8 total
Application for accident benefits dismissed; injuries fell within the Minor Injury Guideline and non-earner benefits denied.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including non-earner benefits and various treatment plans.
The respondent denied the benefits 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 provide sufficient objective medical evidence to prove that she suffered from chronic pain or psychological impairments warranting removal from the MIG.
The Tribunal also dismissed the claim for non-earner benefits, finding that the applicant continued to work and engage in her pre-accident activities, and therefore did not suffer a complete inability to carry on a normal life.
The application was dismissed in its entirety.
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 argued for removal from the MIG based on chronic pain and psychological impairments.
The Tribunal found insufficient medical evidence of functional impairment arising from chronic pain or psychological injuries, preferring the respondent's insurer's examinations over the applicant's medical reports.
The application was dismissed, and the applicant was found not entitled to the disputed treatment plans, interest, or an award.
Applicant's injuries confined to Minor Injury Guideline; only initial physiotherapy treatment plans approved.
The applicant sought statutory accident benefits following a motor vehicle accident, including five physiotherapy treatment plans, a chronic pain assessment, and a functional impairment evaluation.
The Tribunal found that the applicant failed to prove her physical or psychological injuries fell outside the MIG, preferring the respondent's independent medical examination reports over the applicant's experts.
The Tribunal approved the first two physiotherapy treatment plans as reasonable and necessary, subject to the $3,500 MIG limit, but denied the remaining plans and assessments due to a lack of objective medical evidence.
The applicant was awarded interest on the approved plans but denied a special award for unreasonable delay.
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline.
The applicant sought medical benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.
The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) limit, which had been exhausted.
The applicant claimed removal from the MIG based on psychological impairments and chronic pain.
The Tribunal found insufficient evidence of a psychological impairment or chronic pain, noting the applicant's post-accident life and functional capacity remained largely unchanged.
The Tribunal concluded the injuries were minor and fell within the MIG.
Claims for an award and costs were also dismissed.
Tribunal calculates IRB quantum with CPP deductions and grants 35% award for insurer's unreasonable delay.
The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and attendant care benefits from the respondent insurer.
The Tribunal determined the quantum of IRBs payable, finding that post-accident employment income and CPP disability benefits were deductible, and applied the age 65 adjustment formula.
The claim for attendant care benefits was dismissed as the applicant's limitations were found to be caused by pre-existing conditions and unrelated post-accident strokes rather than the accident.
The Tribunal awarded the applicant interest on outstanding IRBs and a 35% special award under O. Reg. 664, finding the respondent unreasonably delayed payment of IRBs after August 2018 despite having sufficient information to calculate the amounts owed.
Application for accident benefits dismissed; applicant failed to prove injuries fell outside the Minor Injury Guideline.
The respondent denied several treatment plans 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 chronic pain and psychological impairments.
The Tribunal found the applicant's evidence regarding chronic pain to be inconsistent and preferred the respondent's psychological expert over the applicant's.
The Tribunal concluded the applicant's injuries were predominantly minor and she was not removed from the MIG.
As the $3,500 MIG limit was exhausted, the treatment plans were not payable.
The respondent's request for costs was denied.
Applicant removed from Minor Injury Guideline due to chronic pain; chronic pain assessment approved but physiotherapy denied.
The respondent denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant suffered from chronic pain, removing him from the MIG.
However, the Tribunal denied the claim for physiotherapy, finding it was not reasonable and necessary as previous identical treatment had not helped.
The Tribunal granted the claim for a chronic pain assessment, finding it reasonable and necessary to investigate the condition further.
Application for accident benefits beyond the Minor Injury Guideline dismissed due to applicant's high functionality.
The central issue was whether the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant's medical experts opined that he suffered from chronic pain and psychological impairments outside the MIG.
However, the adjudicator preferred the insurer's medical examination and the applicant's own statements, which confirmed he was working full-time, attending school, and maintaining his social life.
The adjudicator concluded the injuries were predominantly minor and dismissed the application for benefits beyond the MIG cap, as well as claims for interest and a special award.
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