Heather Seiling

The applicant, who was struck by a car while riding his bicycle, sought $2,200 for an occupational therapy assessment and attendant care needs evaluation under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal dismissed the application, finding insufficient evidence that the treatment plan was reasonable and necessary.

The Tribunal preferred the insurer's medical evidence, noting the applicant's complex pre-existing medical history and a lack of contemporaneous medical records supporting accident-related functional impairments.

The applicant sought statutory accident benefits following a motor vehicle accident in August 2015.

She claimed entitlement to medical benefits for occupational therapy assessments, a concussion assessment, assistive devices, and retroactive attendant care benefits.

The Licence Appeal Tribunal dismissed all claims, finding that the applicant failed to demonstrate the treatment plans were reasonable and necessary.

The Tribunal preferred the respondent's expert evidence, noting the significant passage of time since the accident and the applicant's self-reported independence with activities of daily living.

The claims for retroactive attendant care benefits were denied as the applicant did not provide a reasonable explanation for the delay in submitting the required forms, nor did she prove the expenses were incurred.

Claims for interest and a special award were consequently dismissed.

The applicant sought statutory accident benefits for a chronic pain program and assistive devices (a lawn mower and snow blower) following a motor vehicle accident.

The Tribunal found that the chronic pain program was not reasonable and necessary, relying on insurer's examinations indicating the applicant had reached maximum medical recovery and was an adaptive pain coper.

The Tribunal also denied the assistive devices, noting the applicant's pre-accident inability to perform lawn care and snow removal tasks.

The application was dismissed.

The Applicant was catastrophically injured in a motor vehicle accident, sustaining a traumatic brain injury and chronic pain.

He applied for statutory accident benefits, including non-earner, attendant care, and housekeeping benefits, which the Insurer denied or underpaid.

The Arbitrator found that the Applicant suffered a complete inability to lead a normal life and awarded non-earner benefits.

The Arbitrator also deemed past attendant care and housekeeping expenses to have been incurred under s. 3(8) of the Schedule, finding that the Insurer unreasonably withheld benefits by failing to advise the impecunious and functionally illiterate Applicant that it would pay for professional services.

However, the Arbitrator declined to order a special award, finding the Insurer's conduct was not sufficiently egregious.

The applicant, a 31-year-old homemaker and mother, suffered serious physical and psychological injuries in a motor vehicle accident.

She applied for non-earner benefits, which the respondent insurer terminated.

The Tribunal applied the Heath test to determine if the applicant suffered a complete inability to carry on a normal life.

Finding the applicant and her treating practitioners credible, and placing limited weight on the insurer's assessors, the Tribunal concluded that the applicant's pain and psychological impairments continuously prevented her from engaging in substantially all of her pre-accident activities, particularly caregiving and homemaking.

The Tribunal ordered the respondent to pay the non-earner benefits and interest on overdue amounts.