5 total
Application for catastrophic impairment and non-earner benefits dismissed; applicant failed to meet impairment thresholds.
The applicant sought statutory accident benefits following a 2012 motor vehicle accident, claiming she sustained a catastrophic impairment and was entitled to non-earner benefits.
The Tribunal found the applicant did not meet the 55% whole person impairment threshold under Criterion 7, nor did she demonstrate the required marked impairments under Criterion 8.
The Tribunal preferred the evidence of the respondent's assessors, noting the applicant successfully attends university full-time and maintains part-time employment.
The claims for catastrophic impairment and non-earner benefits were dismissed.
Application for catastrophic impairment benefits dismissed; ongoing impairments attributed to pre-existing medical and psychiatric conditions.
The applicant sought statutory accident benefits following two motor vehicle accidents in 2013 and 2014, claiming he sustained a catastrophic impairment due to mental and behavioural disorders.
The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove a marked or extreme impairment in any of the four functional domains.
The Tribunal preferred the evidence of the respondent's experts, noting that the applicant's experts failed to adequately consider his extensive pre-existing medical and psychiatric conditions, including chronic pain, depression, and strokes.
The Tribunal also found that the disputed treatment plans for a functional ability evaluation and an attendant care assessment were not reasonable and necessary, as the applicant's ongoing impairments were primarily attributable to the progression of his pre-accident conditions.
Claims for an award and interest were consequently dismissed.
Claim for catastrophic impairment assessments dismissed as not reasonable and necessary given lack of medical evidence.
The applicant sought payment for a $25,659.25 treatment and assessment plan (OCF-25) for catastrophic impairment assessments following a 2006 motor vehicle accident.
The Licence Appeal Tribunal found the assessments were not reasonable and necessary, as the medical evidence did not support a causal relationship between the accident and the current complaints, which were similar to those from a prior 2002 accident.
The Tribunal also noted the physical injuries were minor and there was no evidence of psychological impairment.
The claims for the OCF-25, interest, and a special award were 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.
Accident benefits claim dismissed as applicant failed to prove injuries fell outside the Minor Injury Guidelines.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming his injuries fell outside the Minor Injury Guidelines (MIG) due to chronic pain and psychological impairments.
The arbitrator found the applicant lacked credibility, having provided inconsistent and inaccurate information to various medical assessors, including failing to disclose a subsequent eye surgery.
The arbitrator concluded the applicant did not prove his injuries fell outside the MIG.
Consequently, the claims for multidisciplinary treatment plans and a psychological assessment were dismissed.
The applicant was also ordered to repay an erroneous payment of $135.60 to the insurer.
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