27 total
Application for post-104 week income replacement benefits dismissed as applicant failed to meet complete inability test.
The applicant sought post-104 week income replacement benefits following a motor vehicle accident.
The insurer denied the benefits, arguing the applicant did not meet the complete inability test.
The Tribunal found that the applicant failed to establish on a balance of probabilities that she suffered a complete inability to engage in any employment or self-employment for which she was reasonably suited.
The Tribunal noted the applicant's pre-existing health issues and failure to address causation regarding a subsequent accident.
The medical evidence provided did not sufficiently address the complete inability test.
The application was dismissed.
Applicant awarded ongoing income replacement benefits after proving complete inability to work due to accident-related impairments.
The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) after the insurer terminated them.
The Tribunal found that the applicant, a self-employed painter and contractor, suffered a substantial inability to perform the essential tasks of his pre-accident employment within 104 weeks of the accident, primarily due to a specific phobia of driving.
For the post-104-week period, the Tribunal found the applicant was completely unable to engage in any employment for which he was reasonably suited by education, training, or experience, due to a combination of physical and psychological impairments caused by the accident.
The applicant was awarded ongoing IRBs and interest, but his claim for a special award under Regulation 664 was dismissed.
Application for catastrophic impairment dismissed; GOS-E assessment must isolate brain injury effects from other impairments.
The applicant sought a determination of catastrophic impairment under the Statutory Accident Benefits Schedule following a motor vehicle accident.
The central issue was whether the applicant's traumatic brain injury resulted in a Severe Disability or Lower Moderate Disability under the Extended Glasgow Outcome Scale (GOS-E).
The Tribunal found that the GOS-E assessment must be conducted by a physician or neuropsychologist, not an occupational therapist, and must isolate the effects of the brain injury from other physical or psychological injuries.
Preferring the evidence of the respondent's neuropsychologist, the Tribunal concluded the applicant sustained only a mild traumatic brain injury and did not meet the threshold for catastrophic impairment.
Non-earner benefit denied due to surveillance evidence; medical benefits for chronic pain granted.
The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and funding for chiropractic services and a chronic pain assessment.
The Licence Appeal Tribunal dismissed the claim for a non-earner benefit, finding that surveillance evidence and inconsistencies in the applicant's self-reporting undermined her claim of a complete inability to carry on a normal life.
However, the Tribunal granted the medical benefits, concluding that the applicant suffered from an accident-related pain condition and that the proposed treatments were reasonable and necessary to address her physical and psychological impairments.
The respondent's request for costs was denied.
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline.
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 the $3,500 limit had been exhausted.
The applicant argued her pre-existing knee osteoarthritis, psychological impairments, and chronic pain removed her from the MIG.
The Tribunal found the pre-existing condition was not exacerbated by the accident and did not prevent maximal recovery.
The Tribunal also found insufficient medical evidence to support a psychological impairment or chronic pain diagnosis that would remove the applicant from the MIG.
Income replacement benefit denied as applicant lacked credibility and failed to prove substantial inability to work.
The applicant was injured in a motor vehicle accident and sought an income replacement benefit (IRB) after initially returning to work but claiming he could not continue due to accident-related back pain.
The insurer denied the benefit, arguing the applicant lacked credibility and was terminated from his employment for other reasons.
The adjudicator found the applicant's testimony regarding his medical history and prior injuries to be highly inconsistent and lacking credibility.
Relying on the respondent's orthopedic expert who found no objective impairment, the adjudicator concluded the applicant did not suffer a substantial inability to perform his employment and dismissed the appeal.
Accident benefits denied as injuries fell within Minor Injury Guideline and applicant's expert evidence was tainted by conflict of interest.
The Applicant sought statutory accident benefits following a motor vehicle accident.
The Insurer denied several treatment plans and assessments, arguing the Applicant's injuries fell within the Minor Injury Guideline (MIG).
The arbitrator found that the Applicant's psychological and orthopaedic expert reports were tainted by a conflict of interest, as the primary psychologist had a close personal and financial relationship with the Applicant, and other experts relied on her clinic's flawed assessments.
The arbitrator excluded or gave no weight to the Applicant's expert evidence and accepted the Insurer's independent medical examinations.
The arbitrator concluded the injuries were predominantly minor and dismissed the claims for further benefits.
No co-appearing lawyers found.
No judges found.