Dr. Jacqueline Auguste

The applicant sought various statutory accident benefits following a motor vehicle accident, including psychological assessments, chronic pain assessments, chiropractic services, and a gym membership.

The respondent insurer denied the benefits and argued the applicant was barred from proceeding because she failed to attend a neurology insurer's examination.

The adjudicator found the neurology examination was not reasonably necessary, allowing the application to proceed.

However, the adjudicator dismissed all claims for benefits, finding the applicant failed to meet her onus to prove the treatment plans were reasonable and necessary, as she did not provide sufficient medical evidence linking her complaints to the accident or showing the goals of the treatment plans could reasonably be met.

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

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant sought removal from the MIG on the basis of psychological impairment and chronic pain.

The Tribunal found insufficient objective medical evidence to support a psychological impairment or chronic pain with functional impairment caused by the accident.

As the applicant remained within the MIG and the $3,500 limit was exhausted, the claims for further medical benefits, an award, and interest were dismissed.

The applicant sought non-earner benefits and funding for two chiropractic treatment plans following a motor vehicle accident.

The respondent denied the benefits based on insurer examinations which concluded the applicant's impairments were pre-existing and did not result in a complete inability to carry on a normal life.

The Tribunal preferred the respondent's multidisciplinary assessment over the applicant's late-filed psychological report, finding the latter lacked contemporaneous relevance and adequate documentary review.

The Tribunal dismissed the application, concluding the applicant failed to prove entitlement to the non-earner benefit or the disputed treatment plans.

The applicant sought statutory accident benefits following a 2019 motor vehicle accident.

The Tribunal found the applicant was precluded from claiming Income Replacement Benefits due to her failure to submit an OCF-3 until four years post-accident.

However, the Tribunal removed the applicant from the Minor Injury Guideline (MIG) based on uncontested psychological impairments diagnosed by her section 25 assessor.

The Tribunal approved treatment plans for psychological services, a psychological assessment, and a social work assessment, but denied physical therapy, a chronic pain assessment, and out-of-pocket expenses due to a lack of evidence linking ongoing physical complaints to the accident.

Claims for a special award and costs were dismissed.

The applicant sought income replacement benefits and approval for various treatment plans following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove on a balance of probabilities that he suffered a substantial inability to perform the essential tasks of his employment or a complete inability to engage in any employment.

The Tribunal preferred the respondent's medical evidence, noting inconsistencies in the applicant's expert reports and relying on the applicant's successful completion of a three-month accounting work placement.

The claims for treatment plans, an award, and interest were also dismissed.

The applicant sought entitlement to statutory accident benefits for chiropractic services, assistive devices, a chronic pain assessment, and a neurological assessment following a 2019 motor vehicle accident.

The respondent insurer denied the benefits and requested the exclusion of late-filed medical records, which the Tribunal allowed into evidence as the delay was minimal and non-prejudicial.

Ultimately, the Tribunal dismissed the application, finding that the applicant failed to meet her burden of proving the treatment plans were reasonable and necessary.

The Tribunal preferred the objective medical evidence from the respondent's multiple insurer's examinations, which consistently found normal ranges of motion and no objective signs of accident-related impairments warranting the disputed treatments.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to four treatment plans and attendant care benefits.

The Tribunal found the applicant was entitled to one treatment plan for physiotherapy services, as it was supported by contemporaneous medical records and recommended by the family physician.

The remaining treatment plans were denied because the applicant failed to prove they were reasonable and necessary, and the proposed assessments were duplicative.

The claim for attendant care benefits was denied because the applicant failed to provide evidence that the expenses were incurred.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's denial of several treatment plans.

The Licence Appeal Tribunal found the applicant was not entitled to a chronic pain assessment, as it would duplicate extensive assessments already completed by an orthopaedic surgeon and a neurologist.

However, the Tribunal granted the claims for physiotherapy and occupational therapy for driving anxiety, relying on medical evidence that the applicant had not reached maximal medical improvement.

The claim for assistive devices was largely denied due to a lack of supporting evidence, though a documentation fee was approved.

The Tribunal awarded interest on the overdue benefits but declined to order a special award, finding the insurer's denials were not unreasonable.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The insurer denied treatment plans for physiotherapy and an in-home occupational therapy assessment.

The Licence Appeal Tribunal found the first physiotherapy treatment plan was reasonable and necessary, as the applicant's condition had regressed when treatment was paused during the COVID-19 pandemic.

However, the Tribunal dismissed the claims for the occupational therapy assessment and a subsequent physiotherapy plan, finding insufficient medical evidence to support them.

The applicant's claim for an award for unreasonable delay was also dismissed.

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

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

The applicant claimed removal from the MIG was warranted due to psychological injuries, chronic pain, and a pre-existing right knee condition.

The Tribunal found the applicant failed to meet his burden of demonstrating his injuries fell outside the MIG.

The Tribunal preferred the respondent's psychological assessment over the applicant's, found no objective evidence of chronic pain, and concluded the pre-existing knee condition did not preclude recovery from the accident-related injuries.

