Dr. Michael Ko

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal found that while the applicant's pre-existing chronic pain and degenerative disc disease removed her from the Minor Injury Guideline, she had reached maximum medical improvement from her accident-related injuries.

Relying on the respondent's medical assessments, the Tribunal concluded that further facility-based treatment was not reasonable and necessary.

The application for benefits, interest, and a special award was dismissed.

The applicant, a 69-year-old retiree, was involved in a motor vehicle accident and sought a non-earner benefit from the respondent insurer.

The respondent denied the benefit, arguing the applicant did not suffer a complete inability to carry on a normal life and had a pre-existing shoulder injury.

The Tribunal found that the applicant failed to establish that his impairment continuously prevented him from engaging in substantially all of his pre-accident activities.

Medical evidence and the applicant's own self-reporting indicated he had returned to most of his activities of daily living.

The application for a non-earner benefit was dismissed, and the respondent's request for costs was also dismissed.

The applicant was involved in a rear-end motor vehicle accident and sought statutory accident benefits for a chronic pain assessment.

The respondent insurer denied the benefit, arguing the applicant's ongoing impairments were related to pre-accident workplace injuries.

The Tribunal found that the accident materially contributed to the applicant's impairments and that the chronic pain assessment was reasonable and necessary to determine if the applicant suffered from chronic pain syndrome.

The Tribunal ordered the respondent to pay the $2,010.10 cost of the assessment plus interest.

The applicant sought ongoing income replacement benefits, a special award, interest, and costs following a motor vehicle accident.

The insurer had initially terminated the applicant's income replacement benefits based on Insurer Examinations placing her within the Minor Injury Guideline, but later reinstated them after receiving additional medical records.

The Tribunal held it lacked jurisdiction under section 281 of the Insurance Act to order ongoing benefits after reinstatement.

The Tribunal dismissed the claim for a special award under Regulation 664, finding the adjuster acted properly based on the medical evidence available at the time.

Claims for interest and costs were also dismissed.

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

The respondent denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that she did not meet the test for income replacement benefits (IRB).

The adjudicator found that the applicant's injuries, which included chronic pain syndrome and a partial rotator cuff tear, took her outside the MIG.

The adjudicator approved all but one of the disputed treatment plans, finding them reasonable and necessary to address her chronic pain and functional limitations.

The adjudicator also found the applicant was substantially unable to perform the essential tasks of her pre-accident employment as a packing finisher, entitling her to IRBs.

Interest was awarded on overdue payments, but a claim for a special award under Regulation 664 was denied.

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

The insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG due to pre-existing conditions, chronic pain, and psychological injuries.

The Tribunal found that the applicant failed to provide compelling evidence to establish any of these exceptions, preferring the objective evidence of the insurer's examiners over the applicant's self-reported symptoms and clinical impressions.

The Tribunal also dismissed the claim for Income Replacement Benefits, finding insufficient evidence of a substantial inability to perform the essential tasks of pre-accident employment.

The appeal was denied.

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

The respondent insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG), subjecting her to a $3,500 treatment limit.

The applicant argued she should be exempted from the MIG due to pre-existing conditions and a psychological impairment.

The Tribunal found that the applicant failed to provide compelling evidence of a pre-existing condition that would prevent maximal medical recovery within the MIG.

Furthermore, the Tribunal rejected the claim of psychological impairment due to unexplained discrepancies in the applicant's self-reporting to different medical experts.

The Tribunal concluded the injuries were predominantly minor, the $3,500 cap applied, and no further benefits or interest were payable.

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

The respondent insurer denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 limit.

The applicant argued for removal from the MIG based on a pre-existing knee condition, chronic pain, and psychological impairments.

The Tribunal found insufficient evidence that the pre-existing condition would prevent maximal recovery.

Relying on the respondent's independent medical examinations, the Tribunal concluded the applicant did not suffer from chronic pain or a psychological impairment caused by the accident.

The injuries were deemed predominantly minor, and the claims for chiropractic services were denied.

The applicant sought statutory accident benefits for a psychological assessment and a chronic pain assessment 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 applicant failed to prove she suffered from a psychological impairment or chronic pain that would remove her from the MIG, preferring the respondent's medical assessments which aligned with the family physician's clinical notes.

The Tribunal also found insufficient evidence that a pre-existing shoulder condition prevented maximal recovery.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's denial of psychological services, chiropractic treatments, a chronic pain assessment, and a chronic pain program.

The Licence Appeal Tribunal found the psychological, chiropractic, and chronic pain program treatments to be reasonable and necessary, preferring the evidence of the applicant's treating practitioners over the insurer's assessors.

The claim for a chronic pain assessment was denied as redundant.

The applicant was awarded interest on overdue payments, but claims for a special award and costs were dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic and psychological services.

The respondent insurer denied the treatment plans based on insurer examinations which found no objective physical impairments and concluded that the applicant's psychological symptoms were related to pre-existing behavioural issues rather than the accident.

The adjudicator agreed with the respondent's medical experts, finding that the applicant failed to prove the treatments were reasonable and necessary.

The application was dismissed.

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

The insurer terminated the IRB claim, alleging the applicant wilfully misrepresented her employment status by working after the accident while claiming to be disabled.

The arbitrator found that while the applicant did wilfully misrepresent that she had not worked on several specific days, the misrepresentation was not 'material' enough to justify terminating all benefits, as the insurer could simply deduct the earnings from the IRB.

The arbitrator awarded the IRB (less a deduction for days worked) and a medical benefit, but denied an attendant care assessment.

A special award of $2,000 was also ordered against the insurer for unreasonably withholding benefits, though the amount was tempered due to the applicant's own deceitful conduct.

The Applicant sought payment for three chiropractic treatment plans and non-earner benefits following a 2015 motor vehicle accident.

The insurer denied the claims on the basis that the Applicant's injuries fell within the Minor Injury Guideline (MIG) and were not reasonable and necessary.

The Tribunal found the Applicant lacked credibility due to inconsistent statements about his employment and failure to disclose a prior 2013 accident with similar injuries.

The Tribunal accepted the insurer's independent medical examinations, concluding the Applicant failed to prove his impairments were directly caused by the 2015 accident or that he met the test for non-earner benefits.

The appeal was dismissed entirely.