Dr. R. Saplys

The applicant sought statutory accident benefits following an e-bike collision.

The respondent denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that she did not suffer a substantial inability to perform the essential tasks of her employment.

The Tribunal found that the applicant failed to prove her injuries warranted removal from the MIG, noting a lack of compelling medical evidence for psychological impairments and relying on insurer's examinations.

The Tribunal also dismissed the claim for income replacement benefits, citing surveillance evidence showing the applicant working and riding a bike.

All claims for medical benefits, attendant care benefits, interest, and an award were dismissed.

The applicant sought entitlement to two treatment plans for chiropractic services and interest under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent denied the plans based on an insurer's examination which concluded the applicant sustained only uncomplicated soft tissue injuries.

The Tribunal found that the applicant failed to meet her burden of proving the treatment plans were reasonable and necessary, preferring the respondent's medical evidence over the applicant's chronic pain assessment, which relied heavily on subjective reporting.

The application was dismissed, and the respondent's request for costs due to late disclosure was denied.

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

The respondent denied certain treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and its $3,500 funding limit.

The Licence Appeal Tribunal found that the applicant's psychological complaints and spondylolysis did not warrant removal from the MIG, preferring the respondent's insurer examination reports over the applicant's psychological assessment.

The Tribunal dismissed the claims for additional medical benefits and interest.

Furthermore, the Tribunal awarded $200 in costs to the respondent due to the applicant's unreasonable behaviour, including late filings, adding unpleaded issues, and falsely certifying service of materials.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and the cost of a multi-disciplinary assessment from her insurer.

The insurer terminated IRBs after 104 weeks and denied the assessment costs.

The Licence Appeal Tribunal found that the applicant suffered a substantial inability to perform the essential tasks of her pre-accident employment as a restaurant crew member due to unresolved left shoulder tendonitis, entitling her to IRBs up to the 104-week mark.

However, the Tribunal concluded she did not meet the post-104 week test of a complete inability to engage in any suitable employment, relying on surveillance evidence and vocational assessments showing she could perform alternative jobs.

The Tribunal also awarded partial costs for the multi-disciplinary assessment, finding the occupational therapy, orthopedic, and vocational components reasonable and necessary, while denying the psychological and neurological components.

The Applicant sought a determination that she sustained a catastrophic impairment following a motor vehicle accident, claiming her accident-related injuries necessitated cervical spinal fusion surgery.

The Respondent denied the claim, arguing the surgery resulted from pre-existing degenerative spinal conditions.

The Tribunal found that the Applicant's physical and psychological impairments combined to a 41% whole person impairment, falling short of the 55% threshold required for catastrophic impairment.

The Tribunal concluded that the Applicant's need for surgery was caused by the natural progression of her pre-existing congenital degenerative disc disease and spinal stenosis, and that an intervening chiropractic manipulation broke any chain of causation with the accident.

The claims for attendant care benefits and interest were consequently dismissed.

The appellant appealed an arbitrator's decision denying his claim for income replacement benefits under the Statutory Accident Benefits Schedule.

The appellant claimed he had a legitimate contract of employment as a sales representative before the accident.

The Director's Delegate upheld the arbitrator's finding that the evidence did not establish a genuine employment contract, dismissing the income replacement claim.

However, the appeal was allowed in part to award the appellant the full $1,670 cost of a psycho-vocational assessment, finding it was a reasonable expense recommended by his treating doctors.

The insurer's cross-appeal for repayment of benefits was dismissed.