Dr. D. Mula

The applicant was struck by a vehicle as a pedestrian and sought statutory accident benefits, including a determination of catastrophic impairment, income replacement benefits (IRBs), and various medical benefits.

The Tribunal found that the applicant did not sustain a catastrophic impairment, as his physical and psychological impairments did not meet the 55% whole person impairment threshold under criteria 6 and 7, nor did he suffer marked impairments in three domains under criterion 8.

The Tribunal also dismissed the claim for IRBs, noting the applicant had returned to work for nearly three years post-accident and failed to demonstrate a complete inability to engage in suitable employment.

Claims for a functional abilities evaluation and worksite assessment were dismissed as not reasonable and necessary.

The applicant was awarded minor amounts for treatment plan form fees and interest on those amounts, but the claim for a special award was dismissed as the insurer's denials were not unreasonable.

The applicant sought statutory accident benefits following an accident involving an all-terrain vehicle.

The insurer denied benefits, including income replacement benefits, attendant care benefits, and a determination of catastrophic impairment.

The Tribunal found the applicant was excluded from receiving income replacement benefits because he was operating an uninsured vehicle without a valid license.

The Tribunal also dismissed the claims for catastrophic impairment and other benefits, finding the applicant's self-reporting to medical assessors was unreliable and contradicted by video surveillance showing a higher level of functioning than reported.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident.

The respondent denied the treatment plan, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been exhausted.

The applicant argued that pre-existing conditions, chronic pain, and psychological impairments removed him from the MIG.

The Tribunal found insufficient evidence of a pre-existing condition that would preclude recovery within the MIG, and determined the applicant did not meet the criteria for chronic pain or a psychological impairment.

The application was dismissed as the applicant sustained a minor injury and had exhausted the MIG funding limit.

The applicant sought statutory accident benefits for two chiropractic treatment plans totaling over $17,000 following a motor vehicle accident.

The respondent insurer denied the plans on the basis that the physical injuries were soft tissue in nature and resolved, noting a prior workplace injury to the same areas.

The Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, citing inconsistencies in the medical records, a two-year gap in treatment, and the significant role of the prior workplace injury.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs), medical and rehabilitation benefits, and costs of examinations.

The respondent brought a preliminary motion to dismiss the application due to the applicant's failure to comply with production orders and attend an insurer's examination, which the Tribunal dismissed.

On the merits, the Tribunal found the applicant failed to prove a substantial inability to perform the essential tasks of his employment, noting significant credibility issues and a failure to produce relevant financial and employment records.

The Tribunal also dismissed the claims for medical benefits and examination costs, preferring the evidence of the respondent's assessors over the applicant's evidence.

The application was dismissed in its entirety.

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

The respondent insurer determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and refused to fund treatment plans exceeding the $3,500 limit.

The applicant applied to the Licence Appeal Tribunal, arguing that pre-existing conditions, psychological injuries, and chronic pain warranted removal from the MIG.

The Tribunal found that the applicant failed to provide sufficient medical evidence to support removal from the MIG, noting that the psychological report's conclusions were unsupported by its own psychometric testing and uncorroborated by other medical records.

The application was dismissed, and the disputed treatment plans were denied as the MIG funding limit had been exhausted.

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

The respondent insurer determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and refused to pay for certain physiotherapy treatment plans.

The applicant applied to the Licence Appeal Tribunal, arguing that chronic pain removed them from the MIG.

The adjudicator found that the applicant's pain was intermittent and did not meet the criteria for chronic pain syndrome, preferring the evidence of the respondent's independent medical examiner over the applicant's family physician.

The adjudicator concluded the injuries were predominantly minor and subject to the $3,500 funding limit.

One treatment plan was denied as it proposed treatment outside the MIG, while another was approved subject to the funding limit.

No interest was awarded.