Dr. D. Prendergast

The applicant was injured in a motor vehicle accident in November 2016 and sought statutory accident benefits from the respondent insurer.

The insurer denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant suffered from chronic pain syndrome and a specific driving-related phobia caused by the 2016 accident, removing her from the MIG.

The Tribunal granted the applicant's claims for a physiotherapy treatment plan and a psychological assessment, finding them reasonable and necessary, but denied a claim for occupational therapy services.

The applicant was also awarded interest on overdue benefits.

The applicant sought statutory accident benefits following a minor motor vehicle accident, including income replacement benefits (IRBs) and various medical benefits for physiotherapy, psychological, and chronic pain assessments.

The adjudicator dismissed the application in its entirety.

The adjudicator found that the applicant did not suffer a substantial inability to perform the essential tasks of her pre-accident employment, preferring the respondent's insurer's examination reports over the applicant's expert, who relied heavily on self-reporting and failed to review prior assessments.

The requested medical benefits were deemed not reasonable and necessary, as the evidence indicated the applicant's injuries fell within the Minor Injury Guidelines and she demonstrated the ability to perform her pre-accident duties and activities of daily living.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits, including income replacement benefits, housekeeping benefits, and the cost of a multidisciplinary assessment.

The insurer terminated income replacement and housekeeping benefits shortly after the accident.

The arbitrator found that the applicant suffered significant soft-tissue injuries that developed into chronic pain and fibromyalgia, rendering her substantially unable to perform her pre-accident physically demanding job as a product demonstrator, and completely unable to engage in alternative employment.

Income replacement benefits were reinstated.

However, the claim for housekeeping benefits was dismissed, as the evidence showed the applicant retained essential independence in her household tasks, albeit at a slower pace.

The arbitrator also approved the cost of the multidisciplinary assessment, finding it reasonable and necessary given the applicant's complex psycho-physical presentation, and awarded interest on overdue amounts.

The applicant sought interim income replacement benefits after the insurer terminated them.

The arbitrator found that the insurer's termination of benefits was based on a flawed Designated Assessment Centre (DAC) process, which failed to comply with section 64 of the Statutory Accident Benefits Schedule.

The arbitrator also found that the applicant established a strong prima facie case for entitlement to benefits and demonstrated financial urgency.

The insurer was ordered to pay interim benefits of $313.77 per week, with the issues of a special award and expenses reserved for the main arbitration hearing.