Dr. Rod

The applicant requested a reconsideration of a Tribunal decision which found that his accident-related impairments fell within the Minor Injury Guideline (MIG) and that he was not entitled to a disputed treatment plan.

The applicant argued that the adjudicator erred in law by rejecting his expert's diagnosis of chronic pain syndrome, misweighing medical evidence, and incorrectly applying sections 38(8) and 38(9) of the Statutory Accident Benefits Schedule regarding the insurer's notice of denial.

The Tribunal dismissed the reconsideration request, finding that the applicant was attempting to relitigate issues that had already failed at the initial hearing.

The Tribunal held that it had correctly weighed the medical evidence and that the insurer's notice of denial was sufficient to inform the applicant of the reasons for denial and the application of the MIG.

The applicant sought statutory accident benefits following a rear-end collision, claiming his injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain syndrome and psychological impairments.

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor, relying on insurer examinations that concluded his physical and psychological symptoms did not warrant removal from the MIG.

The Tribunal gave little weight to the applicant's pain specialist report, finding it relied entirely on self-reporting and contradicted objective evidence.

The applicant's claims for a $13,667.32 chronic pain program, an award for unreasonable delay, interest, and costs were all dismissed.

The applicant sought entitlement to a non-earner benefit, an attendant care benefit, and a treatment plan for psychological services following a motor vehicle accident on December 3, 2010.

The respondent denied the benefits, arguing the injuries were minor and the treatment plan was not reasonable and necessary.

The Tribunal found that the applicant failed to establish causation for the non-earner and attendant care benefits, noting her current complaints mimicked those from a prior 2008 accident for which she was already receiving benefits.

The Tribunal also found the claim for psychological services was statute-barred because the applicant failed to dispute the clear and unequivocal denial within the two-year limitation period.

The application was dismissed in its entirety.

The applicant sought a medical and rehabilitation benefit of $14,804.51 for a multidisciplinary chronic pain program following a motor vehicle accident.

The adjudicator found that the insurer's initial notices of denial were defective under s. 38(8) of the Schedule because they lacked medical reasons and failed to include the required Insurer Examination reports.

Consequently, the insurer was liable to pay for any treatment incurred between the date the notice was due and the date the defect was cured.

However, on the substantive issue, the adjudicator concluded that the treatment plan was not reasonable and necessary, as the applicant had reached maximum medical recovery, returned to full-time work, and showed no ongoing musculoskeletal or psychological impairments.

Claims for an award and costs were dismissed.

The appellant was injured in an altercation outside a bar where he was assaulted and subsequently struck by the assailants' departing vehicle.

He appealed an arbitrator's decision denying his claims for income replacement benefits and further medical benefits beyond the Minor Injury Guideline (MIG) cap.

The Director's Delegate upheld the arbitrator's findings that only the vehicle strike constituted an 'accident' under the Statutory Accident Benefits Schedule, that the appellant failed to prove pre-accident employment, and that his soft tissue injuries fell within the MIG.

The appeal was dismissed, save for a correction to the arbitrator's costs order.

The Applicant sought accident benefits following an incident where he was assaulted by individuals who threw a rock at him from a vehicle, punched and kicked him, and then struck him with the vehicle as they drove away.

The Arbitrator found that the injuries from the assault (rock, punches, kicks) did not arise from an 'accident' as defined in the Schedule, but the soft tissue injuries from being struck by the retreating vehicle did.

However, the Applicant's claims for Income Replacement Benefits were denied due to a lack of credible evidence regarding his employment status at the time of the accident.

The Arbitrator also concluded that the injuries sustained from the vehicle contact fell within the Minor Injury Guideline, restricting his entitlement to Medical and Rehabilitation Benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement, medical, and housekeeping benefits.

The insurer terminated benefits, arguing the applicant's pain responses were exaggerated and his psychological issues stemmed from pre-existing childhood trauma rather than the accident.

The arbitrator found the applicant credible and concluded that the accident was a material contributing factor to his chronic pain syndrome, fibromyalgia, and depression.

The arbitrator awarded ongoing income replacement benefits, medical benefits for various treatments, and housekeeping benefits.

Furthermore, the arbitrator found the insurer acted unreasonably in denying certain treatment plans without a designated assessment, and ordered the insurer to pay a special award under section 282(10) of the Insurance Act.