Dr. Lisa Becker

The applicant was involved in a motor vehicle accident and sought a determination of catastrophic impairment and entitlement to various statutory accident benefits.

The Licence Appeal Tribunal found that the applicant sustained a catastrophic impairment under both Criterion 6 (64% whole person impairment) and Criterion 2 (severe and permanent alteration of lower extremities with a SCIM score of 4).

The Tribunal awarded incurred attendant care benefits from October 2021 to March 2022 but denied ongoing attendant care benefits as the applicant failed to provide an updated Form 1 reflecting her current needs.

Claims for four specific treatment plans were dismissed as the applicant provided no evidence to support them.

Interest was awarded on all overdue payments.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including attendant care benefits and funding for a multidisciplinary catastrophic impairment assessment.

The respondent insurer denied the benefits.

The Tribunal found that the applicant failed to prove the attendant care benefits were reasonable and necessary, as insurer's examinations indicated she had returned to her pre-accident functional abilities.

The Tribunal also denied the catastrophic impairment assessment treatment plan, finding insufficient medical evidence to support that it was reasonably possible the applicant sustained a catastrophic impairment.

The application was dismissed.

The applicant sought statutory accident benefits for a catastrophic impairment following a motor vehicle accident.

The Licence Appeal Tribunal had previously determined in a 2024 decision that the applicant did not sustain a catastrophic impairment.

The applicant filed a second application based on new medical reports.

The respondent raised the preliminary issue of res judicata.

The Tribunal found that the three preconditions for res judicata were met.

Furthermore, the Tribunal declined to waive the doctrine, finding that the new medical reports did not constitute fresh evidence that would conclusively impeach the original results, as they relied on the applicant's inaccurate self-reporting of her pre-accident condition.

The application was dismissed.

The applicant requested a reconsideration of a Tribunal decision finding that her brain contusion fell within the Minor Injury Guideline (MIG).

The applicant argued the Tribunal erred in law by interpreting 'contusion' in the definition of 'minor injury' to include brain contusions, asserting this was incompatible with the catastrophic impairment definition.

The Tribunal dismissed the request, holding that the legislature did not exclude intracranial contusions from the minor injury definition, and a brain contusion remains a minor injury unless it results in a non-minor impairment.

The Tribunal also found no error of fact in its weighing of the medical evidence.

The applicant sought a determination of catastrophic impairment and entitlement to various treatment plans following a motor vehicle accident.

The Tribunal found that the applicant did not meet the 55% whole person impairment threshold under either Criterion 6 (physical) or Criterion 7 (combined physical and psychological), assessing his physical impairment at 37% and combined impairment at 43%.

The Tribunal denied the claim for outstanding catastrophic impairment assessments, finding them duplicative.

However, the Tribunal granted the cost of a NuStep cross trainer, finding it reasonable and necessary for the applicant's rehabilitation.

The Tribunal also granted the cost of a neurovisual assessment because the insurer's denial notice failed to comply with the requirements of s. 38(8) of the Schedule.

The applicant's request for costs was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for an occupational therapy device, specifically the repair of a heated car seat, costing $927.60.

The respondent denied the treatment plan, relying on an insurer's examination that concluded the device was not reasonable and necessary.

The Tribunal found that the applicant met her burden of proving the device was reasonable and necessary to manage her chronic pain while driving in winter months, supported by her occupational therapist's report.

The Tribunal ordered the respondent to pay for the treatment plan with interest, but declined to order a special award as there was no evidence of unreasonable delay or ill intention.

The applicant sought a determination that he sustained a catastrophic impairment following a motor vehicle accident, along with entitlement to treatment plans for assistive devices and a mental/behavioural assessment.

The Tribunal assessed the applicant's whole person impairment (WPI) rating, weighing competing expert evidence on psychological impairment, neurogenic bladder, sexual dysfunction, and upper extremity impairment.

The Tribunal found a total WPI rating of 52%, falling short of the 55% threshold required for catastrophic impairment.

