Dr. Efala

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

The Licence Appeal Tribunal found the applicant did not meet the burden of proving her injuries warranted removal from the MIG.

The Tribunal preferred the respondent's medical evidence, which included comprehensive reviews of medical records and in-person assessments, over the applicant's evidence, which was found to be contradictory and lacking in documentary review.

As the applicant remained within the MIG, her claims for various treatment plans, an award for unreasonable delay, and interest were dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied his claims for an income replacement benefit, attendant care, and medical benefits following a motor vehicle accident.

The applicant alleged the Tribunal violated procedural fairness, made errors of law and fact, heard false evidence, and sought to introduce new evidence.

The adjudicator dismissed the reconsideration request, finding no breach of procedural fairness in the Tribunal's procedural rulings or hearing management.

While acknowledging minor factual errors in the original decision, the adjudicator concluded they were inconsequential and would not have changed the outcome regarding causation of the applicant's physical and psychological impairments.

The applicant sought payment for various treatment plans for psychological therapy, physiotherapy, occupational therapy, and assessments following a motor vehicle accident.

The Licence Appeal Tribunal found that the psychological treatment plans were funded at the appropriate rate for a psychotherapist, rather than a psychologist.

The Tribunal also found that the remaining physical therapy and assessment plans were not reasonable and necessary, as the applicant had reached maximum medical recovery and further assessments would be duplicative.

The claims for a special award and interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits, medical benefits for PRP therapy, and attendant care benefits.

The Tribunal found that the applicant's physical impairments, specifically severe osteoarthritis in his hips, and his psychological impairments were not caused by the accident but were pre-existing or related to his termination from employment.

The Tribunal preferred the evidence of the respondent's insurer examination assessors over the applicant's experts, noting the applicant's lack of credibility and his experts' failure to review pre-accident medical records.

The application was dismissed in its entirety.

The applicant was injured while riding a public bus and sought statutory accident benefits, including non-earner benefits, catastrophic impairment assessments, and various medical and rehabilitation benefits.

The Licence Appeal Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, dismissing the claim for non-earner benefits.

However, given the applicant's significant pre-existing conditions and accident-related physical and psychological injuries, the Tribunal found the catastrophic impairment assessments reasonable and necessary, excluding a file review fee.

The Tribunal also approved a neurological assessment and a psychological treatment plan, while dismissing the remaining treatment plans.

The applicant sought entitlement to statutory accident benefits for a chronic pain assessment and a neurological assessment following a 2015 motor vehicle accident.

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

The Tribunal preferred the evidence of the respondent's medical examiners, which indicated the applicant's injuries were manageable with soft tissue interventions and that his neurological symptoms were likely unrelated to the accident.

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

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits, which the respondent insurer denied.

The applicant applied to the Licence Appeal Tribunal to dispute the denial of treatment plans for a chronic pain assessment, psychological assessment and services, and chiropractic services.

The adjudicator found that the applicant established he suffered from chronic pain syndrome as a result of a coccyx fracture, making the chronic pain assessment reasonable and necessary.

However, the applicant failed to prove on a balance of probabilities that he sustained accident-related psychological injuries or required further chiropractic treatment.

The application was allowed in part, with the respondent ordered to pay for the chronic pain assessment with interest.

The applicant, who was involved in a motor vehicle accident, sought payment for various treatment plans including a neurological assessment, physiotherapy, chiropractic treatment, and psychological services under the Statutory Accident Benefits Schedule.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that the disputed treatment plans were reasonable and necessary.

The adjudicator noted inconsistencies in the applicant's self-reporting to assessors compared to her family doctor's records, and found the expert reports provided by both parties to be problematic or unpersuasive.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and various medical and rehabilitation benefits.

The Tribunal found that the applicant was not employed at the time of the accident and therefore did not qualify for IRBs.

The Tribunal also dismissed the claims for an orthopedic mattress, chiropractic treatment, and psychological treatment, finding that the impairments were either pre-existing or the treatments were not proven to be reasonable and necessary.

The application was dismissed in its entirety.

The applicant was injured in a motor vehicle accident and sought Income Replacement Benefits (IRB) and medical benefits under the Statutory Accident Benefits Schedule.

The respondent denied the benefits.

The Tribunal found the applicant was substantially unable to perform the essential tasks of her pre-accident employment as a cleaner for the first 104 weeks, entitling her to IRB for that period.

However, the applicant failed to prove a complete inability to engage in any employment for which she was reasonably suited beyond the 104-week mark, as she had subsequently worked as a caregiver.

The claims for psychological and physiotherapy treatment plans were dismissed for lack of evidence proving they were reasonable and necessary.

A claim for a special award was also dismissed.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that awarded the applicant the cost of an orthopaedic assessment.

The Tribunal originally found that the insurer failed to provide a 'clear and unequivocal' denial of the treatment plan and that the insurer requested an insurer's examination more often than reasonably necessary.

On reconsideration, the Vice-Chair held that the Tribunal made significant errors of law and fact, noting that section 38(8) of the Schedule does not require a 'clear and unequivocal' denial and that the insurer's notice was compliant.

The Vice-Chair also found a breach of procedural fairness because the insurer was not given an opportunity to make submissions on the frequency of examinations.

Upon reviewing the merits, the Vice-Chair concluded the applicant failed to prove the orthopaedic assessment was reasonable and necessary, and varied the decision to dismiss the application for the assessment.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming a substantial inability to perform the essential tasks of her employment as a personal support worker.

The respondent denied the IRBs and sought repayment for an alleged overpayment.

The Tribunal found that the applicant failed to prove a substantial inability to work, as the medical evidence indicated she was engaging in modified work duties and failed to delineate her essential tasks.

The Tribunal also dismissed the respondent's claim for repayment, finding insufficient evidence to prove the overpayment was actually advanced and received.

Both the applicant's claim and the respondent's claim for repayment were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including medical benefits and income replacement benefits (IRBs).

The insurer denied the claims on the basis that the applicant's impairments fell within the Minor Injury Guideline (MIG) and that he did not meet the disability test for IRBs.

The arbitrator dismissed all of the applicant's claims, finding significant credibility issues due to inconsistent reporting of pre-accident medical history, post-accident employment, and income.

The arbitrator concluded that the applicant's impairments were predominantly minor injuries and that he failed to prove a substantial inability to perform the essential tasks of his pre-accident employment, noting that he had worked in physically demanding jobs post-accident.