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Tribunal awards attendant care benefits and a 35% special award due to insurer's unreasonable denial.
The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care and rehabilitation benefits.
The Licence Appeal Tribunal denied attendant care benefits for the initial period because the expenses were not incurred by the applicant's daughters.
However, the Tribunal granted attendant care benefits for a subsequent period, finding them reasonable and necessary, and deemed the expenses incurred because the insurer unreasonably withheld payment by relying on an insurer's examination without explaining why it preferred that report over contemporaneous medical evidence.
The Tribunal also approved a treatment plan for life skills training.
Due to the insurer's lack of transparency and unreasonable conduct in denying the attendant care benefits, the Tribunal ordered a special award of 35% under s. 10 of O. Reg. 664, plus interest.
Accident benefits claims dismissed as applicant failed to prove injuries warranted removal from the Minor Injury Guideline.
The applicant was involved in two separate motor vehicle accidents and sought statutory accident benefits, which the respondent insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).
The applicant argued that his physical and psychological injuries, as well as pre-existing conditions, warranted removal from the MIG.
The Tribunal found that the applicant failed to provide persuasive medical evidence, such as diagnoses from qualified practitioners, to prove his injuries extended beyond the MIG definition.
The Tribunal preferred the evidence of the respondent's physiatrists, who concluded the injuries were soft tissue in nature and treatable within the MIG.
As the applicant had exhausted the MIG limits for both accidents, the claims for outstanding treatment plans and interest were dismissed.
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline.
The applicant sought non-earner benefits, medical and rehabilitation benefits, and attendant care 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 she did not meet the test for non-earner benefits.
The Tribunal found that the applicant failed to provide compelling evidence to prove she suffered a complete inability to carry on a normal life.
Furthermore, the Tribunal concluded that the applicant's injuries were minor and she had exhausted the MIG limit, disentitling her to the claimed medical and attendant care benefits.
The application was dismissed.
No co-appearing lawyers found.
No judges found.