24 total
Application for income replacement benefits dismissed due to credibility issues and failure to disclose prior injuries.
The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming she was unable to return to her pre-accident employment as a retail customer service representative.
The insurer denied the claim, citing surveillance evidence, failure to disclose a prior workplace injury, and failure to disclose an offer of modified work from her employer.
The Tribunal dismissed the application, finding the applicant's evidence unpersuasive due to these omissions and preferring the insurer's medical assessments, which included validity testing and found no objective physical impairment.
Applicant's pre-existing conditions and chronic pain diagnosis remove her injuries from the Minor Injury Guideline.
The applicant sought medical and rehabilitation benefits following a motor vehicle accident.
The insurer denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant's pre-existing conditions, including knee osteoarthritis and abdominal issues, as well as a post-accident chronic pain diagnosis, removed her from the MIG.
The Tribunal ordered the insurer to pay for multiple treatment plans and a chronic pain assessment, finding them reasonable and necessary, but denied the cost of a medical bracelet and the applicant's request for costs.
Application for catastrophic impairment determination dismissed as applicant's 51% WPI fell short of 55% threshold.
The applicant sought a determination that her impairments from a motor vehicle accident met the 55% whole person impairment (WPI) threshold for catastrophic impairment under the Statutory Accident Benefits Schedule.
The adjudicator evaluated conflicting medical evidence regarding the applicant's neurological and psychological impairments, including sleep disorders, mental status, and somatic disorders.
While the adjudicator preferred much of the applicant's medical evidence and found the insurer's assessors had underestimated the impairments, the final combined WPI was determined to be 51%.
As this fell short of the 55% threshold, the application was dismissed.
Application for accident benefits dismissed; applicant failed to prove injuries fell outside the Minor Injury Guideline.
The applicant was injured when a garage door closed on her vehicle and sought accident benefits from her insurer.
The insurer denied treatment plans on the basis that the applicant's impairments fell within the Minor Injury Guideline (MIG).
At arbitration, the applicant failed to present medical evidence or expert testimony to establish that her injuries fell outside the MIG or that her ongoing pain was causally linked to the accident.
The arbitrator accepted the uncontradicted expert evidence of the insurer's medical and psychological assessors, concluding that the applicant's impairments were predominantly minor injuries.
The application for additional treatment was dismissed.