Dr. Yahmad

The insurer applied for repayment of $10,571.43 in income replacement benefits (IRBs) paid to the insured person, while the insured person sought entitlement to various treatment plans and an award for unreasonable delay.

The Tribunal found that the insurer provided a valid and timely repayment notice and was entitled to the full repayment amount, as the insured person had returned to work earning her pre-accident wages and failed to comply with section 33 requests for income information.

The Tribunal denied the insured person's claims for physiotherapy and medication, finding insufficient evidence of reasonableness and necessity, but approved a neurology assessment plan based on persistent post-concussion symptoms.

Claims for an award and costs were dismissed.

The applicant sought income replacement benefits (IRB) and medical benefits for chiropractic treatment following a motor vehicle accident.

The respondent denied the benefits based on multiple insurer's examinations (IEs) which concluded the applicant did not suffer a substantial inability to perform the essential tasks of his employment.

The Tribunal found that the applicant failed to meet his burden of proof, as his family doctor's clinical notes did not directly attribute his ongoing pain to the accident and did not address his inability to work.

The Tribunal accepted the consistent findings of the respondent's IE assessors and dismissed the claims for IRB, medical benefits, interest, and an award.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a catastrophic impairment and was entitled to post-104 income replacement benefits, attendant care, and various medical benefits.

The Licence Appeal Tribunal dismissed the application.

The Tribunal gave no weight to the applicant's key expert psychiatrist, who recanted his findings during cross-examination when confronted with evidence of the applicant's actual functional capabilities, including international travel and childcare.

Consequently, the applicant failed to prove she met the criteria for catastrophic impairment or that she suffered a complete inability to engage in suitable employment.

As the non-catastrophic benefit limits were exhausted, all claims were dismissed.

The applicant sought medical and rehabilitation benefits, including chronic pain treatment, an MRI, and orthopaedic and neurological assessments, following a 2016 motor vehicle accident.

The insurer denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to establish that the treatments and assessments were reasonable and necessary.

The Tribunal preferred the objective evidence of the insurer's assessors over the applicant's chronic pain specialist, noting the applicant did not meet the AMA Guides criteria for chronic pain syndrome.

The applicant was injured in a motor vehicle accident while skateboarding and sought statutory accident benefits for chiropractic services, assistive devices, and psychological services.

The respondent denied the treatment plans on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant failed to provide sufficient medical evidence to support the need for the proposed treatments, noting that independent medical examinations concluded the applicant had reached maximal medical recovery.

The Tribunal also found no evidence that the assistive devices expense was incurred, and that the applicant had impliedly consented to the hourly rate paid for psychological services.

The application was dismissed.

The applicant was severely injured in a head-on motor vehicle collision and applied for statutory accident benefits.

After exhausting non-catastrophic limits, she sought a determination of catastrophic impairment and entitlement to further attendant care, housekeeping, and medical/rehabilitation benefits.

The Tribunal found the applicant catastrophically impaired under Criterion 7, accepting a combined Whole Person Impairment rating of 59% based on physical and mental/behavioral impairments, including a mild traumatic brain injury.

The Tribunal awarded attendant care and housekeeping benefits for incurred amounts, as well as an occupational therapy treatment plan, but dismissed claims for physiotherapy and a special award.

The applicant was also ordered to repay income replacement benefits received while employed.

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

The insurer denied the plans based on section 44 assessments indicating the applicant had achieved maximal medical recovery.

The Tribunal found the applicant failed to demonstrate the treatment plans were reasonable and necessary, noting limited evidence of improvement, the applicant's self-reported normal function, and the lack of objective referrals for treatment.

The application was dismissed.

The applicant was injured in a single-vehicle accident and sought a determination of catastrophic impairment based on a Glasgow Coma Scale (GCS) score of 9 or less.

The adjudicator found that while the applicant's GCS score dropped to 8T and 9T following surgery, this was due to pharmacologic sedation and intubation rather than brain impairment.

The applicant's initial GCS scores were 13 to 15, indicating no brain impairment upon arrival at the trauma centre.

The application was dismissed.