33 total
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline limits.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming her chronic pain and psychological injuries warranted removal from the Minor Injury Guideline (MIG).
The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor.
The Tribunal preferred the evidence of the insurer's examiners, noting that the applicant's experts failed to explain how her pain improved over time and then worsened years later, and that her psychological assessment was conducted by a panel lacking a qualified psychologist or psychiatrist.
As the applicant had exhausted her $3,500 MIG limit, her claims for further medical benefits, an award, and interest were dismissed.
Application for accident benefits dismissed; injuries fell within the Minor Injury Guideline and IRB test unmet.
The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that their injuries fell within the Minor Injury Guideline (MIG).
The applicant also claimed entitlement to income replacement benefits (IRBs) and a physiotherapy treatment plan.
The Licence Appeal Tribunal found that the applicant's physical and psychological injuries were predominantly minor, relying on contemporaneous medical records and independent assessments.
The Tribunal also dismissed the claim for IRBs, noting a lack of medical evidence demonstrating an inability to work.
All claims were dismissed.
Application for statutory accident benefits dismissed as treatment plans were not reasonable and necessary.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to psychological treatment, a driver's reintegration evaluation, and physiotherapy.
The respondent insurer denied the benefits, and the applicant applied to the Licence Appeal Tribunal.
The Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, relying on the opinions of the insurer's examiners who found no ongoing musculoskeletal or neurological impairment and that the psychological treatment proposed was excessive or premature.
The application was dismissed.
Application for accident benefits dismissed as applicant failed to prove entitlement beyond the Minor Injury Guideline.
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.
Application for non-earner benefits dismissed as applicant failed to prove complete inability to carry on normal life.
The applicant sought a non-earner benefit (NEB), interest, and an award following a motor vehicle accident.
The respondent denied the NEB and requested the applicant attend insurer's examinations.
The applicant challenged the sufficiency of the notices of examination and the experts' duty forms.
The Tribunal found the notices of examination were sufficient and that the applicant failed to comply with the rules for challenging expert reports.
On the merits, the Tribunal held the applicant failed to prove he suffered a complete inability to carry on a normal life, preferring the respondent's medical evidence which was obtained during the disputed period over the applicant's evidence obtained well after.
The claims for NEB, interest, and an award were dismissed.
The respondent's request for costs was also dismissed as the applicant's conduct was not frivolous or vexatious.
Application for accident benefits dismissed as injuries were predominantly minor with no functional impairment.
The respondent denied several benefits, arguing the applicant's injuries fell within the Minor Injury Guideline and were subject to the $3,500 coverage limit.
The Tribunal found that the applicant's physical injuries were sprains and strains, which are defined as minor injuries.
The Tribunal preferred the psychological evidence indicating the applicant's psychological symptoms were subclinical and did not impair her function, supported by contemporaneous counselling records showing she maintained a normal, active lifestyle.
The Tribunal also rejected the argument that chronic pain removed the applicant from the minor injury limit, as there was no evidence of functional impairment.
Consequently, the claims for attendant care, treatment plans, and a non-earner benefit were dismissed.
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident, arguing his physical injuries, chronic pain, and psychological impairments warranted removal from the Minor Injury Guideline (MIG).
The Licence Appeal Tribunal found that the applicant's partial supraspinatus tear and C6 radiculopathy met the definition of minor injuries.
Applying the four-part test for chronic pain, the adjudicator concluded the applicant failed to demonstrate severe and constant pain or functional impairment sufficient to remove him from the MIG.
The Tribunal also accepted the respondent's psychological assessment finding no psychological injury.
As the injuries fell within the MIG and the respondent provided valid denials for the disputed treatment plans, the application was dismissed, and no interest or awards were granted.
The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.
The applicant argued her injuries fell outside the MIG due to a pre-existing condition, chronic pain syndrome, and psychological impairments.
The Tribunal found insufficient compelling medical evidence to establish a pre-existing condition or chronic pain syndrome.
Applying the "but for" test for causation, the Tribunal concluded the applicant's psychological impairments were related to social, work, and family stressors rather than the accident.
Non-earner benefit granted; accident-related psychological impairments and sleep deprivation caused complete inability to carry on normal life.
The applicant was injured in a motor vehicle accident and sought a non-earner benefit, which the respondent insurer denied.
The Tribunal applied the Heath test to compare the applicant's pre- and post-accident activities.
Finding the applicant's evidence credible and preferring the applicant's psychological expert over the insurer's assessors, the Tribunal concluded that the applicant's accident-related impairments, including severe sleep deprivation, panic attacks, and driving anxiety, continuously prevented her from engaging in substantially all of her pre-accident activities.
The Tribunal ordered the respondent to pay the non-earner benefit of $185.00 per week from May 27, 2016, ongoing, plus interest.
Applicant removed from Minor Injury Guideline due to chronic pain; chiropractic treatment approved, psychological assessment denied.
The respondent insurer denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that while the applicant did not suffer a psychological injury warranting removal from the MIG, he did establish a chronic pain condition that placed his claims outside the MIG.
The Tribunal approved the treatment plan for chiropractic services as reasonable and necessary, but denied the treatment plan for a psychological assessment.
Interest was awarded on the overdue payments for the approved chiropractic treatment.
Application for accident benefits dismissed due to unreliable self-reporting and undisclosed returns to work.
The applicant was injured in a motor vehicle accident and sought Income Replacement Benefits (IRBs) and medical benefits for chiropractic services.
The insurer terminated IRBs and denied further treatment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and he was able to return to work.
The Tribunal found the applicant's self-reporting to be unreliable, noting he had returned to work multiple times without disclosing it to the insurer or medical assessors.
Relying on independent medical examinations and surveillance evidence, the Tribunal concluded the applicant did not suffer a substantial inability to perform the essential tasks of his employment and his injuries were treatable within the MIG.
Application for non-earner, attendant care, and medical benefits dismissed for failure to meet evidentiary burdens.
The applicant sought entitlement to a non-earner benefit, attendant care benefits, and medical benefits for dental services and a TMJ assessment following a motor vehicle accident.
The Licence Appeal Tribunal dismissed all claims.
The adjudicator found the applicant failed to provide a pre-accident baseline to establish a complete inability to carry on a normal life for the non-earner benefit.
The attendant care claim was denied because the applicant failed to prove the expenses were incurred, relying on non-contemporaneous expense sheets.
The medical benefits were denied due to insufficient evidence establishing a causal link between the accident and the dental/TMJ issues.
Claims for statutory accident benefits dismissed due to unreliable testimony and significant pre-existing medical history.
The applicant was injured in a motor vehicle accident and claimed statutory accident benefits for caregiving, attendant care, housekeeping, and a psychological assessment.
The insurer denied the claims.
The arbitrator found the applicant's testimony unreliable and preferred the clinical notes of his family physician, which showed a significant pre-accident history of kidney stones and narcotic drug dependence.
The arbitrator concluded the applicant was not substantially disabled from his pre-accident activities shortly after the accident and was not the primary caregiver of his children.
The claim for the psychological assessment was denied because the application form did not meet the statutory screening requirements and the assessment relied on inaccurate pre-accident history.
All claims, including a claim for a special award, were dismissed.
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