The Tribunal partially approved the treatment plan for assistive devices, granting funding for a bed, mattress, pillow, and related occupational therapy services, but denied the mental/behavioural assessment and a claim for a special award.

Interest was awarded on the overdue benefits.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing her injuries warranted removal from the Minor Injury Guideline (MIG) due to a head injury, chronic pain, and pre-existing conditions.

The Licence Appeal Tribunal found that the applicant's cerebral contusion fell within the definition of a minor injury and rejected the assertion that she suffered a traumatic brain injury or concussion.

The Tribunal also found insufficient evidence of chronic pain causing functional impairment, noting the applicant returned to work within two months and failed to meet the criteria under the AMA Guides.

Finally, the applicant failed to provide compelling evidence that her pre-existing conditions prevented maximal recovery within the MIG.

The application for treatment plans outside the MIG, an award, and interest was dismissed.

The applicant sought $19,097.00 for a multidisciplinary catastrophic impairment assessment following a 2012 motor vehicle accident.

The respondent insurer denied the treatment plan, arguing the applicant sustained only minor soft tissue injuries and had a significant pre-existing medical history.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to provide corroborating medical evidence to support the necessity of the assessments or justify their costs, particularly given the $2,000 cap per assessment under section 25(5)(a) of the Schedule.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident, claiming catastrophic impairment due to psychological injuries, non-earner benefits, treatment plans, and education expenses.

The Licence Appeal Tribunal found the applicant was not catastrophically impaired, preferring the respondent's psychiatric assessment which properly accounted for her significant pre-existing mental health conditions and post-accident stressors.

Claims for non-earner benefits and treatment plans were dismissed as the applicant failed to prove a complete inability to carry on a normal life or the reasonableness and necessity of the plans.

The Tribunal granted the claim for education expenses, finding the applicant was unable to continue her college program due to the accident.

The applicant sought a determination that he sustained a catastrophic impairment under Criterion 8 (mental and behavioural disorders) following a 2012 motor vehicle accident.

The Tribunal found that the applicant's multidisciplinary catastrophic impairment evaluation was conducted in compliance with section 45(2)1 of the Schedule.

However, the Tribunal concluded that the applicant did not sustain a Marked (Class 4) impairment in the domain of Adaptation.

The Tribunal preferred the evidence of the respondent's experts, finding that the applicant's self-reporting was unreliable and that his psychological impairments did not significantly impede his useful functioning.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision finding he was not catastrophically impaired.

The applicant argued the Tribunal breached procedural fairness by relying on sections 45(2)1 and 2 of the Statutory Accident Benefits Schedule to reject his expert medical reports, without raising the issue during the hearing.

The Vice-Chair agreed, finding that the failure to provide notice and an opportunity to respond to this central issue violated the principles of natural justice.

The reconsideration was granted in part, the catastrophic impairment decision was cancelled, and a rehearing on that issue was ordered.

The applicant was injured in a motor vehicle accident and sought a determination that she sustained a catastrophic impairment under Criterion 8 (mental or behavioural disorder) of the Statutory Accident Benefits Schedule.

The respondent denied the claim, relying on its psychiatric assessor who found only mild to moderate impairments.

The Tribunal preferred the evidence of the applicant's assessors, noting that they appropriately included pain-related impairments and relied on functional occupational therapy assessments which demonstrated the applicant's significant deterioration when challenged by tasks.

The Tribunal concluded the applicant suffered marked impairments in three of four functional domains and declared her catastrophically impaired.

The applicant sought a determination of catastrophic impairment under Criterion 8 (mental or behavioural disorder) following a motor vehicle accident.

The Tribunal found that the applicant's multidisciplinary catastrophic impairment evaluation was not conducted by a physician as required by the Schedule, as the physicians merely rubber-stamped the findings of a neuropsychologist and an occupational therapist.

Because a neuropsychologist is precluded from determining catastrophic impairment outside of Criterion 7, the Tribunal gave no weight to the medical evidence and dismissed the catastrophic impairment claim.