The application was dismissed.

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

The insurer denied several treatment plans for physiotherapy, psychological services, and a chronic pain assessment, arguing the applicant's physical injuries fell within the Minor Injury Guideline (MIG) and the psychological treatment plans were excessive.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove that his pre-existing conditions or accident-related physical injuries precluded maximal recovery within the MIG.

The Tribunal preferred the insurer's expert evidence, which found no objective physical impairments and concluded the proposed psychological treatments and chronic pain assessment were not reasonable and necessary.

The applicant sought post-104 week income replacement benefits following a motor vehicle accident.

The insurer denied the benefits based on insurer's examinations concluding the applicant did not suffer a substantial inability to perform his pre-accident employment.

The Tribunal found the applicant failed to prove on a balance of probabilities that he suffered a complete inability to engage in any employment for which he was reasonably suited by education, training, or experience.

The Tribunal preferred the evidence of the insurer's experts, noting the applicant exaggerated his pain symptoms and his alleged impairments lacked an objective basis causally linked to the accident.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought medical, rehabilitation, and income replacement benefits from the respondent insurer.

The insurer denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and terminated her income replacement benefits.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that her injuries warranted removal from the MIG on the basis of chronic pain or psychological impairment.

As the MIG limits were exhausted, the disputed treatment plans were not payable.

The Tribunal also found the applicant failed to prove a substantial inability to perform her pre-accident employment or a complete inability to engage in any employment, dismissing her claim for income replacement benefits.

The applicant sought medical benefits for chiropractic and physiotherapy treatments following a motor vehicle accident.

The respondent denied the treatment plans on the basis that the applicant had reached maximum medical improvement from her soft tissue injuries.

The Tribunal found that the applicant's self-reports of chronic pain were not compelling and that the treatment plans were not reasonable and necessary.

The application was dismissed and no benefits or interest were awarded.

This trial determined damages for the plaintiff, Katrina Pisani, who sustained injuries in a rear-end motor vehicle collision where liability was admitted by the defendant, Holly McDaniel.

The central issue was whether the plaintiff's injuries met the "permanent serious impairment of an important physical, mental or psychological function" threshold under the Insurance Act.

The court found that the plaintiff's chronic pain, sleep disruption, fatigue, irritability, depression, and anxiety constituted permanent, serious, and important impairments, thereby meeting the threshold.

The court awarded general damages, past loss of income, loss of competitive advantage, past and future loss of housekeeping and home maintenance ability, and costs of future care.

The claim for out-of-pocket expenses was dismissed due to insufficient evidence.

The applicant sought medical benefits following a motor vehicle accident.

The respondent insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been exhausted.

The applicant argued that pre-existing conditions, psychological injuries, and chronic pain warranted removal from the MIG.

The Licence Appeal Tribunal found that the applicant failed to provide compelling medical evidence of a pre-existing condition that would prevent maximal recovery within the MIG.

The Tribunal also determined that the applicant's psychological symptoms and pain complaints were clinically associated sequelae of his minor soft tissue injuries.

Although the respondent failed to provide timely notice of denial for one treatment plan, barring it from relying on the MIG for that specific plan, the Tribunal found the treatment was not reasonable and necessary.

The application was dismissed.

The applicant sought entitlement to various statutory accident benefits, including treatment plans for an occupational therapy assessment, a functional abilities evaluation, a concussion assessment, and physical therapy, following a motor vehicle accident.

The adjudicator found that the applicant failed to provide objective medical evidence to support the treatment plans.

Relying on the respondent's insurer's examination report, which found the applicant had full range of motion and required no further facility-based treatment, the adjudicator concluded the disputed benefits were not reasonable and necessary.

The application was dismissed in its entirety.

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

The respondent denied several treatment and assessment plans, arguing they were not reasonable and necessary.

The Tribunal found that while the applicant's pre-existing degenerative disc disease and chronic pain syndrome removed her from the Minor Injury Guideline, she had reached maximum medical improvement from her accident-related injuries.

Relying on the respondent's medical examinations, the Tribunal concluded that further facility-based treatment would not yield substantial improvement.

The application for benefits, interest, and a special award was dismissed.

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

The respondent insurer denied the benefits.

The Licence Appeal Tribunal found that while the applicant's pre-existing chronic pain and degenerative disc disease removed her from the Minor Injury Guideline, she had reached maximum medical improvement from her accident-related injuries.

Relying on the respondent's medical assessments, the Tribunal concluded that further facility-based treatment was not reasonable and necessary.

The application for benefits, interest, and a special award was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her injuries, including chronic pain and psychological impairment, removed her from the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found insufficient evidence of a psychological impairment or chronic pain syndrome that caused functional impairment.

The Tribunal concluded the applicant's injuries fell within the MIG, and since the $3,500 limit had been exhausted, no further medical benefits or assessments were payable.

Claims for an award and interest were dismissed.