Himadri Kaul

The applicant, who suffered a lower limb amputation in a motor vehicle accident, sought $8,000.49 for assistive devices including an adjustable bed, platform bed, and specialty bedding.

The respondent had partially approved the treatment plan for a memory foam mattress but denied the remaining items.

The Tribunal found that the applicant failed to prove the disputed items were reasonable and necessary.

Relying on the respondent's in-home occupational therapy assessment, the Tribunal concluded the applicant could safely transfer using his existing bedframe and that comfort alone did not satisfy the statutory criteria for funding.

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

The adjudicator found that the applicant should be removed from the Minor Injury Guideline due to chronic pain with functional impairment.

However, the applicant was not entitled to a non-earner benefit because he did not suffer a complete inability to carry on a normal life, as he continued to work part-time and perform some daily activities.

The adjudicator approved several treatment plans for physiotherapy and an in-home assessment because the insurer failed to provide valid denial notices under s. 38(8) of the Schedule.

Claims for a chiropractic examination, an award, and costs were dismissed.

The applicant sought entitlement to various treatment plans for occupational therapy, physiotherapy, and psychological services following a motor vehicle accident.

The respondent denied the benefits, arguing they were not reasonable and necessary and that the claims were barred by the 260-week limitation period under s. 20(1) of the Schedule.

The Tribunal found that while the claims were not time-barred, the applicant failed to provide sufficient evidence to prove the treatment plans were reasonable and necessary.

The application was dismissed.

The applicant, who sustained a catastrophic impairment including a traumatic brain injury in a motor vehicle accident, sought various statutory accident benefits.

The Licence Appeal Tribunal found the applicant was entitled to a non-earner benefit for a limited period, as she demonstrated a complete inability to carry on a normal life.

The Tribunal also approved a treatment plan for psychological services, finding it reasonable and necessary given her ongoing psychological impairments.

However, claims for a rehabilitation support worker, occupational therapy, kinesiology, and life skills training were dismissed due to insufficient evidence or because similar previously approved funds remained unutilized.

The claim for a special award was dismissed as the insurer did not act in bad faith.

The applicant sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent insurer denied the treatment plans.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the disputed treatment plans were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's assessors, noting credibility issues and a lack of contemporaneous medical evidence supporting the applicant's assessors.

Claims for interest and an award for unreasonable delay were also dismissed.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, claiming catastrophic impairment due to psychological disorders.

The Licence Appeal Tribunal found that while the applicant suffered from accident-related post-traumatic stress disorder and major depressive disorder, these resulted in only moderate impairments in the activities of daily living and social functioning.

Consequently, the applicant did not meet the threshold for catastrophic impairment under Criterion 8.

The Tribunal also dismissed claims for attendant care benefits, finding them not reasonable and necessary based on orthopedic evidence of normal range of motion.

Claims for an attendant care assessment and various treatment plans were dismissed because the applicant had exhausted the $65,000 non-catastrophic funding limit.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming catastrophic impairment, income replacement benefits, and various medical and assessment costs.

The Licence Appeal Tribunal found that the applicant did not meet the threshold for catastrophic impairment under either Criterion 7 (55% whole person impairment) or Criterion 8 (marked impairment in three spheres of functioning), preferring the evidence of the respondent's assessors.

The Tribunal also dismissed the claims for income replacement benefits, an accounting report, catastrophic assessment costs, and social worker treatment, finding them either unsupported by evidence or exceeding allowable rates.

The applicant was precluded from disputing a treatment plan due to failing to attend an insurer examination.

However, the Tribunal granted the cost of assistive devices, finding them reasonable and necessary to help the applicant with housekeeping tasks.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, including a cannabis prescription, physiotherapy, occupational therapy, and assistive devices.

The insurer denied the cannabis prescription pending a section 44 assessment, which the applicant refused to attend, arguing it was unreasonable and not permitted for prescription drugs.

The Tribunal held that the applicant was barred from proceeding with the cannabis claim because the insurer's request for a section 44 assessment was reasonable and properly noticed.

The Tribunal further dismissed the claims for physiotherapy, occupational therapy, and a rollator walker, finding that the applicant failed to prove the treatment plans were reasonable and necessary, preferring the evidence of the insurer's assessors who found the applicant's soft tissue injuries were uncomplicated.