Dr. Robertus

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed removal from the MIG was warranted due to chronic pain and psychological impairments.

The Tribunal found the applicant failed to establish chronic pain with functional impairment, placing little weight on his expert's diagnosis because it did not address functional limitations.

The Tribunal also preferred the respondent's psychological assessment over the applicant's, finding no psychological impairment.

The application was dismissed, and the disputed treatment plans and interest were denied.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

The respondent denied various treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing for removal from the MIG due to chronic pain and psychological impairments.

The Tribunal found that the applicant failed to meet the burden of proving chronic pain with a functional impairment under the AMA Guidelines, noting normal physical exams and lack of compelling evidence of functional decline.

The Tribunal also found insufficient evidence of a psychological condition, citing multiple assessments indicating symptom exaggeration and malingering.

The application was dismissed, and the applicant remained subject to the $3,500 MIG limit.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing that her chronic pain and psychological impairments warranted removal from the Minor Injury Guideline (MIG).

The adjudicator found that the applicant failed to meet her burden of proof, as her chronic pain claims lacked objective medical corroboration and her psychological claims were inconsistent with her self-reported functionality to other assessors.

The adjudicator concluded that the applicant's injuries were predominantly minor and subject to the MIG limits.

Because the MIG limits were already exhausted, the disputed treatment plans were not considered, and claims for an award and interest were dismissed.

The applicant sought a non-earner benefit (NEB) and payment for multiple treatment plans following a 2017 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant's entitlement to a NEB was not triggered because he failed to submit a completed disability certificate within the required 104-week timeframe and did not provide a reasonable explanation for the delay.

The Tribunal also dismissed the claims for the treatment plans, preferring the respondent's insurer examination reports which concluded the requested psychological, chronic pain, physiotherapy, and occupational therapy services were not reasonable and necessary.

Claims for an award and interest were also dismissed.

The applicant sought medical and rehabilitation benefits, including chronic pain treatment, an MRI, and orthopaedic and neurological assessments, following a 2016 motor vehicle accident.

The insurer denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to establish that the treatments and assessments were reasonable and necessary.

The Tribunal preferred the objective evidence of the insurer's assessors over the applicant's chronic pain specialist, noting the applicant did not meet the AMA Guides criteria for chronic pain syndrome.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to prove his physical, psychological, or chronic pain impairments warranted removal from the MIG.

However, the Tribunal ordered the respondent to pay for a psychiatric assessment and a chronic pain assessment because the respondent's denial letters failed to explicitly cite the MIG, violating the notice requirements under s. 38(8) and s. 38(9) of the Schedule.

The remaining treatment plans were denied.

The applicant sought reconsideration of a decision that dismissed his claim for a chronic pain assessment, neurological assessment, and interest.

The applicant argued the Tribunal made errors of fact and law, including failing to properly consider the AMA Guides criteria for chronic pain and various medical reports.

The Tribunal found no error, noting the lack of ongoing pain complaints in the family physician's records, the applicant's return to modified work and pre-accident activities, and the fact that the objective medical findings contradicted a chronic pain diagnosis.

The request for reconsideration was dismissed.

The applicant was injured in a motor vehicle accident and sought a medical benefit of $2,902.55 for physiotherapy, which the respondent insurer denied.

The applicant argued the accident aggravated pre-existing conditions, while the respondent contended the applicant's current complaints were caused by a subsequent cancer diagnosis and spinal surgery.

The Tribunal found that the applicant failed to prove on a balance of probabilities that the treatment plan was reasonable and necessary as a result of the accident, noting the medical evidence linked his severe back and leg pain to his cancer rather than the collision.

The application for benefits, interest, and an award was dismissed.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits for psychological treatment and a chronic pain program.

The insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline.

The Tribunal found that the applicant suffered from chronic pain and was entitled to partial payment for both treatment plans.

The rehabilitative components and psychological services were deemed reasonable and necessary, while transportation costs, social work, education elements, and additional progress reports were denied.

The respondent insurer requested a reconsideration of a Tribunal decision that removed the applicant from the Minor Injury Guideline (MIG) due to spinal injuries and a chronic pain disorder.

The insurer argued the Tribunal erred in fact by finding a diagnosis of chronic pain syndrome and erred in law regarding the definition of minor injury and causation.

The Vice Chair found that while the Tribunal technically erred in stating there was a specific diagnosis of chronic pain syndrome, the error was not significant enough to alter the decision, as the removal from the MIG was primarily based on objective evidence of spinal injuries.

The Tribunal also made no errors in law regarding the definition of minor injury or causation.

The request for reconsideration was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits beyond the $3,500 Minor Injury Guideline (MIG) limit.

The respondent denied the benefits, arguing the injuries were minor.

The Tribunal found that the applicant's injuries, which included disc bulges, central canal stenosis, and chronic pain syndrome, were not minor and removed him from the MIG.

The Tribunal approved the chronic pain assessment, chronic pain treatment program, and psychological assessment as reasonable and necessary, but denied the orthopaedic assessment.

The applicant was also awarded interest on the overdue benefits.