7 total
Application for accident benefits dismissed as applicant failed to prove treatment plans were reasonable and necessary.
The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to treatment plans for custom orthotics, a Functional Abilities Evaluation, and a vocational assessment.
The respondent denied the benefits based on Insurer's Examinations which concluded the treatments and assessments were not reasonable and necessary.
The Tribunal found that the applicant failed to provide sufficient contemporaneous medical evidence to support the treatment plans and preferred the respondent's expert evidence.
The application was dismissed, and claims for an award and interest were denied.
Applicant awarded income replacement benefits and a treatment plan; special award for unreasonable delay denied.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.
The insurer denied an income replacement benefit (IRB) and two treatment plans.
On a rehearing, the Tribunal found the applicant was entitled to the IRB, as medical evidence supported a substantial inability to perform the essential tasks of his pre-accident employment due to chronic pain and a right shoulder impairment.
The Tribunal denied the April 11, 2022 treatment plan as it was submitted while the applicant was in the Minor Injury Guideline (MIG) and duplicated an approved OCF-23.
The September 21, 2022 treatment plan was approved as reasonable and necessary.
The Tribunal denied the applicant's request for a special award, finding the insurer's reliance on its assessors' reports was not unreasonable.
Reconsideration granted and rehearing ordered due to Tribunal's failure to consider key medical evidence.
The applicant requested reconsideration of a Licence Appeal Tribunal decision that denied his claims for an income replacement benefit and treatment plans following a motor vehicle accident.
The Vice-Chair found that the original adjudicator made significant factual errors by overlooking a key letter from the applicant's treating physician that connected his injuries to the accident, and by failing to explicitly consider the applicant's psychological expert evidence.
These errors were found to likely have impacted the outcome of the decision.
The request for reconsideration was granted, the original decision was cancelled, and the matter was ordered to be reheard by a new adjudicator based on the existing written record.
Tribunal awards four treatment plans for physical injuries to applicant previously removed from Minor Injury Guideline.
The applicant was injured in a motor vehicle accident and sought payment for four treatment plans for chiropractic and physiotherapy services under the Statutory Accident Benefits Schedule.
The respondent insurer denied the plans, arguing the applicant's physical injuries fell under the Minor Injury Guideline and relying on an insurer's examination report.
The Tribunal found that the applicant had been removed from the Minor Injury Guideline for psychological injuries, which did not preclude treatment for physical injuries.
Relying on clinical notes and records that consistently documented the applicant's ongoing neck, back, and shoulder pain, the Tribunal concluded all four treatment plans were reasonable and necessary.
The applicant was awarded the cost of the treatment plans plus interest.
Application for accident benefits dismissed; applicant failed to prove complete inability to carry on normal life.
The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits, transportation expenses, chiropractic services, and lost educational expenses.
The Licence Appeal Tribunal dismissed the application in its entirety.
The adjudicator found the applicant failed to prove a complete inability to carry on a normal life, noting she resumed her university studies with the same course load as before the accident.
The claims for transportation and chiropractic services were dismissed for lack of evidence establishing they were reasonable and necessary.
The claim for lost educational expenses was denied because the tuition expenses were incurred after the accident, contrary to the requirements of section 21(5) of the Schedule.
Application for accident benefits largely dismissed; one chiropractic treatment plan approved for pain reduction.
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.
Applicant awarded post-104-week IRBs due to complete inability to work from post-concussion syndrome.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including post-104-week income replacement benefits (IRBs), attendant care benefits, and funding for medical assessments.
The Tribunal found the applicant was entitled to ongoing IRBs, as her post-concussion syndrome and chronic pain resulted in a complete inability to engage in any employment for which she was reasonably suited.
The Tribunal also approved a neuropsychological assessment but denied a speech language pathology assessment, noting the applicant's post-accident public speaking engagements.
Claims for attendant care benefits, a special award, and costs were dismissed.
No co-appearing lawyers found.
No judges found.