5 total
Accident benefits denied as applicant misrepresented employment status and failed to prove impairments.
The applicant sought statutory accident benefits, including income replacement benefits and medical benefits, following a motor vehicle accident.
The adjudicator found the applicant to be an unreliable witness who misrepresented her post-accident employment status.
The applicant's claim for a chiropractic treatment plan was barred by the two-year limitation period.
The claims for income replacement benefits and other medical benefits were dismissed as the applicant failed to prove she suffered a substantial inability to perform her employment tasks or that the treatments were reasonable and necessary.
Claims for interest and a special award were also dismissed.
Application for income replacement benefits dismissed due to lack of contemporaneous medical evidence of disability.
The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming she was substantially unable to perform her pre-accident employment tasks.
The Licence Appeal Tribunal dismissed the application, finding the applicant failed to provide contemporaneous medical evidence of disability during the claim period.
The Tribunal relied on insurer's examinations and the applicant's successful enrollment in a computerized accounting program to conclude she was not disabled from her sedentary administrative duties.
Claims for an award and interest were consequently dismissed.
Application for accident benefits dismissed; injuries fell within the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident.
The insurer denied treatment plans for chiropractic care and a psychological assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant failed to provide medical evidence to show her injuries fell outside the MIG, including failing to meet the criteria for chronic pain.
The Tribunal also found the requested treatment plans were not reasonable and necessary, as the applicant provided no evidence of treatment goals or incurred expenses.
The application was dismissed.
Application for accident benefits dismissed as shoulder injury was pre-existing and psychological treatment was unnecessary.
The applicant sought medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a rear-end motor vehicle accident.
The insurer denied treatment plans for physiotherapy, psychological services, a neuropsychological assessment, and an attendant care assessment.
The Tribunal found that the applicant's left shoulder injury was a pre-existing condition that was not caused or exacerbated by the accident, failing the "but for" causation test.
The Tribunal preferred the insurer's psychological assessment over the applicant's experts, finding insufficient objective evidence to support a psychological diagnosis.
The application was dismissed, and no benefits or interest were awarded.
Applicant removed from Minor Injury Guideline but denied treatment plans for failing to specify provider details.
The adjudicator found that the applicant's injuries fell outside the Minor Injury Guideline (MIG) due to pre-existing physical conditions and an exacerbation of psychological injuries, relying on the respondent's own Insurer's Examination reports.
However, the adjudicator dismissed the claims for various treatment plans, finding them not reasonable and necessary because they proposed block fees without specifying the provider or duration of modalities, contrary to the Professional Services Guideline.
Claims for the costs of disability certificates, interest, and costs of the proceeding were also dismissed.
No co-appearing lawyers found.
No judges found.