Dr. Dumitrascu

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

The respondent insurer deemed her injuries to fall within the Minor Injury Guideline (MIG), capping her medical and rehabilitation benefits at $3,500.

The applicant applied to the Licence Appeal Tribunal, arguing she should be removed from the MIG due to chronic pain and pre-existing conditions.

The Tribunal found that the applicant failed to meet her burden of proving a chronic pain condition, preferring the thorough and uncontested evidence of the respondent's medical experts.

The Tribunal also found no evidence that any pre-existing conditions prevented maximal recovery within the MIG limits.

Consequently, the applicant's injuries were deemed minor, and her claims for further medical benefits and interest were dismissed.

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

The insurer denied treatment plans for chiropractic care and a psychological assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that while the applicant's physical injuries were predominantly minor, she had demonstrated on a balance of probabilities that she sustained psychological and neurological impairments justifying removal from the MIG.

The Tribunal approved the $2,200 psychological assessment as reasonable and necessary, but denied the $2,095.28 chiropractic treatment plan, finding the physical complaints did not warrant further facility-based intervention.

The applicant was injured in a motor vehicle accident and sought medical benefits, cost of examinations, and a non-earner benefit.

The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to prove on a balance of probabilities that she suffered from chronic pain, a psychological impairment, or a pre-existing condition that would remove her from the MIG.

Furthermore, the applicant did not meet the Heath test to establish a complete inability to carry on a normal life.

The application for benefits was dismissed.

The applicant sought medical and rehabilitation 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 treatment cap had been exhausted.

The applicant argued that his injuries were not minor due to chronic pain, neurological injury, post-concussive syndrome, pre-existing conditions, and psychological impairment.

The Tribunal found that the applicant failed to prove on a balance of probabilities that his physical or psychological injuries fell outside the MIG.

The Tribunal preferred the respondent's s. 44 psychological assessment over the applicant's evidence and rejected the applicant's argument that cultural differences invalidated the respondent's assessment.

The application was dismissed.

The applicant insurer sought judicial review of a Director's Delegate decision upholding an arbitrator's award for private school tuition and a special award for unreasonably withholding benefits under the Statutory Accident Benefits Schedule.

The Divisional Court found the Delegate's broad interpretation of 'incurred' and 'undertaken' under s. 15 of SABS was reasonable.

The court also upheld the finding that the insurer unreasonably denied benefits by relying on flawed expert reports and ignoring the insured's future needs.

The court fixed the quantum of the special award at $20,000.

The appellant insurer appealed an arbitrator's decision granting a special award to the respondent for unreasonably withholding payments for rehabilitation support worker services and private school tuition.

The Director's Delegate confirmed the appeal decision, finding that there was an adequate evidentiary foundation to support the arbitrator's finding that the insurer acted unreasonably.

The insurer had failed to consider new information, including a DVD with statements from the respondent's rehabilitation team, and relied on overlapping and preliminary assessments to deny benefits.