4 total
Applicant found not catastrophically impaired; most treatment plans denied except for a chronic pain assessment.
The applicant sought statutory accident benefits following a 2016 motor vehicle accident, claiming catastrophic impairment under Criteria 7 (55% whole person impairment) and Criteria 8 (marked impairment in three of four domains).
The Licence Appeal Tribunal found the applicant's whole person impairment was 47%, falling short of the 55% threshold, and that he did not suffer marked impairment in social functioning.
The Tribunal denied most of the disputed treatment and assessment plans, finding them not reasonable and necessary, but approved a $2,665.50 chronic pain assessment.
Claims for attendant care benefits, an award for unreasonable delay, and costs were dismissed.
Applicant entitled to pre-104 week income replacement benefits but denied post-104 week benefits and treatment plans.
The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB), physiotherapy, catastrophic impairment assessments, and a special award.
The Tribunal found the applicant was substantially unable to perform his pre-accident employment due to chronic pain, entitling him to an IRB up to the 104-week mark.
However, the applicant failed to prove a complete inability to engage in any suitable employment, denying him post-104 week IRBs.
The disputed treatment plans for physiotherapy and catastrophic impairment assessments were deemed not reasonable and necessary.
The claim for a special award was dismissed as the insurer reasonably relied on its medical assessments.
Income replacement and housekeeping benefits awarded for limited periods; applicant failed to prove ongoing disability.
The applicant was injured in a motor vehicle accident and sought income replacement and housekeeping benefits from his insurer.
The insurer terminated benefits, arguing the applicant failed to attend an insurer's examination and was no longer disabled.
The arbitrator found the applicant had a reasonable excuse for missing the examination due to confusing correspondence and language barriers.
The arbitrator awarded income replacement benefits for the initial period and up to February 17, 2004, finding insufficient evidence of disability beyond that date, as the applicant's leg numbness was likely a benign condition.
Housekeeping benefits were awarded at a reduced rate of $20 per week based on an in-home assessment, as the applicant's evidence regarding his pre-accident housekeeping was vague and unsupported.
Insurer awarded $21,446 repayment after applicant fraudulently misrepresented self-employment income to obtain maximum accident benefits.
The applicant was injured in a motor vehicle accident and claimed statutory accident benefits, asserting he was a successful self-employed jewellery manufacturer.
The insurer paid the maximum weekly income benefit of $600 based on a purported purchase order.
The arbitrator found that the applicant had fraudulently misrepresented the status of his business and the existence of the purchase order, and that the insurer had erred in calculating benefits based on anticipated rather than earned income.
The applicant was found to be self-employed but only entitled to the minimum weekly benefit of $185.60 for 156 weeks.
The insurer was awarded a repayment of $21,446.40 for the overpayment.
Claims for benefits beyond 156 weeks and a special award were dismissed.
No co-appearing lawyers found.
No judges found.