Dr. McDowall

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline (MIG) and the termination of her income replacement benefits (IRBs).

The Tribunal found that the applicant failed to establish on a balance of probabilities that she suffered from a psychological impairment or chronic pain that would warrant removal from the MIG.

The Tribunal preferred the evidence of the insurer's experts, noting that the applicant's expert reports were either uncorroborated by contemporaneous medical records or based on limited reviews.

Furthermore, the Tribunal held that the applicant was not entitled to ongoing IRBs, as she did not demonstrate a substantial inability to perform the essential tasks of her pre-accident employment as a machine operator, particularly given her subsequent employment at a fast-food restaurant involving similar physical demands.

The application was dismissed.

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

The respondent denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and sought repayment of $4,000 in Income Replacement Benefits (IRBs) alleging wilful misrepresentation of employment status.

The Tribunal found the applicant was removed from the MIG because medical evidence established he suffered a concussion.

The Tribunal dismissed the respondent's claim for IRB repayment, finding insufficient evidence that the applicant was working during the specific period the benefits were paid.

The applicant was awarded treatment plans for occupational therapy and psychological assessments, as they were deemed reasonable and necessary.

The claim for a special award under s. 10 of Regulation 664 was dismissed, as the respondent's reliance on its assessors was not unreasonable.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy, a concussion assessment, and a psychological assessment.

The respondent denied the benefits, initially relying on the Minor Injury Guideline (MIG).

The Tribunal found the applicant proved the physiotherapy and concussion assessment were reasonable and necessary based on clinical notes documenting pain and headaches.

The Tribunal partially approved the concussion assessment and fully approved the physiotherapy plans.

The claim for a psychological assessment balance was dismissed for lack of submissions.

The Tribunal denied the applicant's request for a special award under s. 10 of Reg. 664, finding the insurer's reliance on its medical assessors was reasonable, but awarded interest on overdue payments.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that his injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant failed to prove a psychological impairment warranting removal from the MIG, placing little weight on a psychological report based solely on self-reporting.

Claims for income replacement benefits were dismissed due to a lack of supporting medical evidence.

The Tribunal ordered the insurer to pay $200.00 for an improperly deducted disability certificate fee, but denied the remaining treatment plans as the MIG limits were exhausted.

A claim for a bad faith award under s. 10 of Regulation 664 was also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to treatment plans for chiropractic services and a psychological assessment outside the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on a psychological condition and a potential concussion.

The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from a psychological condition or a concussion, relying on the family doctor's clinical notes and an insurer's examination that suggested malingering.

As the applicant remained within the MIG, the disputed treatment plans were not payable, and claims for an award and interest were dismissed.

The applicant sought a non-earner benefit and funding for chiropractic and acupuncture treatment plans following a motor vehicle accident.

The Tribunal found the applicant failed to prove a complete inability to carry on a normal life, preferring the respondent's occupational therapy assessment over the applicant's vague evidence regarding pre- and post-accident activities.

The treatment plans were also denied as the applicant failed to provide corroborating medical evidence to establish they were reasonable and necessary.

The Tribunal further held that the respondent's denial letters contained sufficient medical reasons under s. 38(8) of the Schedule.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, various treatment plans for physiotherapy and psychological services, an attendant care assessment, and medication expenses.

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal found that the applicant failed to prove a complete inability to carry on a normal life, as medical evidence and self-reporting indicated he retained the ability to perform most daily activities, albeit with some diminished capacity.

Furthermore, the Tribunal concluded that the proposed treatment plans were not reasonable and necessary, relying on a physiatry report and hospital records showing no significant physical injuries.

Claims for medication were dismissed as duplicate receipts, and consequently, claims for interest and a special award were also denied.

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

The respondent denied various treatment plans for physiotherapy and psychological services on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued her injuries fell outside the MIG due to a psychological impairment and pre-existing conditions.

The Tribunal found the applicant's physical injuries were soft tissue in nature and her psychological testing did not support a formal diagnosis.

The Tribunal accepted the respondent's section 44 assessors' conclusions that the injuries were minor.

As the MIG limit was exhausted, the disputed treatment plans and interest were denied.

The applicant sought statutory accident benefits for physiotherapy, chiropractic services, psychological treatment, and prescription medications following a motor vehicle accident.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to meet his burden of proving the treatment plans and medication expenses were reasonable and necessary.

The Tribunal preferred the respondent's medical evidence, which indicated the applicant sustained soft-tissue injuries and had achieved maximum medical recovery.

The application was dismissed in its entirety, including claims for interest and a special award.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain, psychological impairments, and possible rib fractures.

The Licence Appeal Tribunal found the applicant failed to meet his burden of proof, noting a lack of objective medical evidence, inconsistent self-reporting, and a preference for the respondent's section 44 assessments.

