11 total
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant argued that chronic pain and psychological impairments warranted removal from the MIG.
The Tribunal found that the applicant sustained predominantly soft-tissue injuries and failed to establish chronic pain with functional impairment or a psychological condition sufficient to remove him from the MIG.
The application for disputed treatment plans and interest was dismissed.
Application for accident benefits dismissed; applicant failed to prove psychological impairments warranting removal from the MIG.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained psychological impairments warranting removal from the Minor Injury Guideline (MIG).
The Tribunal found the applicant failed to prove on a balance of probabilities that she suffered an accident-related psychological impairment, noting a lack of corroborating medical evidence and questioning the reliability of the psychological assessment report.
As the applicant remained within the MIG, her claims for treatment plans and assessments beyond the MIG limit, as well as interest, were dismissed.
Application for statutory accident benefits dismissed as applicant failed to prove treatment plans were reasonable and necessary.
The applicant sought statutory accident benefits following a motor vehicle accident, including transportation services, chiropractic services, and psychological assessments and services.
The respondent denied or partially approved the treatment plans.
The Tribunal found that the applicant failed to prove on a balance of probabilities that the disputed treatment plans were reasonable and necessary.
The applicant did not provide sufficient medical evidence to support the need for transportation expenses, facility-based chiropractic treatment outside the Minor Injury Guideline, or extended psychological sessions.
The application was dismissed, and claims for interest and an award for unreasonable delay were also dismissed.
Application for accident benefits dismissed as applicant failed to prove psychological impairment warranting removal from MIG.
The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant applied to the Licence Appeal Tribunal, arguing he should be removed from the MIG due to a psychological impairment.
The Tribunal found the applicant failed to prove a psychological condition warranting removal, noting he returned to work shortly after the accident and his family physician's records contained no psychological complaints.
The application for physiotherapy, a psychological assessment, and interest was dismissed.
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline limit.
The applicant was involved in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.
The applicant applied to the Licence Appeal Tribunal, arguing his physical injuries fell outside the MIG and that he sustained an accident-related psychological impairment.
The Tribunal found that the medical evidence supported physical injuries consistent with the MIG, such as cervical strain and whiplash-associated disorder.
Furthermore, the Tribunal concluded the applicant did not sustain an accident-related psychological impairment, noting a lack of contemporaneous medical evidence corroborating his reported symptoms.
As the applicant remained within the MIG and the limit was nearly exhausted, the disputed treatment plans were denied.
The application was dismissed.
Applicant awarded non-earner benefits and partial treatment plans after demonstrating complete inability to carry on normal life.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a non-earner benefit and various treatment plans for chiropractic and psychological services.
The respondent denied the benefits.
The Licence Appeal Tribunal found that the applicant suffered a complete inability to carry on a normal life due to chronic pain and psychological impairments, entitling her to the non-earner benefit for the maximum 104-week period.
The Tribunal also partially approved several treatment plans for physical rehabilitation, acupuncture, and a psychological assessment, finding them reasonable and necessary.
Claims for an award under s. 10 of Reg. 664 were dismissed, but interest on overdue benefits was granted.
Application for accident benefits dismissed; applicant failed to prove impairments warranting removal from the Minor Injury Guideline.
The respondent denied benefits beyond the $3,500 Minor Injury Guideline (MIG) limit.
The applicant argued that her physical injuries, pre-existing alopecia, psychological impairments, and chronic pain warranted removal from the MIG.
The Tribunal found that the applicant's physical injuries were uncomplicated soft-tissue injuries.
The Tribunal preferred the respondent's medical evidence, noting that the applicant's psychological and chronic pain diagnoses were not supported by her family physician's clinical notes and records, and that her experts failed to review fulsome medical documentation.
The application was dismissed, and the disputed treatment plans were found not payable.
The applicant sought statutory accident benefits following a 2014 motor vehicle accident.
The insurer denied certain treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant argued for removal from the MIG based on physical injuries, psychological impairment, and chronic pain.
The Tribunal found the applicant failed to meet the evidentiary burden to prove her injuries warranted removal from the MIG.
The Tribunal preferred the insurer's medical examinations over the applicant's evidence, noting inconsistencies and a lack of functional impairment.
The application was dismissed, and the disputed treatment plans, interest, and award were denied.
Psychological benefits and driver assessment granted; physical therapy and orthopaedic assessments denied for lack of objective evidence.
The applicant was injured in a motor vehicle accident and sought medical benefits and cost of examinations under the Statutory Accident Benefits Schedule.
The insurer denied the claims, initially relying on the Minor Injury Guideline (MIG) limits, though it later conceded the applicant was removed from the MIG due to a psychological impairment.
The Tribunal found that the requested psychological services and driver reintegration assessment were reasonable and necessary, preferring the evidence of the applicant's psychologist over the contradictory reports of the insurer's expert.
However, the Tribunal dismissed the claims for physiotherapy, an orthopaedic assessment, and a functional abilities evaluation, finding insufficient objective evidence to support them and noting the applicant's own report that physical therapy was no longer helpful.
The claim for a special award under s. 10 of Regulation 664 was dismissed as the insurer's reliance on its experts' reports was not unreasonable.
Insurer ordered to pay medical benefits, examination costs, and a $5,000 special award for unreasonable delay.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits, which the insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).
The arbitrator found that the applicant's injuries, which included chronic pain, a head injury resulting in hearing impairment, and psychological impairments, took him outside the MIG.
The arbitrator ordered the insurer to pay for the disputed medical benefits and the costs of various examinations.
Although the applicant established an entitlement to attendant care benefits, the claim was dismissed because the quantum could not be proven under section 19(3)4 of the Schedule.
The arbitrator also ordered the insurer to pay a $5,000 special award for unreasonably delaying and withholding benefits, noting the insurer's failure to properly investigate the applicant's head injury and chronic pain.
Arbitrator dismisses claims for further accident benefits, finding injuries fell within WAD II Guideline.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement, medical, and housekeeping benefits.
The insurer terminated benefits, arguing the applicant's injuries fell within the Pre-approved Framework Guideline for Whiplash Associated Disorder Grade II (WAD II).
The arbitrator found that the applicant's impairments did not fall outside the WAD II Guideline, relying on independent assessments and surveillance evidence showing the applicant working and driving.
The arbitrator dismissed the claims for further medical treatment, income replacement, and housekeeping benefits, and ordered the applicant to repay an overpayment of income replacement benefits.
The claim for a special award was also dismissed as the insurer acted reasonably.
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