Dr. Belfon

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

The respondent initially placed the applicant in the Minor Injury Guideline and denied treatment plans based on section 44 assessments.

After receiving further medical documentation, the respondent voluntarily removed the applicant from the guideline and approved the disputed treatment plans.

The applicant sought a special award under section 10 of Regulation 664, arguing the 90-day delay in adjusting the file was unreasonable.

The Tribunal dismissed the claim for an award, finding the insurer's reliance on its assessors and subsequent good-faith adjustment of the file upon receiving new evidence did not constitute excessive or imprudent delay.

The applicant was awarded interest on the overdue benefits.

The applicant sought accident benefits following a motor vehicle accident, claiming removal from the Minor Injury Guideline (MIG) due to a concussion and psychological impairment, as well as entitlement to income replacement benefits (IRBs) and various treatment plans.

The Tribunal found the medical evidence did not support a concussion or psychological impairment, keeping the applicant within the MIG and denying the treatment plans.

Although the applicant failed to meet the substantive test for IRBs, the Tribunal awarded IRBs from February 27, 2023, to April 14, 2023, because the insurer failed to respond to the disability certificate within the required 10 business days under s. 36(4) of the Schedule.

Claims for an award were dismissed.

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 that the applicant suffered from a psychological condition, specifically Adjustment Disorder with mixed anxiety and depressed mood, which removed her from the MIG.

The Tribunal preferred the evidence of the applicant's psychological assessor over the respondent's assessor.

Consequently, the Tribunal concluded that all disputed treatment plans for psychological and chiropractic services were reasonable and necessary, and ordered the respondent to pay them with interest.

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

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

The Tribunal found that the applicant sustained a concussion, removing her from the MIG.

However, the Tribunal dismissed the claim for the physiotherapy treatment plan, finding that the applicant failed to meet her onus to prove the treatment was reasonable and necessary.

Claims for an award and interest were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain and psychological impairment.

The Licence Appeal Tribunal found the applicant's evidence insufficient to establish chronic pain or a psychological condition, preferring the respondent's medical examination which diagnosed soft-tissue injuries.

The Tribunal also found the respondent's denial notices complied with the Schedule.

The application was dismissed, and the applicant was denied the disputed treatment plans, interest, and an award.

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 he should be removed from the MIG due to chronic pain with a functional impairment.

The adjudicator found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain with a functional impairment, noting that insurer examinations identified no functional impairments and the applicant continued to work two jobs.

As the applicant remained within the MIG limit, he was not entitled to the disputed treatment plans or interest.

The application was dismissed.

The applicant sought entitlement to two treatment plans for physiotherapy services totaling $6,775.13 following a motor vehicle accident.

The respondent denied the benefits.

The Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, noting that the applicant had returned to work and pre-accident activities, and that a home exercise program was sufficient.

The Tribunal preferred the evidence of the respondent's medical examiner over the applicant's chronic pain expert.

The application was dismissed and no interest was awarded.

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

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

The applicant sought removal from the MIG on the basis of chronic pain and psychological impairment.

The Tribunal found that the applicant failed to meet the burden of proving chronic pain, as he did not meet the AMA Guides criteria and the respondent's medical examination was preferred.

The Tribunal also found insufficient evidence of a psychological impairment.

The applicant was held to remain within the MIG and was entitled only to the remaining balance of the $3,500 limit, plus interest on any overdue payments.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

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

The Tribunal found that the applicant suffered from chronic pain syndrome with functional impairment, removing him from the MIG.

The Tribunal ordered the respondent to pay for a chronic pain assessment and a psychological assessment, finding them reasonable and necessary.

The applicant's claim for an award for unreasonable delay was dismissed, but interest on overdue payments was granted.

The applicant sought income replacement benefits following a motor vehicle accident.

The respondent denied the benefits and raised a preliminary issue that the applicant was statute-barred from claiming pre-104 benefits due to her failure to attend section 44 insurer examinations.

The Tribunal agreed, finding the applicant failed to attend properly scheduled examinations without a reasonable explanation.

Regarding post-104 benefits, the Tribunal found the applicant did not suffer a complete inability to engage in employment, noting she had returned to work and closed her business due to pandemic lockdowns rather than accident-related impairments.

The claims for benefits, interest, and an award were dismissed.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident.

