Dr. Tavares

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to an income replacement benefit (IRB), various treatment plans, and removal from the Minor Injury Guideline (MIG) due to psychological impairments.

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor and subject to the $3,500 MIG limit, as the psychological evidence relied entirely on self-reporting and lacked objective clinical support.

The Tribunal also dismissed the claim for an IRB, finding the applicant failed to prove a substantial inability to perform the essential tasks of his employment as a real estate agent.

All claims, including requests for interest and an award, were dismissed.

The applicant was injured in a motor vehicle accident and sought a non-earner benefit, medical and rehabilitation benefits, and the cost of an examination from the respondent insurer.

The adjudicator found that the applicant failed to prove a complete inability to carry on a normal life, as she continued to engage in her pre-accident activities of daily living.

The adjudicator also preferred the insurer's medical assessments, concluding that the proposed treatment plans and assessments were not reasonable and necessary.

The application was dismissed.

The applicant sought statutory accident benefits for chiropractic treatment, hospital expenses, and a psychological assessment 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 adjudicator found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain or a psychological impairment that would take him out of the MIG.

As the applicant had already exhausted the $3,500 MIG limit, the disputed benefits were not payable.

The respondent's request for costs was also denied.

The applicant was struck by a vehicle as a pedestrian and sought statutory accident benefits.

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

The Tribunal found that the applicant's psychological injuries, including depression and anxiety, removed her from the MIG.

The Tribunal ordered the respondent to pay for the disputed chiropractic treatment plans and a psychological assessment, finding them reasonable and necessary, along with interest on overdue payments.

Both parties' requests for costs were denied.

The applicant sought medical benefits for chiropractic treatment, a functional abilities assessment, and a catastrophic impairment assessment following a motor vehicle accident.

The respondent insurer denied the benefits on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant's physical injuries had largely resolved and her ongoing psychological issues and left thumb injury were not caused by the accident.

Relying on the family doctor's records and the insurer's examination reports, the Tribunal concluded the requested treatment and assessments were not reasonable and necessary.

The application was dismissed.

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

The insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant contended that psychological impairments and chronic pain removed him from the MIG.

The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from psychological impairments or chronic pain caused by the accident.

The Tribunal concluded the injuries were predominantly minor and treatable within the MIG.

Furthermore, the applicant was not entitled to a non-earner benefit as he did not suffer a complete inability to carry on a normal life, nor was the proposed chiropractic treatment reasonable and necessary.

The Applicant sought statutory accident benefits following two motor vehicle accidents in November 2009.

He claimed entitlement to housekeeping and home maintenance services, attendant care benefits, income replacement benefits, and various assessment expenses.

The arbitrator dismissed all claims, finding the Applicant's testimony lacked credibility and corroboration.

The arbitrator concluded the Applicant's impairment was a Grade II whiplash-associated disorder falling within the Pre-approved Framework Guideline, precluding attendant care benefits and limiting income replacement benefits.

Furthermore, the Applicant failed to provide reasonably required employment information, barring his claim for income replacement benefits under section 33 of the SABS.