13 total
Application for accident benefits dismissed as insurer's denials of treatment plans were procedurally compliant.
The applicant sought payment for a psychological assessment and a functional abilities evaluation following a motor vehicle accident.
The applicant argued that the insurer's denials were procedurally defective under s. 38(8) of the Schedule, triggering the 'shall pay' provision of s. 38(11).
The Tribunal found that the insurer's denials provided a principled rationale based fairly on the applicant's file, relying on insurer examination reports that concluded the applicant had no accident-related psychological impairment and that his physical injuries had resolved.
The application was dismissed, and claims for an award and interest were denied.
Application for psychological assessment dismissed as self-reported symptoms were contradicted by surveillance evidence.
The applicant sought entitlement to a $2,200 psychological assessment, a special award, and interest following a motor vehicle accident.
The Licence Appeal Tribunal dismissed the application, finding the treatment plan was not reasonable and necessary.
The Tribunal rejected the applicant's psychological evidence, noting it relied on self-reporting that was contradicted by surveillance footage showing the applicant driving frequently and engaging in various activities.
The Tribunal accepted the respondent's insurer examination, which found no psychological symptoms warranting further investigation.
Application for non-earner benefits and treatment plans dismissed for insufficient evidence and non-compliance with guidelines.
The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, psychological services, an occupational therapy assessment, and out-of-pocket expenses.
The Tribunal found that the applicant was not entitled to the non-earner benefit because she failed to provide sufficient evidence comparing her pre- and post-accident activities to establish a complete inability to carry on a normal life.
The Tribunal also denied the psychological treatment plans because the applicant failed to justify the service providers charging rates higher than those prescribed for psychotherapists in the Professional Services Guideline, and failed to justify transportation costs.
The requests for an occupational therapy assessment, a massage chair, and a flight cancellation fee were also dismissed as not reasonable and necessary or not payable under the Schedule.
Claims for an award and interest were dismissed.
Application for accident benefits dismissed due to unexcused 19-month delay in notifying the insurer.
The applicant was involved in a motor vehicle accident and applied for statutory accident benefits 19 months later.
The respondent insurer denied the claim on the basis that the applicant failed to notify them of his intention to apply within seven days, as required by section 32(1) of the Schedule.
The Tribunal found that the applicant failed to provide a credible or reasonable explanation for the delay under section 34, rejecting his psychological assessment report as unpersuasive.
The application was dismissed and the applicant was barred from proceeding.
Application for accident benefits dismissed; applicant failed to prove injuries warranted removal from the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant argued for removal from the MIG due to chronic back and neck pain and psychological impairments.
The Tribunal found insufficient objective medical evidence to support chronic pain or psychological impairment caused by the accident, noting that the psychological reports relied heavily on subjective complaints and contained copied sections.
As the applicant's injuries remained within the MIG and the limits were exhausted, the claims for treatment plans, interest, and an award were dismissed.
Application for accident benefits dismissed; injuries fell within Minor Injury Guideline and income replacement denied.
The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor and subject to the $3,500 limit under the Minor Injury Guideline, as the applicant failed to establish chronic pain or a psychological impairment.
The Tribunal also dismissed the claim for an income replacement benefit, finding the applicant's accounting report unreliable and contradicted by his own reports of returning to work post-accident.
All claims, including those for additional chiropractic treatment and interest, were dismissed.
Applicant removed from Minor Injury Guideline due to psychological impairment; non-earner benefit and chiropractic treatment denied.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.
The insurer denied certain benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that she failed to comply with requests for medical records under s. 33 of the Schedule.
The Tribunal found that the applicant did not fail to comply with s. 33 requests, as she had provided all available records from her family doctor.
The Tribunal held that the applicant's injuries were not predominantly minor, accepting an uncontradicted psychological assessment diagnosing her with major depressive disorder and specific phobia.
However, the Tribunal denied the applicant's claim for a non-earner benefit due to a lack of evidence regarding her pre-accident activities.
A treatment plan for chiropractic care was also denied for lack of supporting medical evidence, while a psychological assessment was approved as reasonable and necessary.
