5 total
Application for non-earner and medical benefits dismissed due to lack of objective evidence and embellishment.
The applicant sought a non-earner benefit and a medical benefit for an occupational therapy assessment following a motor vehicle accident.
The Tribunal found that the applicant failed to establish a complete inability to carry on a normal life, noting inconsistent effort and embellishment during insurer's examinations.
The Tribunal preferred the insurer's expert reports over the applicant's psychological assessment, which failed to compare pre- and post-accident functioning.
The application was dismissed, and the applicant was not entitled to the claimed benefits or interest.
Reconsideration denied; no error in law or breach of procedural fairness in admitting insurer's evidence.
The applicant sought reconsideration of a decision finding he sustained a minor injury and was not entitled to non-earner benefits.
He argued the adjudicator erred in law by allowing the respondent to file insurer's examination reports and violated procedural fairness by failing to impartially assess his evidence.
The adjudicator dismissed the request, finding no error in law or breach of procedural fairness, as the applicant failed to properly identify the evidence he sought to exclude and failed to meet his burden of proof regarding his entitlement to benefits.
Application for accident benefits dismissed as surveillance evidence contradicted claims of severe impairment.
The applicant sought income replacement benefits and medical benefits following a minor motor vehicle accident.
The Licence Appeal Tribunal dismissed the application, finding that the applicant did not suffer a complete inability to engage in employment.
The Tribunal relied on surveillance evidence showing the applicant socializing, driving, and taking vacations, which contradicted his claims of severe impairment.
The Tribunal also found the claimed medical benefits were not reasonable and necessary, as previous treatments had not improved his condition and independent medical examinations found him capable of working.
Appeal for accident benefits dismissed as barred by res judicata; new medical reports were not fresh evidence.
The applicant sought statutory accident benefits following a 2013 motor vehicle accident.
The insurer denied the claims, and the applicant appealed to the Licence Appeal Tribunal.
The insurer raised a preliminary issue that the claims were barred by res judicata, as the applicant had previously appealed the same claims, resulting in a final decision that her injuries fell within the Minor Injury Guideline and she was not entitled to income replacement benefits.
The Tribunal agreed, finding that the applicant's new medical reports did not constitute fresh, new, and previously unavailable evidence that would impeach the prior decision.
The appeal was dismissed as barred by res judicata, and costs were denied.
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline.
The applicant sought statutory accident benefits following a rear-end motor vehicle collision.
The insurer denied various benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Licence Appeal Tribunal found that the applicant's physical injuries were minor and had resolved, as evidenced by normal imaging and his return to work.
The Tribunal rejected the applicant's claim of chronic pain syndrome, finding he did not meet the AMA Guides criteria.
Claims for Income Replacement Benefits, attendant care, and various treatment plans were dismissed because the applicant failed to prove impairments beyond the MIG or an inability to work.
The Tribunal also dismissed claims for an award under O. Reg. 664, noting that technical deficiencies in the insurer's notices do not automatically entitle an applicant to benefits.
No linked lawyers found.
No linked judges found.