9 total
Application for non-earner benefits and treatment plans dismissed as applicant failed to prove complete inability.
The applicant sought a non-earner benefit, various chiropractic treatment plans, an orthopaedic assessment, interest, and an award under the Statutory Accident Benefits Schedule following a motor vehicle accident.
The Licence Appeal Tribunal dismissed the application, finding the applicant failed to demonstrate a complete inability to carry on a normal life, as medical evidence indicated she continued to substantially engage in her pre-accident activities.
The Tribunal also found the applicant did not meet her burden to prove the disputed treatment plans were reasonable and necessary.
Claims for interest and an award were consequently dismissed.
Application for accident benefits dismissed; applicant failed to prove injuries warranted removal from Minor Injury Guideline.
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).
The applicant sought removal from the MIG on the basis of chronic pain and psychological injury.
The Tribunal found insufficient evidence of chronic pain with functional impairment and preferred the respondent's psychological assessment over the applicant's.
The application was dismissed, and the applicant was held to the $3,500 MIG limit.
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 physical impairments, chronic pain, and psychological impairments.
The Licence Appeal Tribunal found the applicant failed to establish that his pre-existing right shoulder condition precluded recovery within the MIG, relying on an insurer's examination that found no residual impairment.
The Tribunal also rejected the chronic pain claim, noting the applicant continued to work and lacked functional impairment.
Finally, the Tribunal dismissed the psychological impairment claim, preferring the insurer's in-person assessments over the applicant's virtual assessment and self-reporting.
The application was dismissed, and the applicant remained subject to the MIG.
Application for accident benefits dismissed as applicant failed to prove treatment plans were reasonable and necessary.
The applicant sought entitlement to statutory accident benefits for chiropractic and psychological services following a motor vehicle accident.
The adjudicator found that the applicant failed to establish that the chiropractic treatment plans were reasonable and necessary, noting a lack of supportive medical referrals and failure to link a knee injury to the accident.
The adjudicator also denied the disputed amounts for psychological services, finding no evidence to support the necessity of the specific administrative items claimed.
The application was dismissed.
Application for accident benefits dismissed; injuries found to be predominantly minor and subject to MIG.
The respondent denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant failed to establish that his injuries, including alleged post-concussion syndrome, psychological impairments, and chronic pain, warranted removal from the MIG.
The Tribunal preferred the evidence of the respondent's insurer examinations over the applicant's self-reported symptoms and chiropractor's report.
As the applicant remained within the MIG, the disputed treatment plans were not payable and the application was dismissed.
Application for accident benefits dismissed; applicant failed to prove injuries warranted removal from the Minor Injury Guideline.
The respondent denied various treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant argued for removal from the MIG based on chronic pain and psychological injuries.
The Tribunal found the applicant failed to prove chronic pain with a functional limitation.
Regarding psychological injuries, the Tribunal preferred the respondent's expert evidence, which relied on objective testing, over the applicant's expert, who used primarily subjective self-reporting tools.
The application was dismissed, and the applicant was held to the MIG.
The applicant argued for removal from the MIG based on psychological impairments, pre-existing conditions, and chronic pain.
The Tribunal drew an adverse inference against the applicant for failing to produce required medical records.
The Tribunal found the applicant failed to prove on a balance of probabilities that she suffered a psychological impairment, that her pre-existing conditions prevented maximal recovery within the MIG, or that she developed chronic pain as a result of the accident.
The application was dismissed, and the applicant was found not entitled to the disputed treatment plans or interest.
Application for accident benefits dismissed; applicant remained subject to the Minor Injury Guideline and failed to prove IRB entitlement.
The applicant sought income replacement benefits (IRBs) and medical benefits following a motor vehicle accident.
The Licence Appeal Tribunal found that the applicant failed to prove a substantial inability to perform the essential tasks of his employment as an Uber driver, noting he continued to work full-time.
The Tribunal also held that the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG) limit of $3,500.
The applicant failed to establish that his pre-existing chronic pain or alleged psychological injuries warranted removal from the MIG.
Consequently, the claims for IRBs, disputed treatment plans, and interest were dismissed.
Application for income replacement benefits dismissed due to significant credibility issues and unreliable self-reporting.
The applicant sought income replacement benefits (IRBs) following a motor vehicle accident in December 2021.
The respondent denied the benefits based on section 44 assessments.
The adjudicator found significant inconsistencies in the applicant's self-reporting, including discrepancies regarding his medication use, treatments, and a subsequent accident in 2022.
The adjudicator placed less weight on the applicant's expert reports because they relied heavily on his unreliable self-reports and failed to review relevant medical records.
Preferring the respondent's section 44 assessments, the adjudicator concluded that the applicant failed to prove on a balance of probabilities that he suffered a substantial inability to perform the essential tasks of his pre-accident employment.
The application for IRBs and interest was dismissed, and the respondent's request for costs was denied.
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