Dr. Janet Clewes

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

The respondent denied various treatment plans and assessments on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG due to alleged concussions, chronic pain, and psychological conditions.

The Tribunal found that the applicant failed to establish an accident-related concussion, chronic pain with functional impairment, or a psychological condition warranting removal from the MIG.

The Tribunal preferred the respondent's medical assessments, which aligned with contemporaneous medical records, over the applicant's self-reported symptoms.

As the applicant remained subject to the MIG, the disputed treatment plans were not analyzed for reasonableness and necessity, and the application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident but was denied by the respondent on the basis that her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG due to a psychological condition, relying on a psychological assessment conducted via video call.

The Tribunal preferred the respondent's in-person psychological assessment, which found no psychological condition, noting it included validity testing and was conducted directly by a psychologist.

The Tribunal held the applicant to the MIG limit and dismissed the claims for disputed treatment plans and interest.

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

The Tribunal found that the applicant sustained a psychological condition as a result of the accident, warranting removal from the Minor Injury Guideline (MIG).

The applicant was denied funding for five chiropractic treatment plans and a psychological assessment due to insufficient evidence.

However, the Tribunal approved a treatment plan for a chronic pain assessment, finding reasonable grounds based on family doctor records.

The applicant was awarded interest on overdue benefits but denied a special award under s. 10 of Reg. 664.

The applicant sought statutory accident benefits following a motor vehicle accident, including a determination of catastrophic impairment under Criterion 8 (mental and behavioural disorders), income replacement benefits, attendant care benefits, and various treatment plans.

The Tribunal found that the applicant did not meet the catastrophic impairment threshold, as she failed to establish a marked impairment in the sphere of social functioning, noting her ongoing close familial relationships and 18-month post-accident employment at a school.

The Tribunal also dismissed the claims for income replacement benefits, finding the respondent's medical experts persuasive that she did not suffer a substantial inability to perform her pre-accident employment tasks.

The claims for attendant care benefits and treatment plans were dismissed due to a lack of evidence demonstrating the expenses were incurred or reasonable and necessary.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent insurer's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed physical injuries including whiplash and soft tissue sprains, as well as psychological impairments such as an adjustment disorder.

The Licence Appeal Tribunal found that the applicant's physical injuries were captured by the minor injury definition and that he failed to provide compelling medical evidence of a pre-existing condition or a psychological impairment warranting removal from the MIG.

Consequently, the applicant was held to the $3,500 MIG limit and denied the disputed treatment plans beyond that cap, though he was awarded interest on any overdue payments within the limit.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, arguing his physical and psychological injuries warranted removal from the Minor Injury Guideline (MIG).

The Tribunal found no medical evidence linking his subsequent diagnoses of anxiety, depression, and bipolar disorder to the accident, noting they arose from personal and pandemic-related stressors.

Relying on insurer examinations that found no residual physical impairment or accident-related psychological injury, the Tribunal concluded the applicant failed to prove his injuries fell outside the MIG.

The application for treatment plans and interest was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found his injuries fell within the Minor Injury Guideline (MIG) and denied his claim for ongoing Income Replacement Benefits (IRB).

The applicant argued the Tribunal breached procedural fairness, ignored new medical evidence, and erred in fact regarding the MIG and the IRB dispute period.

The adjudicator found no breach of procedural fairness and held that the new evidence could have been obtained prior to the hearing.

While the adjudicator agreed the Tribunal made a factual error regarding the dates in dispute for the IRB claim, upon reviewing the evidence for the corrected period (February 26, 2020 to April 23, 2023), the adjudicator concluded the applicant failed to prove a substantial inability to perform the essential tasks of his employment.

The reconsideration was allowed in part to correct the dates, but the claim for ongoing IRB was dismissed.

The applicant sought accident benefits following a motor vehicle accident, which the respondent insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG due to chronic pain, but the Tribunal found insufficient evidence of functional limitations or psychological impairment to warrant removal.

The Tribunal also dismissed the applicant's claim for a non-earner benefit, noting a lack of evidence demonstrating a complete inability to carry on a normal life.

Finally, the Tribunal found the respondent provided sufficient medical reasons for denying the disputed treatment plans within the required timelines.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming chronic pain and psychological impairments warranted removal from the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found the applicant failed to provide compelling medical evidence of chronic pain syndrome or psychological impairment caused by the accident.

The Tribunal preferred the respondent's section 44 assessments, which found the applicant's injuries were minor and did not result in functional impairment.

