Fiona Kalp

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and occupational therapy.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued she was removed from the MIG due to a partial rotator cuff tear, right arm radiculopathy, and a psychological impairment.

The Tribunal found that the applicant failed to prove on a balance of probabilities that she suffered from radiculopathy or an accident-related psychological impairment that would remove her from the MIG.

As the injuries were predominantly minor and the funding limit was exhausted, the claims for treatment plans and interest were dismissed.

The applicant was catastrophically impaired in a motor vehicle accident and sought statutory accident benefits, including attendant care and home modifications.

The respondent insurer partially denied the claims based on its own assessments.

The Licence Appeal Tribunal found that the applicant's functional limitations, including cognitive and physical impairments, necessitated the maximum attendant care benefit of $6,000 per month and home modifications totaling $344,864, which included an in-home elevator and therapy room.

The Tribunal also awarded the cost of a housing analysis assessment but denied the cost of a second attendant care assessment submitted prematurely.

Finally, the Tribunal ordered a special award under s. 10 of Regulation 664, finding the respondent unreasonably withheld benefits by failing to properly investigate the applicant's functional needs despite having access to medical evidence supporting the claims.