Applicant removed from Minor Injury Guideline for psychological impairments but denied income replacement benefits.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits (IRBs), removal from the Minor Injury Guideline (MIG), and funding for psychological and physiotherapy treatment plans.
The Licence Appeal Tribunal found that the applicant failed to prove a substantial inability to perform the essential tasks of her pre-accident employment as a nail specialist, dismissing the IRB claim.
However, based on psychological assessments diagnosing adjustment disorder and anxiety, the Tribunal determined the applicant's injuries fell outside the MIG.
Consequently, the Tribunal approved the $2,200 psychological assessment but denied the $4,115.12 physiotherapy plan, preferring the respondent's physiatrist evidence that further physical treatment was unwarranted.
Application for income replacement benefits dismissed as work stoppage was due to COVID-19, not accident impairments.
The applicant sought income replacement benefits (IRBs) following a 2017 motor vehicle accident.
The respondent initially paid IRBs but terminated them in March 2018 based on insurer's examinations.
The applicant claimed entitlement for two periods: March 2018 to April 2019 (pre-104 weeks) and March 2020 onwards (post-104 weeks).
The Tribunal dismissed the application, finding the applicant failed to prove a substantial inability to perform the essential tasks of his employment for the first period, noting evidence he had returned to work earlier than claimed.
For the post-104-week period, the Tribunal found the applicant stopped working in March 2020 due to COVID-19 concerns rather than a complete inability to engage in employment due to accident-related impairments.
Application for post-104-week income replacement benefits dismissed as applicant failed to prove complete inability to work.
The applicant sought post-104-week Income Replacement Benefits (IRBs) following a motor vehicle accident.
The Licence Appeal Tribunal considered whether the applicant suffered a complete inability to engage in any employment or self-employment for which he was reasonably suited by education, training, or experience.
The Tribunal preferred the respondent's medical and vocational assessments, which found the applicant capable of working in alternative occupations such as a retail salesclerk, over the applicant's tort-focused expert reports.
The application was dismissed, as the applicant failed to meet the post-104-week IRB test, and no interest was payable.
Claim for accident benefits partially granted for a psychological assessment; income replacement benefits and neurological assessment denied.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs) and funding for psychological and neurological assessments.
The insurer denied the claims.
The Licence Appeal Tribunal found that the applicant failed to prove her physical impairments were caused by the accident, noting significant pre-existing conditions and a lack of pre-accident medical records.
However, the Tribunal found her psychological impairments were accident-related, preferring the evidence of the applicant's psychologist over the insurer's expert.
The Tribunal denied the claim for IRBs, finding the applicant did not suffer a substantial inability to perform her pre-accident employment tasks.
The claim for a psychological assessment was partially granted, while the neurological assessment was denied.
The insurer's request for costs was also dismissed.
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 and interest following a motor vehicle accident.
The respondent denied the benefits, arguing the applicant failed to prove a complete inability to carry on a normal life and that his impairments were related to a subsequent accident.
The Tribunal found that the applicant's medical evidence, including reports from his chiropractors and psychologist, either related to the subsequent accident, lacked a comparison of pre- and post-accident activities, or fell outside the 104-week eligibility period.
The Tribunal preferred the respondent's multidisciplinary assessment, which concluded the applicant did not suffer a complete inability.
The application was dismissed.
The court dismissed the defendants' threshold motion, finding the plaintiff's chronic pain and psychological injuries constituted a permanent and serious impairment.
The plaintiff sought damages for injuries from a motor vehicle accident.
The defendants admitted liability but brought a threshold motion to declare the plaintiff's non-pecuniary loss claim barred under s. 267.5(5) of the Insurance Act, arguing the plaintiff did not sustain a permanent, serious impairment of an important physical, mental, or psychological function.
The court applied the three-part Meyer v. Bright test, finding the plaintiff suffered permanent chronic pain, anxiety, driving phobia, and depression, which constituted a permanent and serious impairment of important functions.
The defendants' motion was dismissed.