Dr. San Bui

The applicant sought statutory accident benefits 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) and the $3,500 limit had been exhausted.

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

The Tribunal found that the applicant failed to prove that his pre-existing conditions precluded recovery within the MIG, and assigned no weight to the applicant's expert reports regarding psychological issues and chronic pain because they failed to consider an intervening accident.

The application was dismissed.

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

The respondent denied several treatment plans and withheld payment for approved services, arguing the service provider failed to provide requested information.

The Tribunal found it had jurisdiction to hear the dispute over withheld payments and ordered the respondent to pay the approved amounts, less $400 for unexplained supplementary goods.

The Tribunal dismissed the applicant's claims for further physiotherapy, a social work assessment, and disability certificates, finding them not reasonable and necessary.

Claims for an award and interest were also dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought medical and rehabilitation benefits beyond the $3,500 Minor Injury Guideline (MIG) limit, arguing that a pre-existing clavicle fracture was exacerbated, leading to chronic pain and psychological impairments.

The adjudicator found that the applicant failed to provide compelling evidence of functional impairment or disability resulting from chronic pain, noting that he continued to work and travel, and did not meet the criteria under the AMA Guides.

The adjudicator concluded that the applicant's injuries were predominantly minor and subject to the MIG limit.

As the MIG limit had been exhausted, the disputed treatment plans were denied and the application was dismissed.

The applicant sought medical 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) and the $3,500 funding limit had been exhausted.

The applicant argued that pre-existing conditions, psychological injuries, and chronic pain warranted removal from the MIG.

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

The Tribunal also determined that the applicant's psychological symptoms and pain complaints were clinically associated sequelae of his minor soft tissue injuries.

Although the respondent failed to provide timely notice of denial for one treatment plan, barring it from relying on the MIG for that specific plan, the Tribunal found the treatment was not reasonable and necessary.

The application was dismissed.

The applicant sought statutory accident benefits 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 her injuries warranted removal from the MIG, as the medical evidence confirmed only minor soft tissue injuries.

The Tribunal rejected the applicant's expert reports diagnosing chronic pain and psychological impairments, finding them unreliable and unsupported by contemporaneous medical records.

As the MIG limits were exhausted, the application for further medical and rehabilitation benefits was dismissed.

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

The central issues were whether the applicant's injuries fell within the Minor Injury Guideline (MIG) and whether the insurer's payment of over $3,500 in treatment costs constituted a waiver of the MIG limit.

The arbitrator found that the applicant's injuries were minor and that the insurer did not waive the MIG limit simply by overpaying.

The arbitrator rejected the applicant's experts' diagnoses of chronic pain and WAD III, preferring the insurer's experts who concluded the applicant suffered only soft tissue injuries.

All claims for additional rehabilitation benefits and examination costs were dismissed.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident.

The respondent denied treatment and assessment plans for chiropractic services, a social service assessment, and an orthopaedic assessment.

The Tribunal found that the applicant failed to prove the chiropractic services and orthopaedic assessment were reasonable and necessary, largely due to insufficient evidence and an unreliable affidavit from her chiropractor.

However, the Tribunal approved the social service assessment, finding it reasonable and necessary to address the applicant's relationship and job-related issues caused by the accident.

Interest was awarded on the overdue amount, and the respondent's request for costs was denied.

The applicant sought income replacement benefits and housekeeping benefits following a motor vehicle accident.

The insurer denied the claims, relying on surveillance evidence showing the applicant working at her family's dry cleaning business and performing physical tasks without apparent difficulty.

The arbitrator found the applicant and her husband lacked credibility, noting numerous contradictions in their testimony.

The arbitrator preferred the medical evidence of the insurer's experts, who concluded the applicant could perform her pre-accident work and housekeeping tasks, over the applicant's experts, who were unaware she had returned to work.

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

The applicant, a self-employed bagel maker, claimed he lost his business due to physical and mental impairments sustained in a motor vehicle accident.

He sought income replacement benefits, attendant care, housekeeping, and a determination of catastrophic impairment due to a mental or behavioural disorder.

The insurer denied the claims, alleging the applicant was malingering.

The arbitrator found that while the applicant suffered from genuine psychological dysfunction, it predated the accident and was caused by pre-existing business, financial, and marital stressors.

The arbitrator concluded the applicant did not suffer a catastrophic impairment, failed to prove pre-accident self-employment income, and unreasonably withheld business records.

All claims were dismissed except for a small amount of incurred treatment expenses, for which a 50% special award was granted due to the insurer's unreasonable denial.