10 total
Application for accident benefits dismissed; three claims statute-barred and psychological treatment not reasonable and necessary.
The applicant sought statutory accident benefits following a motor vehicle accident.
The insurer denied several treatment plans, and the applicant applied to the Licence Appeal Tribunal.
The Tribunal found that the claims for an OT neurocognitive assessment, physiotherapy, and a chronic pain assessment were statute-barred, as the applicant failed to file the application within the two-year limitation period following clear and unequivocal denials by the insurer.
The Tribunal also dismissed the claim for psychological services, preferring the insurer's section 44 assessment which concluded the applicant did not suffer from an accident-related psychological impairment at the time the plan was submitted.
The application was dismissed in its entirety.
Accident benefits denied as applicant's injuries fell within the Minor Injury Guideline and limits were exhausted.
The applicant sought statutory accident benefits for chiropractic treatment, hospital expenses, and a psychological assessment 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 adjudicator found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain or a psychological impairment that would take him out of the MIG.
As the applicant had already exhausted the $3,500 MIG limit, the disputed benefits were not payable.
The respondent's request for costs was also denied.
Application for medical benefits and assessments dismissed as not reasonable and necessary.
The applicant was involved in a motor vehicle accident and sought medical benefits for chiropractic treatment, a functional abilities assessment, and a catastrophic assessment.
The insurer denied the benefits on the basis that they were not reasonable and necessary.
The Licence Appeal Tribunal found that the applicant's physical injuries had largely resolved and her ongoing psychological issues and thumb injury were not related to the accident.
The Tribunal concluded that the requested treatment and assessments were not reasonable and necessary, and dismissed the application.
Application for accident benefits dismissed as requested treatment and assessments were not reasonable and necessary.
The applicant sought medical benefits for chiropractic treatment, a functional abilities assessment, and a catastrophic impairment assessment following a motor vehicle accident.
The respondent insurer denied the benefits on the basis that they were not reasonable and necessary.
The Licence Appeal Tribunal found that the applicant's physical injuries had largely resolved and her ongoing psychological issues and left thumb injury were not caused by the accident.
Relying on the family doctor's records and the insurer's examination reports, the Tribunal concluded the requested treatment and assessments were not reasonable and necessary.
The application was dismissed.
Applicant removed from Minor Injury Guideline due to chronic pain; chiropractic treatment approved, psychological assessment denied.
The respondent insurer denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that while the applicant did not suffer a psychological injury warranting removal from the MIG, he did establish a chronic pain condition that placed his claims outside the MIG.
The Tribunal approved the treatment plan for chiropractic services as reasonable and necessary, but denied the treatment plan for a psychological assessment.
Interest was awarded on the overdue payments for the approved chiropractic treatment.
Tribunal awards medical benefits and vocational assessment costs, finding injuries were caused by the accident.
The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits, as well as the cost of a vocational assessment, from her auto insurer.
The insurer denied the claims, arguing the injuries were uncomplicated soft tissue injuries and not related to the accident.
The Licence Appeal Tribunal found that the objective medical evidence, including CT and MRI scans, established that the applicant suffered from disc herniation and radiculopathy caused by the accident.
The Tribunal concluded that the requested physiotherapy, chiropractic, psychological services, and vocational assessment were reasonable and necessary.
The applicant was awarded the claimed benefits with interest, and no costs were awarded to either party.
Applicant's claims for accident benefits dismissed as injuries fell within the Minor Injury Guideline.
The applicant, a pedestrian struck by a vehicle, sought statutory accident benefits including attendant care, chiropractic services, and assessments.
The respondent insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and its $3,500 cap.
The applicant contended that chronic pain and psychological impairments took her outside the MIG.
The Tribunal found that the applicant's soft tissue injuries had resolved and that she failed to prove her chronic pain or psychological symptoms were more than mere sequelae of the minor injuries.
Consequently, the MIG applied, precluding attendant care benefits and limiting assessment costs.
The claims were largely dismissed, save for a potential $215 payment for a psychological assessment if it constituted a first visit.
Insurer's procedural non-compliance removes applicant from Minor Injury Guideline, but credibility issues defeat most benefit claims.
The applicant sought various statutory accident benefits following a motor vehicle accident, including ongoing income replacement benefits, removal from the Minor Injury Guideline (MIG), and funding for treatment plans.
The adjudicator found significant credibility issues with the applicant's evidence, including inconsistencies regarding his post-accident employment and medical history.
The claim for ongoing income replacement benefits was dismissed as the applicant failed to prove a substantial inability to perform his pre-accident employment.
However, the adjudicator found that the insurer failed to comply with the procedural requirements of section 38 of the Schedule when responding to a chiropractic treatment plan.
As a result, the insurer was prohibited from taking the position that the MIG applied, and the chiropractic treatment plan was approved.
The remaining claims for prescriptions, a psychological assessment, and costs were dismissed.
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline.
The insurer denied certain treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant's physical and psychological injuries, including soft tissue injuries, were predominantly minor and did not remove her from the MIG.
The Tribunal also rejected the applicant's claim of chronic pain syndrome, noting a lack of supporting medical evidence and functional impairment.
As the injuries fell within the MIG, the treatment plans were not payable and the application was dismissed.
Accident benefits appeal dismissed as applicant failed to prove injuries fell outside the Minor Injury Guideline.
The Applicant sought payment for three chiropractic treatment plans and non-earner benefits following a 2015 motor vehicle accident.
The insurer denied the claims on the basis that the Applicant's injuries fell within the Minor Injury Guideline (MIG) and were not reasonable and necessary.
The Tribunal found the Applicant lacked credibility due to inconsistent statements about his employment and failure to disclose a prior 2013 accident with similar injuries.
The Tribunal accepted the insurer's independent medical examinations, concluding the Applicant failed to prove his impairments were directly caused by the 2015 accident or that he met the test for non-earner benefits.
The appeal was dismissed entirely.
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