However, the Tribunal ordered the insurer to pay up to $2,000 each for the neuropsychological and occupational therapy assessments, as they were reasonable and necessary to explore the applicant's impairments.

The applicant sought a determination that he sustained a catastrophic impairment following a motor vehicle accident, claiming a whole person impairment of 55% or more.

The Tribunal reviewed extensive medical evidence and expert testimony regarding the applicant's physical and psychological impairments, including gait derangement, spine impairment, traumatic brain injury, and mental/behavioural disorders.

The Tribunal concluded the applicant's combined whole person impairment was 41%, falling short of the 55% threshold.

Consequently, claims for attendant care beyond the 104-week limit were dismissed.

The Tribunal partially approved treatment plans for a chronic pain program, chiropractic spinal manipulation, and psychotherapy, subject to remaining policy limits.

Claims for a special award and costs were dismissed.

The respondent insurer requested a reconsideration of a decision finding the applicant sustained a catastrophic impairment and was entitled to attendant care benefits (ACBs) for services provided by his spouse.

The insurer argued the adjudicator erred by admitting opinion evidence on causation from a treating chiropractor who was not qualified as an expert, and by awarding ACBs for care provided by a family member.

The Associate Chair denied the reconsideration, holding that the chiropractor's evidence was admissible as a 'participant expert' under Westerhof, and that the spouse, a trained personal support worker and registered practical nurse, provided the attendant care services in the course of her profession.

The adjudicator's findings that the applicant promised to pay his spouse and required overnight supervision were reasonable and did not constitute significant errors of law or fact.

The applicant was injured in a motor vehicle accident and sought a determination of catastrophic impairment, along with attendant care benefits and various medical and rehabilitation benefits.

The Tribunal found that the applicant sustained a catastrophic impairment, preferring the evidence of the applicant's expert who assigned a 64% physical impairment rating over the respondent's expert.

The Tribunal awarded attendant care benefits of $3,704.91 per month from the date the assessment forms were submitted, but denied retroactive benefits.

The Tribunal also awarded case management services but denied other disputed treatment plans due to late submission or lack of evidence.

The applicant was injured in a motorcycle accident and applied for catastrophic impairment benefits, which the insurer denied.

The central issue was whether the applicant's impairments met the 55% Whole Person Impairment (WPI) threshold, with the insurer arguing that a pre-existing back condition accounted for a significant portion of his current disability.

The arbitrator rejected the insurer's expert evidence regarding the pre-existing condition and symptom magnification, finding the applicant's experts more reliable.

The arbitrator concluded that the applicant sustained a catastrophic impairment as a direct result of the accident and awarded him his full arbitration expenses.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a determination of catastrophic impairment, income replacement benefits, and attendant care benefits.

The insurer argued the applicant's low Glasgow Coma Scale score was due to a pre-accident drug overdose and high blood sugar, not a brain injury from the accident.

The arbitrator rejected the insurer's theory, finding the applicant sustained a catastrophic impairment due to a traumatic brain injury.

The arbitrator also awarded ongoing income replacement benefits and attendant care benefits, but declined to order a special award against the insurer.

John Biro was injured in a 2007 motor vehicle accident and sought various statutory accident benefits from Unica Insurance Inc., including non-earner benefits, attendant care, and medical benefits for medical marijuana.

Unica denied the benefits, arguing that his ongoing impairments were due to his pre-existing ankylosing spondylitis rather than the accident.

The arbitrator found that the accident materially contributed to the aggravation of his pre-existing condition.

The arbitrator denied the non-earner benefit, finding Mr. Biro was able to manage a complex medical marijuana growing enterprise.

However, the arbitrator awarded attendant care benefits for 104 weeks, medical benefits for psychological treatment, and $30 per day for medical marijuana, along with a special award for Unica's unreasonable withholding of the marijuana and psychological treatment benefits.

The arbitrator concluded Mr. Biro did not meet the threshold for catastrophic impairment.