Dr. Jacqueline Auguste

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on a pre-existing shoulder condition, chronic pain, and psychological impairments.

The Tribunal found insufficient compelling medical evidence to support removal on any of these grounds, preferring the respondent's section 44 assessments which concluded the injuries were minor.

As the applicant remained within the MIG, the disputed treatment plans were not considered, and claims for interest and a special award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, chiropractic treatment plans, and a psychological assessment.

The respondent denied the benefits based on section 44 insurer examinations.

The Tribunal found that the applicant failed to prove a complete inability to carry on a normal life, as medical evidence showed she could perform personal care, grocery shop, and swim.

The Tribunal also dismissed the claims for medical benefits, preferring the respondent's expert evidence that the treatments were not reasonable and necessary.

The application was dismissed in its entirety.

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

The respondent denied treatment plans for chiropractic services, an attendant care assessment, and physiotherapy.

The Tribunal found the applicant was barred from proceeding on the chiropractic and attendant care claims because she failed to dispute the clear and unequivocal denials within the two-year limitation period under s. 56 of the Schedule, and declined to extend the time under s. 7 of the LAT Act.

The physiotherapy claim was dismissed as not reasonable and necessary, with the Tribunal finding the respondent's denial complied with s. 38(8).

The application was dismissed in its entirety.

The respondent insurer requested a reconsideration of a Tribunal decision granting the applicant entitlement to a chronic pain assessment.

The insurer argued the Tribunal erred by finding that only psychologists and psychiatrists could provide expert opinion evidence on chronic pain, thereby improperly discounting the evidence of its general practitioner and orthopaedic surgeon.

The Vice-Chair granted the reconsideration, finding the Tribunal erred in its treatment of the medical experts.

Upon rehearing the issue, the Vice-Chair weighed the competing medical evidence and concluded that the applicant's ongoing reports of pain and diagnosis of somatic symptom disorder provided reasonable grounds to warrant a chronic pain assessment.

The treatment plan was deemed reasonable and necessary.

The applicant sought a determination of catastrophic impairment and entitlement to attendant care benefits and income replacement benefits following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant did not meet the criteria for catastrophic impairment under either Criterion 7 (55% whole person impairment) or Criterion 8 (mental and behavioural disorders).

The Tribunal preferred the evidence of the respondent's experts, noting significant validity concerns and sub-maximal effort during the applicant's assessments.

Consequently, the applicant was not entitled to enhanced attendant care benefits, having exhausted her non-catastrophic limits.

The Tribunal also dismissed the claim for income replacement benefits, finding the applicant failed to prove a substantial inability to perform the essential tasks of her pre-accident employment as a personal support worker.

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 Tribunal found that the applicant failed to prove she suffered from chronic pain or a psychological condition that would warrant removal from the MIG.

The Tribunal also dismissed the claim for an income replacement benefit, finding insufficient medical evidence to demonstrate a substantial inability to perform the essential tasks of her pre-accident employment.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, which were denied by the respondent insurer.

The Licence Appeal Tribunal found that the applicant met her burden of proving that a neurological assessment, a chronic pain assessment, and chiropractic services were reasonable and necessary.

The Tribunal preferred the evidence of the applicant's treating practitioners and experts over the insurer's examiners, noting that the insurer's general practitioner was not qualified to opine on chronic pain and that the insurer's psychologist lacked specific findings to support claims of symptom exaggeration.

The application was granted, and the respondent was ordered to pay the disputed amounts with interest.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and several treatment plans.

The Tribunal found the applicant was not entitled to the non-earner benefit, as he continued to work full-time and did not suffer a complete inability to carry on a normal life.

The Tribunal allowed some of the disputed treatment plans, including physiotherapy, an in-home assessment, and a chronic pain assessment, finding them reasonable and necessary.

Other treatment plans were denied, and the Tribunal rejected the applicant's arguments that they were payable due to defective denial notices under s. 38(11).

The Tribunal awarded the applicant $500 in costs due to the respondent's unreasonable failure to comply with production orders.

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

The Licence Appeal Tribunal considered whether the applicant was entitled to psychological and physiotherapy services, interest, and an award under s. 10 of Reg. 664.

The Tribunal denied the claim for psychological services, finding the proposed treatment was not reasonable and necessary given the lack of lasting improvement.

However, the Tribunal granted the claim for physiotherapy services, noting corroborating evidence of chronic pain from treating specialists.

