Dr. L. Koepfler

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a non-earner benefit, medical benefits, and assessment costs.

The insurer initially denied the claims on the basis of the Minor Injury Guideline but later conceded the injuries were non-minor.

The Tribunal found the applicant was not entitled to a non-earner benefit because she continued to engage in substantially all of her pre-accident activities, despite some limitations.

However, the Tribunal ordered the insurer to pay for occupational therapy, physiotherapy, and the costs of psychological, occupational therapy, and chronic pain assessments, finding them reasonable and necessary.

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's injuries were minor and subject to the $3,500 funding limit under the Minor Injury Guideline (MIG), denying several treatment and assessment plans.

The applicant argued she suffered from psychological impairments and chronic pain.

The Tribunal found the applicant did not sustain a psychological impairment, preferring the respondent's psychological assessment over the applicant's evidence.

The Tribunal also found the applicant did not meet the criteria for chronic pain syndrome, preferring the respondent's musculoskeletal assessments over the family doctor's diagnosis.

As the injuries were minor and the funding limit was exhausted, the disputed treatment plans were not payable.

Claims for interest and costs were dismissed.

Both parties requested reconsideration of a decision regarding entitlement to statutory accident benefits following a motor vehicle accident.

The Applicant argued the Tribunal violated procedural fairness by admitting college records and failing to address a costs request, and made errors of fact and law in weighing medical evidence.

The Respondent argued the Tribunal erred in its interpretation of the Schedule regarding assessment fee limits.

The Tribunal granted the Applicant's request in part to address the omitted costs request, which was ultimately denied, and dismissed all other grounds for reconsideration, finding no significant errors of law or fact that would have changed the outcome.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs) and various medical treatment plans.

The insurer initially placed the applicant in the Minor Injury Guideline (MIG) and denied several treatment plans, later removing her from the MIG for psychological impairments but terminating IRBs based on insurer examinations.

The Licence Appeal Tribunal found that the applicant was not entitled to further IRBs, as she did not suffer a substantial inability to perform her essential tasks as an Uber driver, noting she was enrolled in a full-time massage therapy program.

The Tribunal upheld the insurer's denial of most treatment plans under s. 38(5) of the Schedule, but approved one physiotherapy plan and the balance of a psychological assessment.

Claims for an award for unreasonable delay were dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and medical benefits from her insurer.

The insurer initially classified her injuries under the Minor Injury Guideline (MIG) and denied several treatment plans, later removing her from the MIG for psychological impairments but terminating IRBs based on insurer examinations.

The Licence Appeal Tribunal found that the applicant was not entitled to further IRBs, as she failed to prove a substantial inability to perform her essential tasks as an Uber driver, noting she was enrolled in a full-time massage therapy program.

The Tribunal upheld the insurer's denial of early treatment plans under section 38(5) of the Schedule but approved one physiotherapy plan and the balance of a psychological assessment, along with applicable interest.

The claim for an award for unreasonable delay was dismissed.

The insurer appealed arbitration decisions that dismissed its motions to compel the insured to attend insurer examinations and ordered it to pay a special award for unreasonably delaying benefits.

The insured cross-appealed the denial of a special award for other periods of delay.

The Director's Delegate dismissed both appeals.

The Delegate found that the arbitrators did not err in law in refusing the insurer examinations, as the insurer had delayed its requests until after the arbitration process was well underway.

Furthermore, the insurer's concession of entitlement during the hearing precluded a finding that it was denied a fair hearing.

The Delegate upheld the special award, finding no basis to interfere with the arbitrator's assessment of the insurer's unreasonable conduct, and agreed that the insurer's delay while seeking a stay of an interim order was not unreasonable.

The applicant was injured in a minor motor vehicle accident and sought caregiver benefits under the Statutory Accident Benefits Schedule.

The insurer terminated weekly caregiver benefits, and the applicant applied for arbitration.

The arbitrator found that the applicant's testimony regarding her inability to perform caregiver duties was contradicted by statements she made to various medical assessors.

Relying on independent medical examinations which found no musculoskeletal impairment and noted symptom magnification, the arbitrator concluded the applicant failed to prove a substantial inability to engage in her pre-accident caregiving activities.

The arbitrator also found that any psychological issues were more likely related to pre-existing family stressors rather than the minor accident.

The arbitration was dismissed.