Dawn Li

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, which the respondent insurer denied on the basis that her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG due to psychological impairments and chronic pain with functional impairment.

The Tribunal found that the applicant failed to provide sufficient medical evidence linking her psychological complaints or ongoing pain to a functional impairment caused by the accident.

As the $3,500 MIG limit was exhausted, the disputed treatment plans were denied.

The Tribunal also found the insurer complied with the notice requirements under s. 38(8) of the Schedule and dismissed the claims for an award and interest.

The applicant sought statutory accident benefits following a motor vehicle accident, including an OCF-18 for occupational therapy (involving airfare for family) and attendant care benefits (ACB).

The Tribunal found the respondent's denial notice for the OCF-18 was defective under s. 38(8) of the Schedule as it failed to provide sufficient medical reasons, ordering the respondent to pay the OCF-18 with interest.

However, the Tribunal dismissed the applicant's claims for increased ACB, finding the respondent properly relied on a prior Insurer's Examination and the applicant failed to prove the increased ACB was reasonable and necessary.

The claim for an award under s. 10 of Regulation 664 was dismissed.

The applicant sought various statutory accident benefits following a motor vehicle accident, including attendant care, chiropractic, psychological, and occupational therapy services, as well as the cost of a catastrophic impairment assessment.

The Licence Appeal Tribunal found that the insurer failed to provide timely notice of denial for one chiropractic treatment plan, rendering it payable for the period of delay under s. 38(11) of the Schedule.

The Tribunal also approved an in-home assessment.

However, the Tribunal dismissed the claims for attendant care benefits and the remaining treatment plans, finding the applicant failed to prove they were reasonable and necessary, largely preferring the objective findings of the insurer's examiners over the applicant's subjective complaints.

The claim for a special award under s. 10 of Regulation 664 was also dismissed.

The applicant sought a non-earner benefit, medication expenses, and a special award following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to establish a complete inability to carry on a normal life.

The Tribunal relied on the respondent's section 44 assessments and surveillance evidence, which showed the applicant engaging in various physical activities, over the applicant's medical evidence.

The claims for medication expenses, interest, and a special award were also dismissed.

The applicant sought various statutory accident benefits following a motor vehicle accident, including attendant care benefits, treatment plans for chiropractic and psychological services, assistive devices, and several assessments.

The Tribunal found that while the applicant demonstrated a need for attendant care benefits during the disputed period, he failed to prove the expenses were incurred, rendering them not payable.

The Tribunal granted the treatment plans for a nutritional assessment and a chronic pain assessment, finding them reasonable and necessary based on the applicant's reported symptoms and medical records.

The remaining claims were dismissed for lack of evidence or because the Tribunal lacked jurisdiction over items not proven to have been submitted to or denied by the insurer.

The applicant sought a determination of catastrophic impairment and entitlement to attendant care benefits and assessment costs following a motorcycle accident.

The Licence Appeal Tribunal found that the applicant did not meet the threshold for catastrophic impairment under either criterion 7 or 8, preferring the evidence of the respondent's experts over the applicant's expert, whose conclusions relied heavily on inconsistent self-reporting.

The Tribunal also dismissed the claims for attendant care benefits and assessment costs due to a lack of evidence demonstrating incurred expenses or reasonable necessity.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, psychological services, an occupational therapy assessment, and out-of-pocket expenses.

The Tribunal found that the applicant was not entitled to the non-earner benefit because she failed to provide sufficient evidence comparing her pre- and post-accident activities to establish a complete inability to carry on a normal life.

The Tribunal also denied the psychological treatment plans because the applicant failed to justify the service providers charging rates higher than those prescribed for psychotherapists in the Professional Services Guideline, and failed to justify transportation costs.

The requests for an occupational therapy assessment, a massage chair, and a flight cancellation fee were also dismissed as not reasonable and necessary or not payable under the Schedule.

Claims for an award and interest were dismissed.

The applicant sought statutory accident benefits following two motor vehicle accidents in 2017 and 2019.

The Licence Appeal Tribunal found that the applicant failed to prove her psychological impairments were caused by the accidents, attributing her symptoms to personal and financial stressors.

Claims for income replacement benefits, attendant care benefits, and most medical benefits were dismissed, as the applicant had returned to work and independent medical examinations showed she did not require the claimed assistance.

The Tribunal granted one treatment plan for chiropractic services related to the 2019 accident, finding it reasonable and necessary for pain reduction.

The claim for a section 10 award was dismissed.

The applicant sought a non-earner benefit following a motor vehicle accident, claiming a complete inability to carry on a normal life due to physical and psychological impairments.

The respondent denied the benefit, arguing the applicant's psychological issues were pre-existing and that she failed to meet the rigid test for a complete inability.

The Tribunal found that the applicant's psychological assessments lacked objective baseline information regarding her pre-accident activities and afforded them less weight.

Relying on pre-accident medical records showing significant pre-existing limitations, the Tribunal concluded the applicant failed to prove her impairments were caused by the accident or that she suffered a complete inability.

The application was dismissed.