Dr. K. Rod

The applicant sought entitlement to income replacement benefits, various medical benefits, interest, and an award under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application in its entirety.

The adjudicator found the applicant did not qualify for income replacement benefits as she was not employed for 26 of the 52 weeks prior to the accident and was receiving the Canadian Emergency Response Benefit, not Employment Insurance.

The claims for a chronic pain assessment, psychological treatment, and chiropractic treatment were denied as the applicant failed to demonstrate they were reasonable and necessary, with the adjudicator preferring the respondent's medical evidence.

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

The respondent initially placed the applicant in the Minor Injury Guideline but later removed him.

The Tribunal found that proposed chiropractic treatments were not reasonable and necessary, as the applicant had reached maximum medical recovery and past treatments provided little relief.

However, the Tribunal approved a chronic pain assessment, finding it reasonable and necessary because the applicant met the AMA Guides criteria for chronic pain syndrome and had been diagnosed with chronic pain by multiple practitioners.

Claims for a special award and costs were dismissed.

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

The respondent determined the applicant sustained a minor injury, subjecting her to the Minor Injury Guideline (MIG) and its $3,500 funding limit, and denied her claims for non-earner benefits and certain treatment plans.

The Tribunal found that the applicant's injuries were predominantly minor soft-tissue injuries and that her pre-existing chronic pain and psychological issues were not materially exacerbated by the accident.

The Tribunal preferred the respondent's expert evidence, which incorporated a review of pre-accident medical records, over the applicant's experts who relied solely on self-reporting.

The application was dismissed, as the applicant failed to prove her injuries fell outside the MIG or that she suffered a complete inability to carry on a normal life.

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

The insurer denied certain medical benefits, arguing the injuries fell within the Minor Injury Guideline (MIG) and its $3,500 funding limit.

The Tribunal found the applicant suffered from chronic pain syndrome, removing him from the MIG.

The Tribunal ordered the insurer to pay for the disputed treatment plans, plus interest, and awarded the applicant 40% of the withheld amounts under section 10 of O. Reg. 664 due to the insurer's unreasonable denial without obtaining its own medical assessment.

The insurer brought a motion to stay the arbitration pending the insured's attendance at a proposed medical examination by a physiatrist.

The insured had previously been assessed by the same physiatrist, but subsequently submitted new medical reports from specialists diagnosing chronic pain syndrome and a complete inability to work.

The arbitrator found that the proposed examination was reasonably necessary to assist the insurer in determining the insured's entitlement to ongoing income replacement benefits in light of the significant new medical information.

However, the arbitrator declined to stay the arbitration, finding it premature to address the consequences of a potential failure to attend.