Dr. Rahim Jessa

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to treatment plans for chiropractic services, a chronic pain program, and an orthopaedic assessment outside the Minor Injury Guideline (MIG).

The applicant argued that a concussion, chronic pain syndrome, and psychological impairments warranted removal from the MIG.

The Tribunal preferred the respondent's expert evidence, finding that the applicant's dizziness pre-dated the accident, his pain complaints were likely degenerative, and his psychological testing was normal.

The Tribunal concluded the applicant's injuries were predominantly minor, and since the MIG limit was exhausted, the disputed treatment plans were not payable.

Claims for an award and interest were also dismissed.

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

The respondent denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's documented pre-existing chronic pain condition and accident-related psychological impairments warranted removal from the MIG.

The Tribunal ordered the respondent to pay for the disputed attendant care, chiropractic, and psychological treatment plans, along with interest, but denied the claim for assistive devices and a special award for unreasonable delay.

The applicant sought statutory accident benefits following a motor vehicle accident, including a chronic pain assessment, chiropractic treatment, and psychological services.

The Licence Appeal Tribunal found that the chronic pain assessment was incurred before the treatment plan was submitted, barring the claim.

The Tribunal also found that the applicant failed to prove the chiropractic and psychological treatments were reasonable and necessary, preferring the respondent's independent medical examination evidence.

The respondent's request for costs due to the applicant's failure to produce extended health care documents was denied, as no pecuniary prejudice was demonstrated.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought medical, rehabilitation, and income replacement benefits from the respondent insurer.

The insurer denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and terminated her income replacement benefits.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that her injuries warranted removal from the MIG on the basis of chronic pain or psychological impairment.

As the MIG limits were exhausted, the disputed treatment plans were not payable.

The Tribunal also found the applicant failed to prove a substantial inability to perform her pre-accident employment or a complete inability to engage in any employment, dismissing her claim for income replacement benefits.

The applicant sought payment for a physiotherapy treatment plan following a motor vehicle accident.

The respondent denied the plan, arguing the applicant's physical injuries were minor and subject to the Minor Injury Guideline (MIG), although the applicant was removed from the MIG due to psychological impairment.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plan was reasonable and necessary, preferring the respondent's orthopaedic assessment which concluded the physical injuries had resolved.

The application for the treatment plan, an award, and interest was dismissed.

The insurer appealed an arbitrator's preliminary decision that the insured's medical and rehabilitation claim was not subject to the $3,500 limit under the Minor Injury Guideline (MIG).

The Director's Delegate allowed the appeal, finding that the arbitrator erred by failing to apply the correct test of whether the impairment was predominantly a minor injury, improperly shifting the burden of proof to the insurer, and incorrectly concluding that the MIG was non-binding.

Furthermore, the arbitrator breached procedural fairness by conducting independent research and relying on legal arguments without giving the parties an opportunity to respond.

The decision was rescinded and the matter remitted for a full hearing before a different arbitrator.