As the applicant's injuries were deemed predominantly minor, his claims for treatment plans outside the MIG limits, along with claims for interest and a special award, were dismissed.

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

The respondent denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's psychological impairments, including driving-related anxiety and depression, warranted removal from the MIG, preferring the applicant's psychological expert over the respondent's.

However, the Tribunal dismissed the claims for the specific disputed treatment plans because the applicant failed to provide the actual treatment plans (OCF-18s) or make submissions demonstrating that the proposed treatments were reasonable and necessary.

The applicant sought statutory accident benefits following two motor vehicle accidents.

The insurer denied treatment plans for psychological services and an expense claim for acupuncture.

The Tribunal found that the applicant failed to prove the psychological treatment was reasonable and necessary, noting her own medical evidence indicated her symptoms had improved and she had returned to work.

The acupuncture expense was denied because it was incurred before a treatment plan was submitted, contrary to s. 38(2) of the Schedule.

Claims for interest and a special award were also dismissed.

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

The respondent denied a psychological assessment and treatment plan, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered from accident-related psychological impairments, removing him from the MIG.

The Tribunal ordered the respondent to pay for the disputed psychological assessment and treatment plan, finding them reasonable and necessary, as well as the cost of damaged glasses and interest.

The applicant sought a non-earner benefit and interest following a motor vehicle accident.

The respondent denied the benefits on the basis that the applicant did not suffer a complete inability to carry on a normal life.

The Tribunal applied the Heath framework and found that the applicant had resumed substantially all pre-accident activities, including graduating from his MBA program and managing activities of daily living independently.

The application was dismissed as the applicant failed to demonstrate a complete inability to carry on a normal life.

The applicant requested a reconsideration of a Tribunal decision denying her entitlement to chiropractic treatment, psychological services, and interest following a 2016 motor vehicle accident.

The applicant argued the adjudicator made significant errors of law or fact by failing to consider certain medical records and expert evidence.

The Tribunal dismissed the request, finding that the applicant was attempting to re-litigate and reweigh evidence already considered.

The Tribunal maintained that the disputed treatment plans were related to a subsequent 2018 accident rather than the 2016 subject accident.

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

The insurer initially deemed her catastrophically impaired but later reversed its decision based on an addendum report.

The applicant disputed the denial of several treatment plans submitted during the period she was deemed catastrophically impaired.

The Licence Appeal Tribunal held that the insurer could not retroactively apply its decision to revoke the catastrophic impairment designation, as the Schedule is consumer protection legislation.

The Tribunal found the applicant was entitled to apply for enhanced catastrophic policy coverage during that period.

The Tribunal partially approved two psychological treatment plans and two physical therapy treatment plans, finding them reasonable and necessary, but denied the remaining treatment plans and the request for an award.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed chronic pain and psychological impairments warranted removal from the MIG and sought funding for chiropractic treatment and a psychological assessment.

The Tribunal found the applicant's evidence lacked credibility due to inconsistencies between his self-reports and the medical records.

Relying on hospital records, treating physician notes, and the respondent's independent medical examinations, the Tribunal concluded the applicant sustained predominantly minor injuries.

As the $3,500 MIG limit was already exhausted, the disputed treatment plans were denied.

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

The respondent denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant's injuries, specifically fragmentation of the lateral distal tibia, warranted removal from the MIG.

The Tribunal granted the claim for an orthopaedic assessment, finding it reasonable and necessary based on objective evidence of physical complaints and a pre-existing knee injury.

However, claims for physiotherapy were dismissed due to a lack of evidentiary submissions, and a psychological assessment was denied after the applicant's psychological report was excluded for late production.

Interest was awarded on the approved orthopaedic assessment.

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

The respondent denied treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to prove on a balance of probabilities that she should be removed from the MIG due to pre-existing conditions, chronic pain, or psychological impairments.

However, the Tribunal found that the respondent's initial denial of a psychological treatment plan was non-compliant with section 38(8) of the Schedule.

As a result, the respondent was prohibited from relying on the MIG for that specific treatment plan until a compliant notice was issued.

The applicant was awarded the incurred costs for psychological services during the period of non-compliance, but her other claims for chiropractic treatment, a psychological assessment, and an award under Regulation 664 were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed entitlement to a non-earner benefit, a psychological assessment, and removal from the MIG due to chronic pain and psychological impairments.

The Licence Appeal Tribunal found that the applicant failed to provide sufficient medical evidence to warrant removal from the MIG, noting the absence of a chronic pain diagnosis and preferring the insurer's objective psychological assessments.

Furthermore, the applicant did not demonstrate a complete inability to carry on a normal life, as he continued to work and engage in pre-accident activities.

The application was dismissed.