Dr. Lam

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

The respondent insurer denied the benefits, arguing the applicant's injuries were predominantly minor and subject to the $3,500 limit of the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's meniscal tear and unopposed psychological diagnoses warranted removal from the MIG.

However, the Tribunal only approved one treatment plan for $2,800, finding the applicant failed to provide sufficient evidence to prove the remaining claimed expenses were reasonable and necessary.

The respondent insurer requested a reconsideration of a Tribunal decision that removed the applicant from the Minor Injury Guideline (MIG) and awarded various statutory accident benefits, including non-earner benefits (NEBs) and treatment plans.

The insurer argued the Tribunal erred in fact and law on several grounds, including the applicant's failure to attend insurer examinations, the finding of chronic pain, and the start date for NEBs.

The Vice-Chair granted the reconsideration in part, expunging an erroneously awarded expense for clinical notes and records that had been resolved prior to the hearing, and amending the start date for NEBs to six months post-accident based on the applicable pre-June 1, 2016 Schedule.

The request for reconsideration was dismissed on all other grounds, as the insurer was primarily seeking to re-weigh the evidence.

The applicant, a pedestrian struck by a vehicle, sought a non-earner benefit, the cost of a chronic pain assessment, and a medical benefit for chiropractic treatment under the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, as she continued to engage in many pre-accident activities, and therefore denied the non-earner benefit.

The Tribunal also denied the cost of the chronic pain assessment, finding it was not reasonable and necessary as it would not add new information to the file.

However, the Tribunal ordered the respondent to pay the outstanding balance for the chiropractic treatment plan, noting that the respondent's own assessor recommended continued facility-based active treatment.

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

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

The applicant argued she suffered from chronic pain syndrome, removing her from the MIG.

The adjudicator found the applicant's high level of activity, including yoga, snowshoeing, and active holidays, was inconsistent with a diagnosis of chronic pain.

The adjudicator concluded the injuries were predominantly minor and dismissed the application.

The applicant was injured in a motor vehicle accident and sought payment for five chiropractic treatment plans outside the Minor Injury Guideline (MIG) limit.

The applicant argued that a compression fracture discovered two years post-accident removed him from the MIG.

The Tribunal found that the applicant failed to establish on a balance of probabilities that the compression fracture was caused by the accident, relying on the timeline and independent medical examinations.

Consequently, the applicant's injuries remained subject to the MIG limit, and the claims for additional treatment plans and interest were dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement, medical, attendant care, and housekeeping benefits.

The insurer terminated these benefits based on insurer's examinations concluding the applicant did not suffer a substantial inability to perform her tasks and that further treatment was not reasonable or necessary.

The arbitrator dismissed all of the applicant's claims, finding her evidence highly unreliable and lacking credibility due to numerous inconsistencies, failure to produce medical records, and failure to disclose pre-accident medical history.

The arbitrator also accepted evidence from a doctor called by the insurer who testified that his name and signature were used on treatment plans without his knowledge or authorization.