7 total
Application for non-earner benefits dismissed as applicant failed to prove complete inability to carry on normal life.
The applicant sought a Non-Earner Benefit (NEB), interest, and an award under the Statutory Accident Benefits Schedule following a motor vehicle accident.
The Licence Appeal Tribunal found that the applicant failed to prove a complete inability to carry on a normal life, noting inconsistencies in his self-reports and a lack of evidence regarding his pre-accident activities.
The Tribunal preferred the respondent's insurer examination reports over the applicant's psychological assessments, which failed to review medical records or delineate the impact of multiple accidents.
The application was dismissed in its entirety.
Application for statutory accident benefits dismissed as proposed treatments were not reasonable and necessary.
The applicant sought statutory accident benefits following a motor vehicle accident, including chiropractic services, psychological services, and medication expenses.
The Licence Appeal Tribunal dismissed the application, finding that the proposed chiropractic and psychological treatments were not reasonable and necessary based on the respondent's expert medical assessments, which showed no objective physical impairments and a deterioration in mood despite prior psychological treatment.
The medication expense had already been reimbursed.
Claims for interest and a special award were also dismissed.
Application for catastrophic impairment and accident benefits dismissed as applicant failed to meet 55% WPI threshold.
The applicant sought a determination of catastrophic impairment and entitlement to income replacement benefits (IRB), attendant care benefits (ACB), and various treatment plans following a 2018 motor vehicle accident.
The Tribunal found the applicant did not meet the 55% whole person impairment threshold under Criterion 7, concluding his combined physical and mental impairment rating was 40%.
The Tribunal also found the applicant failed to prove a complete inability to engage in suitable employment, dismissing the claim for post-104-week IRB.
As the applicant was not catastrophically impaired and had exhausted non-catastrophic limits, the claims for ACB and treatment plans were also dismissed.
Application for accident benefits dismissed due to insufficient evidence of accident-related functional impairments.
The applicant, who was struck by a car while riding his bicycle, sought $2,200 for an occupational therapy assessment and attendant care needs evaluation under the Statutory Accident Benefits Schedule.
The Licence Appeal Tribunal dismissed the application, finding insufficient evidence that the treatment plan was reasonable and necessary.
The Tribunal preferred the insurer's medical evidence, noting the applicant's complex pre-existing medical history and a lack of contemporaneous medical records supporting accident-related functional impairments.
Catastrophic impairment claim dismissed; applicant failed to prove brain injury or extreme impairment in work functioning.
The applicant sought a determination that she sustained a catastrophic impairment under Criteria 4 and 8 of the Statutory Accident Benefits Schedule following a motor vehicle accident, as well as entitlement to psychological services.
The Tribunal found that the applicant did not meet Criterion 4 because there were no positive findings of a traumatic brain injury on recognized diagnostic imaging.
The Tribunal also found that the applicant did not meet Criterion 8, as the evidence demonstrated she had been working part-time as a personal support worker, which was inconsistent with a Class 5 extreme impairment in work functioning.
The claim for psychological services was dismissed as not reasonable and necessary.
The respondent's request for costs was also dismissed.
Application for statutory accident benefits dismissed as proposed treatment and assessment plans were not reasonable and necessary.
The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including treatment plans for occupational therapy, a chronic pain program, and assessments for neuropsychological, chronic pain, functional cognitive, and catastrophic impairment, as well as a SPECT scan.
The insurer denied the claims.
The Licence Appeal Tribunal dismissed the application in its entirety, finding that the applicant failed to demonstrate on a balance of probabilities that the proposed plans were reasonable and necessary.
The Tribunal relied on insurer examination reports and surveillance evidence showing the applicant engaging in normal activities, which contradicted the applicant's self-reported functional limitations and the opinions of his assessors.
Motion granted compelling plaintiffs to attend defence medical examinations after action set down for trial due to late delivery of expert reports.
The defendant and statutory third party brought a motion to compel the plaintiffs to attend in-person defence medical examinations, including physiatry assessments for both plaintiffs and a psychiatric assessment for one plaintiff, after the action had been set down for trial.
The court granted leave under Rule 48.04(1), finding that the plaintiffs' late delivery of numerous expert reports and medical records demonstrating a significant and unexpected deterioration in their conditions constituted a substantial change in circumstances.
The court ordered the plaintiffs to attend the requested examinations to ensure trial fairness and allow the defendants an adequate opportunity to meet the plaintiffs' case.