3 total
Application for accident benefits dismissed as issue estoppel barred relitigating the applicant's Minor Injury Guideline status.
The applicant sought various medical and rehabilitation benefits following a motor vehicle accident.
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 issue of the applicant's MIG status had already been decided in a previous hearing, and therefore the doctrine of issue estoppel applied.
The Tribunal rejected the applicant's argument that new medical reports constituted fresh evidence or that fairness required waiving issue estoppel, as the reports did not establish that her pre-existing osteoarthritis would prevent maximal recovery under the MIG.
The application was dismissed.
Insured entitled to treatment outside the Minor Injury Guideline due to pre-existing condition and shoulder tear.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a job demands analysis.
The respondent insurer denied the treatment plan, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Licence Appeal Tribunal found that the applicant's injuries were not predominantly minor, relying on medical evidence of a labral tear and a pre-existing C7 nerve root condition that would prevent maximal recovery under the MIG.
The Tribunal ordered the respondent to pay the remaining balance of the treatment plan and interest on the overdue payment, but denied the applicant's request for costs.
Interim attendant care benefits awarded pending catastrophic impairment arbitration due to prima facie case and hardship.
The applicant, a wheelchair user, was injured when a bus stopped suddenly.
The insurer terminated attendant care and housekeeping benefits after 104 weeks, finding she did not suffer a catastrophic impairment.
The applicant brought a motion for interim benefits pending arbitration.
The arbitrator found the applicant established a prima facie case that she suffered a total and permanent loss of use of her left arm, meeting the catastrophic impairment definition.
The arbitrator also found urgency and hardship, as the applicant required additional attendant care following her husband's death to avoid moving to a long-term care facility.
Interim attendant care benefits of $1,117.25 per month were awarded, but interim housekeeping benefits were denied.
No co-appearing lawyers found.
No judges found.