Dr. K. Lawson

The applicant sought non-earner benefits following a motor vehicle accident.

The adjudicator found that the applicant failed to prove on a balance of probabilities that he suffered a complete inability to carry on a normal life, as he provided insufficient evidence regarding his pre-accident activities and time commitments.

The adjudicator preferred the respondent's multidisciplinary assessment report, which concluded the applicant did not meet the test.

The application was dismissed.

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

The respondent insurer determined the injuries fell within the Minor Injury Guideline (MIG) and refused to fund several treatment and assessment plans.

The applicant applied to the Licence Appeal Tribunal, arguing that rotator cuff tendinopathy, psychological injuries, and chronic pain removed her from the MIG.

The Tribunal found that the rotator cuff injury met the definition of a minor injury and that there was insufficient evidence of psychological injuries or chronic pain, preferring the insurer's examination reports over the applicant's orthopaedic assessment.

The Tribunal concluded the applicant sustained predominantly minor injuries, making the disputed treatment plans and interest not payable as they exceeded the $3,500 funding limit.

The applicant, who sustained a catastrophic impairment including a traumatic brain injury in a motor vehicle accident, sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The insurer denied several treatment plans for physiotherapy, occupational therapy, speech-language therapy, and a multi-disciplinary residential program in the United States.

The arbitrator found that the insurer improperly relied on outdated or flawed assessor reports and failed to give adequate weight to the objective evidence of the applicant's treating professionals.

All disputed treatment plans were found to be reasonable and necessary, and the applicant was awarded the claimed benefits with interest.

The Appellant was injured in a motorcycle accident and sought ongoing post-104 week income replacement benefits (IRBs) and a special award from his insurer.

The Arbitrator awarded IRBs for a limited period and denied the special award.

On appeal, the Appellant argued he was entitled to ongoing IRBs due to the insurer's procedural non-compliance with termination requirements and that he met the post-104 week disability test.

The Director's Delegate dismissed the IRB appeal, finding no error of law and affirming that procedural errors do not grant benefits in perpetuity.

However, the Delegate rescinded the denial of the special award, finding the Arbitrator failed to provide adequate reasons addressing whether the insurer's continued refusal to pay IRBs was reasonable in light of new medical evidence provided.

The special award issue was remitted for redetermination.