6 total
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 denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant argued she suffered from psychological impairments and chronic pain that warranted removal from the MIG.
The Tribunal found the applicant failed to provide compelling evidence of an accident-related psychological impairment or functional impairment resulting from chronic pain.
Consequently, the applicant's injuries were deemed predominantly minor, and she was not entitled to the disputed physiotherapy treatment plan or interest.
Application for accident benefits dismissed; applicant failed to prove injuries fell outside the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming her injuries fell outside the Minor Injury Guideline (MIG) due to a pre-existing medical condition, chronic pain, psychological impairments, and physical limitations.
The Tribunal found that the applicant failed to provide sufficient medical evidence from specialists to prove she could not attain maximal recovery within the MIG or that she developed chronic pain syndrome or a psychological impairment.
Relying on the respondent's specialist assessments, the Tribunal concluded the applicant's injuries remained within the MIG.
As the $3,500 limit was exhausted, the disputed treatment plans, interest, and an award were denied.
Application for accident benefits dismissed; injuries fell within the Minor Injury Guideline.
The respondent insurer denied a $2,200 treatment plan for a psychological assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit was exhausted.
The applicant argued for removal from the MIG based on pre-existing conditions, chronic pain, and psychological impairment.
The Tribunal found insufficient evidence of a pre-existing condition preventing maximal recovery, no diagnosis of chronic pain, and rejected the psychological impairment claim due to inconsistencies in the applicant's self-reporting.
The application was dismissed as the injuries were deemed predominantly minor.
The central issue was whether the applicant's injuries fell within the Minor Injury Guideline (MIG), which caps treatment at $3,500.
The applicant argued that psychological impairments, chronic pain, and pre-existing conditions removed him from the MIG.
The Tribunal found that the applicant failed to provide compelling medical evidence from appropriately qualified practitioners to substantiate these claims, preferring the respondent's psychiatric and physiatry evidence.
The Tribunal also excluded the applicant's late challenge to the respondent's expert reports due to non-compliance with the Tribunal's rules on notice.
The application was dismissed, and the claimed medical benefits and assessment costs were denied.
Insurer ordered to pay 40% special award for unreasonably terminating income replacement benefits based on flawed assessments.
The applicant was injured in a motor vehicle accident and received income replacement benefits.
The insurer terminated these benefits at the 104-week mark based on a multidisciplinary assessment suggesting the applicant could perform alternative employment.
The applicant sought a special award, arguing the termination was unreasonable.
The arbitrator found that the insurer failed to critically assess the expert reports, which contained significant inconsistencies and ignored the applicant's pre-accident income and limited education.
The insurer's reliance on a flawed assessment process and failure to consider credible evidence to the contrary constituted an unreasonable withholding of benefits.
A special award of 40% of the withheld benefits was ordered.
Insurer ordered to pay income replacement benefits; accident materially contributed to applicant's psychological and physical disability.
The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them based on an orthopaedic assessment.
The applicant sought benefits for the period until he returned to full-time work, arguing that a combination of physical pain, sleep apnea, and psychological distress rendered him substantially unable to perform his sedentary job.
The arbitrator found the applicant credible and held that the accident materially contributed to his deteriorating physical and mental condition.
The arbitrator concluded the applicant was substantially disabled from performing the essential duties of his employment during the disputed period and ordered the insurer to pay the benefits with interest.
No co-appearing lawyers found.
No judges found.