, noting the applicant had no history of such pain prior to the accident and had consistently sought treatment for over a year.
The Tribunal ordered the insurer to pay the cost of the assessment plus interest.
Accident benefits claims dismissed due to failure to submit required forms before incurring expenses.
The applicant sought statutory accident benefits, including physiotherapy, attendant care, and the cost of an assessment, following a motor vehicle accident.
The Licence Appeal Tribunal dismissed the claims.
The claim for physiotherapy was denied because the applicant failed to provide the relevant treatment and assessment plan in evidence.
The claims for attendant care benefits and the assessment cost were dismissed because the applicant failed to comply with the procedural requirements of the Statutory Accident Benefits Schedule, specifically by incurring the expenses before submitting the required Form 1 and treatment plans to the insurer.
Applicant's pre-existing back injury and psychological issues removed her from the Minor Injury Guideline limits.
The applicant was injured in a motor vehicle accident and sought medical benefits from her insurer.
The insurer denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) limit of $3,500.
The arbitrator found that the applicant had a documented pre-existing back injury and psychological issues that prevented her from achieving maximal recovery within the MIG limits.
The arbitrator ordered the insurer to pay the disputed treatment plans and interest, but dismissed the applicant's claim for a special award, finding the insurer's conduct was not sufficiently unreasonable to warrant punitive measures.
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