The application was dismissed, and the disputed treatment plans were denied.

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

The respondent insurer denied benefits beyond the Minor Injury Guideline (MIG) limit and alleged the applicant was barred from receiving Income Replacement Benefits (IRB) due to a material misrepresentation regarding the use of his vehicle for ride-sharing.

The Tribunal found the respondent failed to prove the vehicle was used for ride-sharing, so the applicant was not barred from IRB and the respondent was not entitled to repayment of previously paid IRB.

However, the Tribunal concluded the applicant's injuries were predominantly minor, preferring the respondent's medical experts over the applicant's expert due to a lack of objective evidence.

As the MIG limit was exhausted, the applicant was not entitled to the disputed medical and attendant care benefits.

The applicant sought attendant care benefits and several treatment plans for psychological, chiropractic, and occupational therapy services following a motor vehicle accident.

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

The Tribunal preferred the respondent's insurer's examination reports over the applicant's medical evidence, noting significant contradictions between the applicant's own examination under oath testimony—where she reported being largely independent and emotionally well—and the severe impairments documented by her assessors.

The applicant sought 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 that she was barred from proceeding for failing to attend an insurer's examination.

The Tribunal found the applicant was not barred from proceeding because the respondent failed to prove notice of the examination was sent.

However, the Tribunal concluded the applicant's injuries were minor, as there was no compelling evidence that her pre-existing psychological conditions or back pain were exacerbated by the accident or precluded her recovery within the MIG limits.

As the MIG limit was exhausted, the application for a psychology assessment and other benefits was dismissed.

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

The respondent determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and capped medical and rehabilitation benefits at $3,500.

The applicant applied to the Licence Appeal Tribunal, arguing that pre-existing conditions, chronic pain, and psychological impairments warranted removal from the MIG.

The Tribunal found insufficient evidence to support the applicant's claims, preferring the respondent's independent medical examination reports over the applicant's orthopaedic expert.

The Tribunal concluded the applicant sustained minor injuries, and having exhausted the $3,500 limit, was not entitled to further chiropractic benefits, interest, or an award.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident.

The respondent denied the claim, arguing the applicant failed to comply with section 33 requests for information regarding a potential address misrepresentation, and alternatively, that the applicant did not meet the disability test.

The Tribunal found the applicant did not have a reasonable explanation for failing to provide most of the requested documents, justifying the respondent's withholding of benefits.

Substantively, relying on the respondent's insurer's examinations, the Tribunal concluded the applicant did not suffer a substantial inability to perform the essential tasks of his pre-accident employment as a cleaner.

The claims for IRBs, an award, interest, and costs were dismissed.

The applicant sought various statutory accident benefits following a motor vehicle accident, including attendant care benefits and multiple treatment plans for psychological and physical injuries.

The Licence Appeal Tribunal denied the claim for attendant care benefits because the applicant failed to prove the expenses were incurred.

However, the Tribunal ordered the insurer to pay for several treatment plans, including a psychological assessment and physical therapy, because the insurer failed to provide proper medical reasons for its denials as required by section 38(8) of the Schedule.

The Tribunal also approved a chronic pain assessment and shockwave therapy based on medical evidence of ongoing pain, but denied other treatment plans for lack of evidence of reasonableness and necessity.

The claim for a special award was dismissed.

The applicant sought statutory accident benefits, including an income replacement benefit and medical treatment, following a motor vehicle accident.

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

The Tribunal found that the applicant's physical injuries were predominantly minor and that she failed to prove a psychological impairment or that a pre-existing condition prevented her maximal recovery.

The Tribunal also dismissed the claim for an income replacement benefit, as the applicant had continued to work post-accident and did not demonstrate a substantial inability to perform the essential tasks of her employment.

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

The insurer denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's pre-existing psychological condition was exacerbated by the accident, removing her psychological impairments from the MIG and entitling her to a psychological assessment.

However, the applicant failed to prove her physical injuries were outside the MIG, so her claims for physiotherapy and an attendant care assessment were denied.

The claim for an award for unreasonable withholding of benefits was also dismissed.

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

The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 cap.

The applicant argued his injuries were not predominantly minor, citing a pre-existing condition and psychological impairment.

The Tribunal found no compelling evidence of a pre-existing condition that would prevent maximal recovery under the MIG, nor sufficient evidence of a psychological injury.

The Tribunal concluded the applicant's injuries fell within the MIG and dismissed the application.