Dr. Osinga

The applicant sought various statutory accident benefits following a 2017 motor vehicle accident, including attendant care benefits, occupational therapy, assistive devices, and assessments.

The Licence Appeal Tribunal found that the applicant's ongoing impairments were caused by pre-existing degenerative conditions rather than the accident, relying on the respondent's orthopaedic assessment.

The Tribunal denied further attendant care benefits and most treatment plans, but approved a psychological assessment, an attendant care assessment, and an inner bathmat.

The claim for a special award was dismissed as the respondent did not act unreasonably or in bad faith.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, claiming catastrophic impairment, income replacement benefits (IRB), and various medical and rehabilitation benefits.

The Licence Appeal Tribunal found the applicant was not catastrophically impaired, as she did not demonstrate Marked or Class 4 impairments in three of four functional domains, relying partly on surveillance evidence showing her ability to socialize and complete tasks.

Consequently, her claim for attendant care benefits was dismissed.

However, the Tribunal granted her claim for a post-104-week IRB, finding her severe chronic pain and heavy medication use rendered her completely unable to engage in suitable employment.

Several treatment plans, including for medical marijuana and lidocaine injections, were approved as reasonable and necessary for pain relief, while others were denied.

The claim for an award for unreasonably withheld benefits was dismissed.

The applicant was struck by a vehicle and sought funding for a multidisciplinary Catastrophic Determination Assessment.

The insurer partially approved the request but denied $8,312.81 for clinic file reviews, transportation, and a neurological assessment.

The Tribunal found that the $2,000 limit per assessment under s. 25(5)(a) of the Schedule is a total cap that includes file reviews and report preparation.

The Tribunal also found the transportation expenses fell within the 50 km deductible and that the applicant failed to prove the neurological assessment was reasonable and necessary.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought a non-earner benefit, the cost of a social work assessment, and the cost of three disability certificates from her insurer.

The insurer denied the claims, arguing the applicant did not suffer a complete inability to carry on a normal life and that the assessments were not reasonable and necessary.

The Licence Appeal Tribunal dismissed the application, finding the applicant's self-reported activities and the insurer's medical examinations demonstrated she was not completely prevented from engaging in her pre-accident activities.

The Tribunal also found the social work assessment was not reasonable and necessary, and the disability certificates were not payable as they were duplicative and not requested by the insurer.

The applicant, a pedestrian struck by a vehicle, sought a non-earner benefit, the cost of a chronic pain assessment, and a medical benefit for chiropractic treatment under the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, as she continued to engage in many pre-accident activities, and therefore denied the non-earner benefit.

The Tribunal also denied the cost of the chronic pain assessment, finding it was not reasonable and necessary as it would not add new information to the file.

However, the Tribunal ordered the respondent to pay the outstanding balance for the chiropractic treatment plan, noting that the respondent's own assessor recommended continued facility-based active treatment.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming he suffered from chronic pain that prevented him from working as a carpenter apprentice.

The adjudicator dismissed the application, finding the applicant's evidence and his expert's chronic pain assessment unreliable due to inconsistencies with the medical records, including evidence of prior injuries, altercations, and drug use.

The adjudicator preferred the respondent's orthopaedic and functional assessments, concluding the applicant failed to prove a substantial inability to perform his pre-accident employment for the pre-104 week period, or a complete inability to engage in suitable employment for the post-104 week period.

Claims for an award and interest were also dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and an orthopaedic assessment.

The respondent insurer denied the claims, arguing the applicant had reached maximal medical recovery.

The Licence Appeal Tribunal found the physiotherapy treatment plan reasonable and necessary, noting the applicant had not pursued surgery due to age-related risks and had not reached maximal medical recovery.

However, the Tribunal denied the request for an orthopaedic assessment, finding it duplicative of a recent examination by an orthopaedic consultant and lacking compelling evidence of a need for further assessment.