4 total
Application for catastrophic impairment and accident benefits dismissed as applicant failed to meet 55% WPI threshold.
The applicant sought a determination of catastrophic impairment and entitlement to income replacement benefits (IRB), attendant care benefits (ACB), and various treatment plans following a 2018 motor vehicle accident.
The Tribunal found the applicant did not meet the 55% whole person impairment threshold under Criterion 7, concluding his combined physical and mental impairment rating was 40%.
The Tribunal also found the applicant failed to prove a complete inability to engage in suitable employment, dismissing the claim for post-104-week IRB.
As the applicant was not catastrophically impaired and had exhausted non-catastrophic limits, the claims for ACB and treatment plans were also dismissed.
Catastrophic impairment and accident benefits claims dismissed due to pre-existing conditions and surveillance evidence.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a catastrophic impairment due to psychological and physical injuries.
The respondent denied the catastrophic impairment designation, non-earner benefits, attendant care benefits, and various treatment plans, arguing her psychological issues and epilepsy were pre-existing.
The Tribunal found that while the accident caused a specific phobia and worsened her pre-existing depression, it did not cause her epilepsy.
The Tribunal concluded the applicant did not meet the threshold for catastrophic impairment under Criterion 7 or 8, relying heavily on surveillance evidence and the respondent's expert reports which showed significant post-accident improvement.
The claims for non-earner benefits, attendant care, and treatment plans were dismissed as the applicant failed to prove a complete inability to carry on a normal life or that the expenses were reasonable and necessary.
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 the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant argued that his injuries, including chronic pain, psychological impairments, and post-concussion syndrome, as well as a pre-existing condition, removed him from the MIG.
The Tribunal found that the applicant failed to provide compelling evidence of a pre-existing condition that would prevent maximal recovery within the MIG.
Furthermore, the Tribunal rejected the applicant's expert reports regarding chronic pain and psychological impairments due to their reliance on incomplete medical histories and self-reporting.
The Tribunal concluded that the applicant sustained predominantly minor injuries subject to the $3,500 limit, and dismissed the application.
Accident benefits appeal dismissed; applicant's injuries fell within the Minor Injury Guideline and non-earner benefits denied.
The insurer denied various medical, rehabilitation, attendant care, and non-earner benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Licence Appeal Tribunal found that the applicant failed to meet the burden of proving her injuries warranted removal from the MIG, noting that her medical evidence was unpersuasive and internally contradictory.
Furthermore, the applicant's claim for non-earner benefits was dismissed because her own statements to independent examiners demonstrated she had resumed a significant portion of her pre-accident activities.
The appeal was dismissed.
No linked lawyers found.
No linked judges found.