The claim for an award under s. 10 was dismissed as the insurer's conduct was not unreasonable.

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 a pre-existing condition, chronic pain, and a psychological impairment.

The Tribunal found the applicant's psychological evidence unpersuasive due to provisional diagnoses and inconsistencies in reporting.

The Tribunal also found insufficient evidence that pre-existing conditions precluded recovery or that the applicant suffered from chronic pain with functional impairment.

The application was dismissed, and the injuries were deemed subject to the MIG limit.

The applicant sought a determination that she sustained a catastrophic impairment and was entitled to attendant care benefits following a motor vehicle accident.

The Tribunal found that the applicant did not sustain a catastrophic impairment, as her psychological and physical impairments did not meet the threshold of three or more marked impairments under Criterion 8.

The Tribunal also denied the claim for attendant care benefits, finding that the applicant failed to prove her spouse suffered an economic loss to provide the care, and therefore the expenses were not incurred.

Claims for interest and a special award were also dismissed.

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 claimed she suffered from psychological impairments and chronic pain warranting removal from the MIG.

The Tribunal found the applicant failed to provide compelling medical evidence of a psychological impairment or chronic pain, preferring the respondent's expert reports which indicated no significant impairments.

As the $3,500 MIG limit had been exhausted, the applicant was not entitled to the disputed treatment plans, interest, or an award for unreasonable delay.

The application was dismissed.

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 Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from a psychological injury or chronic pain with functional impairment that would warrant removal from the MIG.

The Tribunal also dismissed the claims for income replacement benefits, treatment plans, and a doctor's visit expense, finding insufficient objective medical evidence to support the claims.

Consequently, claims for interest and an award were also dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied his claims for a non-earner benefit and attendant care benefits following a motor vehicle accident.

The applicant argued the adjudicator committed breaches of procedural fairness, made errors of law and fact, and exhibited a reasonable apprehension of bias.

The adjudicator dismissed the request, finding that the applicant was attempting to re-litigate his case, failed to properly pinpoint evidence in his submissions as required by the case conference order, and did not establish any procedural unfairness or errors of law or fact that would have changed the outcome.

The applicant sought payment for two treatment plans for chiropractic services following a 2017 motor vehicle accident.

The respondent denied the plans on the basis that the applicant had reached maximum medical improvement.

The adjudicator found that the applicant failed to demonstrate the treatments were reasonable and necessary, noting that the applicant only experienced temporary pain relief and that the respondent's orthopedic assessment found no ongoing accident-related physical impairment.

The application was dismissed and no interest was payable.

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

The respondent denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant suffered from a psychological impairment, removing him from the MIG.

The Tribunal ordered the respondent to pay for several treatment plans, including one where the respondent failed to provide a compliant denial notice under s. 38(8) of the Schedule.

Claims for an award for unreasonable delay were dismissed, but interest on overdue benefits was granted.

The applicant sought entitlement to statutory accident benefits for various treatment and assessment plans following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the plans were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's independent medical examiners, who found no substantial impairment and concluded the applicant had reached maximum medical improvement, over the applicant's medical evidence which lacked contemporaneous support.

The applicant sought $1,977.05 for a physiotherapy treatment plan following a motor vehicle accident.

The respondent denied the plan.

The Tribunal found that the applicant failed to meet her burden of proving the treatment was reasonable and necessary, as she did not provide sufficient specific medical evidence linking her ongoing symptoms to the proposed treatment.

The Tribunal preferred the respondent's orthopedic assessment, which concluded the applicant had reached maximal medical improvement.

The application was dismissed.

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

The Tribunal found the applicant failed to prove her injuries fell outside the Minor Injury Guideline (MIG), rejecting claims of chronic pain syndrome and psychological impairment.

However, the Tribunal held that the insurer failed to provide compliant denial notices under section 38(8) of the Schedule for both a physiotherapy treatment plan and a chronic pain assessment.

As a result, the insurer was prohibited from relying on the MIG for the periods of non-compliance and ordered to pay the incurred costs plus interest.

The applicant's claim for a special award was dismissed.

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

The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to provide objective medical evidence that his physical or psychological injuries were non-minor or that pre-existing conditions precluded his recovery within the MIG.

The Tribunal accepted the respondent's insurer's examinations, which concluded the applicant suffered no psychological impairments and only minor physical injuries.

As the MIG limits had been exhausted, the proposed treatment plans were deemed not reasonable and necessary, and the application was dismissed.