Dr. Nguyen

The appellant, who was injured in a motor vehicle accident, appealed and sought judicial review of a Licence Appeal Tribunal decision denying her catastrophic impairment benefits.

The Divisional Court found that while there was no breach of procedural fairness, the Adjudicator's findings regarding the appellant's whole person impairment under Criterion 6 of the AMA Guides were unreasonable.

Specifically, the Adjudicator unreasonably dismissed evidence of double vision, peripheral neuropathy, and medication side effects.

The court quashed the decision and remitted the matter to the LAT for a new hearing before a different adjudicator.

The applicant requested a reconsideration of a Tribunal decision that denied the cost of an orthopaedic assessment.

The applicant argued the Tribunal erred in law and fact by denying the assessment while relying on it to approve other treatment plans, and by failing to find the respondent's denial notice was deficient.

The Vice Chair dismissed the request, finding no misapprehension of evidence or errors of law or fact.

The Vice Chair noted that accepting part of an assessment does not obligate the Tribunal to find its cost reasonable and necessary, and that the applicant was attempting to reargue the case and raise new arguments not presented at the original hearing.

The applicant sought entitlement to statutory accident benefits following a motor vehicle accident, including three treatment plans for chiropractic services, the cost of an attendant care assessment, and the cost of an orthopaedic assessment.

The Tribunal found the chiropractic treatment plans to be reasonable and necessary, preferring the evidence of the applicant's orthopaedic surgeon over the respondent's assessors.

However, the claims for the attendant care and orthopaedic assessments were dismissed due to insufficient evidence and flawed factual foundations, particularly given surveillance showing the applicant's physical capabilities.

The claim for a special award was also dismissed, but interest was awarded on the payable benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The adjudicator found the applicant was entitled to an income replacement benefit for the disputed period, as her subjective pain experience resulted in a substantial inability to perform the essential tasks of her employment as a production worker.

The adjudicator also approved two physiotherapy treatment plans and the cost of prescription medication, finding them reasonable and necessary.

Claims for the cost of a disability certificate and medical records were dismissed.

The adjudicator declined to order an award under O. Reg. 664, finding the insurer's decisions to withhold benefits were not unreasonable given the medical information available to it at the time.

Interest was awarded on all overdue payments.

The applicant sought payment for orthopaedic and psychological assessments following a motor vehicle accident.

The respondent denied the assessments, and the applicant argued the denial was untimely under section 38(8) of the Statutory Accident Benefits Schedule.

The Tribunal found that while the denial was late, the applicant had not incurred the costs prior to receiving notice of the denial.

The Tribunal held that the applicant was barred from adjudicating the psychological assessment due to a failure to attend a properly scheduled section 44 insurer's examination.

Furthermore, the orthopaedic assessment was found not to be reasonable and necessary.

Claims for a special award under Regulation 664, interest, and costs were all dismissed.