Dr. Ismail

The applicant sought statutory accident benefits following a 2014 motor vehicle accident, including funding for physiatry, chronic pain, and neurological assessments, as well as assistive devices.

The respondent denied the treatment plans on the basis of a lack of contemporaneous medical evidence and the application of the Minor Injury Guideline.

The Tribunal found that the applicant failed to establish on a balance of probabilities that the disputed treatment plans were reasonable and necessary, noting the absence of contemporaneous medical records corroborating the applicant's self-reported chronic pain.

The Tribunal also found that the respondent complied with the notice requirements under s. 38(8) of the Schedule.

The application was dismissed in its entirety.

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

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

The applicant argued her injuries warranted treatment beyond the MIG due to chronic pain and psychological injuries.

The Tribunal found the applicant's injuries were predominantly soft tissue in nature and fell squarely within the definition of minor injuries.

The applicant failed to provide sufficient evidence of chronic pain syndrome or psychological impairment.

The application for medical benefits and interest was dismissed.

The applicant sought income replacement benefits (IRBs) and a special award under Regulation 664 following a motor vehicle accident.

The respondent insurer denied the benefits, arguing the applicant's impairments were based on subjective complaints and her evidence was unreliable.

The Tribunal found the applicant credible and determined she suffered a substantial inability to perform the essential tasks of her pre-accident employment as a gas bar attendant, entitling her to pre-104 week IRBs.

However, the Tribunal dismissed her claim for post-104 week IRBs, finding she failed to prove a complete inability to engage in suitable employment, as she had successfully worked part-time jobs post-accident and failed to prove her subsequent surgeries were accident-related.

The claim for a Regulation 664 award was also dismissed, as the insurer's delay in obtaining addendum reports was not unreasonable given the applicant's delay in providing requested documents.

The applicant sought a medical and rehabilitation benefit of $14,804.51 for a multidisciplinary chronic pain program following a motor vehicle accident.

The adjudicator found that the insurer's initial notices of denial were defective under s. 38(8) of the Schedule because they lacked medical reasons and failed to include the required Insurer Examination reports.

Consequently, the insurer was liable to pay for any treatment incurred between the date the notice was due and the date the defect was cured.

However, on the substantive issue, the adjudicator concluded that the treatment plan was not reasonable and necessary, as the applicant had reached maximum medical recovery, returned to full-time work, and showed no ongoing musculoskeletal or psychological impairments.

Claims for an award and costs were dismissed.

The applicant was injured in a motor vehicle accident and sought payment for two treatment plans for physiotherapy, chiropractic treatment, and massage totaling $5,769.84.

The respondent denied the plans as not reasonable and necessary.

The Tribunal found that the applicant failed to provide sufficient medical evidence to support the need for further facility-based treatment, relying instead on the uncontroverted report of the respondent's physiatrist who found no accident-related impairments.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to an income replacement benefit (IRB) and a medical benefit for acupuncture.

The adjudicator dismissed the IRB claim, finding the applicant failed to prove a substantial inability to perform the essential tasks of his employment, noting he had returned to work and collected employment insurance during the claimed period.

However, the adjudicator found the applicant's injuries were not predominantly minor injuries under the Minor Injury Guideline due to continuous and severe pain symptoms.

Consequently, the applicant was awarded the outstanding balance for the acupuncture treatment plan and interest.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for an in-home assessment, prescription medication, a chronic pain assessment, and chiropractic treatment.

The respondent insurer denied the claims.

The Licence Appeal Tribunal found that the applicant was not entitled to the in-home assessment or the prescription expenses, as the evidence did not establish they were reasonable and necessary for accident-related impairments.

However, the Tribunal granted the claims for the chronic pain assessment and chiropractic treatment, finding that the applicant's pre-existing chronic pain was exacerbated by the accident and that the proposed treatments were reasonable and necessary to manage her symptoms.

Interest was awarded on the overdue payments for the approved benefits.

Following a finding that the insurer unreasonably withheld income replacement and housekeeping benefits, the arbitrator determined the quantum of a special award under s. 282(10) of the Insurance Act.

The insurer had terminated benefits despite its own assessors concluding the applicant was unable to work and required housekeeping assistance.

The arbitrator fixed the special award at $58,000, representing approximately 20% of the withheld payments inclusive of interest, to punish the insurer's blameworthy conduct and deter future similar actions.

The applicant, a self-employed plumber, was injured in a motor vehicle accident and sought statutory accident benefits.

The insurer terminated income replacement and housekeeping benefits and denied various medical benefits.

The arbitrator found that the applicant suffered a complete inability to engage in suitable employment due to his injuries, which aggravated pre-existing conditions, and awarded ongoing income replacement benefits.

The arbitrator also awarded the claimed medical benefits, housekeeping benefits, the cost of an MRI, and interest at 2% per month.

A special award was granted against the insurer for unreasonably withholding payments, with the amount to be determined.