Dr. O. Benmoftah

The applicant, a personal support worker struck by a motor vehicle as a pedestrian, sought statutory accident benefits including an income replacement benefit (IRB), a chronic pain assessment, and psychological treatment.

The Licence Appeal Tribunal dismissed the application.

The Tribunal found the applicant was barred from receiving an IRB for the initial period because she failed to submit a disability certificate until September 2019.

For the subsequent periods, she failed to prove a substantial or complete inability to work, as her family physician's notes indicated she was able to work after November 2018 and she provided no functional abilities evaluation.

The Tribunal also denied the chronic pain assessment and the disputed portion of the psychological treatment plan, finding them not reasonable or necessary based on the medical evidence.

The 79-year-old applicant sought non-earner benefits following a motor vehicle accident.

The insurer paid benefits until January 28, 2017, but terminated them based on multidisciplinary assessments indicating the applicant no longer suffered a complete inability to carry on a normal life.

The Tribunal applied the Heath framework and found that, due to successful physiotherapy and psychotherapy, the applicant had recovered sufficiently to engage in substantially all of his pre-accident activities.

The Tribunal also found the applicant non-compliant for failing to attend a scheduled insurer examination in September 2018, providing an independent basis for termination.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to an orthopaedic assessment and a chiropractic treatment plan.

The Licence Appeal Tribunal dismissed the application, finding that the orthopaedic assessment was a duplication of previous services and not reasonable or necessary.

The Tribunal also found that the chiropractic treatment plan addressed injuries that were not accident-related and that the applicant had already achieved several of the plan's goals.

As no benefits were payable, the claims for interest and an award for unreasonable delay were also dismissed.

The applicant sought income replacement benefits and the cost of vocational and functional abilities assessments following a motor vehicle accident.

The adjudicator found that the applicant failed to prove on a balance of probabilities that she suffered a substantial inability to perform the essential tasks of her pre-accident employment as a kitchen assistant.

The medical evidence submitted by the applicant lacked sufficient detail regarding her job duties and how her limitations impeded her capacity to work.

The claims for the cost of examinations were also dismissed as the applicant failed to prove they were reasonable and necessary.

Consequently, claims for interest and an award for unreasonable delay were denied.