The respondent denied treatment plans for chronic pain and psychological assessments, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant suffered from chronic pain syndrome with functional impairment, removing him from the MIG.

The Tribunal ordered the respondent to pay for the chronic pain and psychological assessments, plus interest, finding them reasonable and necessary.

The applicant's claim for an award for unreasonable delay was dismissed, as the respondent had relied on its section 44 assessors.

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 that the applicant suffered from chronic pain with functional impairment, removing him from the MIG.

The Tribunal ordered the respondent to pay for massage, chiropractic, and physiotherapy treatment plans, as well as a psychological assessment, finding them reasonable and necessary.

The claim for an attendant care assessment was dismissed, as was the claim for an award under Regulation 664, because the respondent had not acted unreasonably given the late production of medical evidence.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to non-earner benefits and medical benefits for psychological and chiropractic services.

The insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that she failed to comply with section 33 requests for information.

The Tribunal found that the applicant's non-compliance with section 33 relieved the insurer of liability for non-earner benefits.

Furthermore, the Tribunal concluded the applicant sustained predominantly minor injuries, as she failed to prove pre-existing conditions, psychological impairments, or chronic pain that would warrant removal from the MIG.

Consequently, the disputed treatment plans were not reasonable and necessary as they exceeded the $3,500 MIG limit.

The application was dismissed.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision.

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

The Tribunal found that the applicant failed to prove she suffered from a pre-existing condition, a concussion, or chronic pain that would warrant removal from the MIG.

Consequently, the applicant was not entitled to the disputed treatment plans as they exceeded the $3,500 funding limit, and no interest was payable.

The application was dismissed.

The applicant sought entitlement to eight treatment plans for physiotherapy and interest under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The adjudicator found that the applicant failed to prove the treatment plans were reasonable and necessary, noting a lack of evidence showing the goals of treatment or how they would be met.

The adjudicator accepted the respondent's medical examination report, which concluded the applicant had reached maximum medical recovery.

The application was dismissed.

The applicant was involved in a motor vehicle accident and sought non-earner benefits and medical benefits for chiropractic treatment under the Statutory Accident Benefits Schedule.

The respondent denied the benefits.

The Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, as she was still able to engage in substantially all of her pre-accident activities, particularly caring for her children.

The Tribunal also found that the proposed treatment plans were not reasonable and necessary, as the applicant had reached maximal recovery from her accident-related injuries and the treatments appeared to be directed at a transient ischemic attack that was not caused by the accident.

The application was dismissed.

The applicant sought a non-earner benefit and various medical and assessment costs following a motor vehicle accident.

The adjudicator found that the applicant did not meet the test for a non-earner benefit, as video surveillance and independent medical examinations demonstrated he had returned to most activities of daily living and his ongoing impairments were largely attributable to pre-existing cancer and chemotherapy.

The claims for psychological treatment, attendant care assessment, and chronic pain assessment were dismissed as not reasonable and necessary.

The adjudicator approved the balance of a psychological assessment and dismissed the claim for a special award.

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

The insurer denied a treatment plan for physiotherapy on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The adjudicator found that the applicant's injuries, primarily soft tissue sprains and strains, were predominantly minor and that there was insufficient evidence of chronic pain or functional impairment to warrant treatment beyond the MIG limit.

As the MIG limit was exhausted, the treatment plan was not payable, and claims for interest and a special award were dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for a psychological assessment and chiropractic treatment.

The respondent insurer denied the treatment plans following insurer's examinations.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment and assessment plans were reasonable and necessary, noting a lack of compelling contemporaneous medical evidence and preferring the respondent's expert reports which indicated minimal psychological and physical impairment.

The application was dismissed and no interest was payable.

The applicants, a mother and son, sought statutory accident benefits following a motor vehicle accident.

The mother claimed caregiver, housekeeping, and medical benefits, while the son claimed income replacement and medical benefits.

The arbitrator dismissed all claims, finding severe credibility issues with both applicants' evidence.

The mother's testimony regarding the children she cared for, her residential address, and her employment of a caregiver was riddled with inconsistencies and contradicted by documentary evidence.

The son's evidence regarding his pre-accident employment and income was also found to be unreliable.

The insurer's medical assessments, which concluded the son's injuries fell within the Minor Injury Guideline, were accepted.