Ruth Billet

The applicant was injured in a motor vehicle accident and sought post-104-week income replacement benefits (IRBs).

The respondent denied the benefits, arguing the applicant did not suffer a complete inability to engage in any employment for which she was reasonably suited.

The Tribunal found that the applicant's physical impairments, specifically complex regional pain syndrome (CRPS) in her right arm, along with psychological impairments, prevented her from engaging in suitable employment, even on a part-time basis.

The Tribunal ordered the respondent to pay IRBs of $400 per week from September 1, 2022, plus interest.

The applicant's claim for an award under s. 10 of Regulation 664 for unreasonable withholding of benefits was dismissed.

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

The Tribunal found the applicant sustained a catastrophic impairment under Criterion 7, reaching a 57% whole-person impairment rating.

The Tribunal also found the applicant met the test for post-104 income replacement benefits due to a complete inability to engage in suitable employment, but denied payment because the applicant failed to file income tax returns as required by section 4(5) of the Schedule.

Finally, the Tribunal determined the applicant was entitled to attendant care benefits of $889.21 per month, but denied payment because the expenses were not incurred.

The applicant sought statutory accident benefits following a motor vehicle accident, including post-104-week income replacement benefits (IRBs) and various treatment plans.

The respondent denied the benefits.

The Tribunal found that the applicant demonstrated a complete inability to engage in any employment for which she was reasonably suited by education, training, or experience, primarily due to chronic pain syndrome and psychological impairments.

The Tribunal awarded IRBs from June 23, 2023, ongoing.

The Tribunal also approved treatment plans for psychological therapy, Botox for migraines, psychological assessments, and a chronic pain program, finding them reasonable and necessary.

However, the Tribunal denied several physical therapy, chiropractic, and assistive device plans, noting a lack of physical improvement from prior physical treatments.

The claim for a special award was dismissed, but interest was awarded on overdue benefits.

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.

The applicant was injured in a 2018 motor vehicle accident and sought ongoing income replacement benefits (IRBs) beyond the 104-week mark, along with medical benefits, an award, and costs.

The respondent denied the IRBs, arguing the applicant could work part-time in alternative roles.

The Tribunal found that the applicant met the post-104 week test for IRBs because the alternative employment proposed by the respondent offered significantly less income and status than her pre-accident work, and her psychological impairments limited her to working only 6 to 10 hours per week.

However, the Tribunal dismissed the claims for metabolic testing, neuromonitoring, and physiotherapy due to insufficient evidence regarding their necessity and reasonable costs.

The claims for a special award and costs were also dismissed.

The applicant was injured in a motor vehicle accident and sought post-104 weeks income replacement benefits (IRBs), arguing she suffered a complete inability to engage in suitable employment.

The Tribunal preferred the respondent's expert evidence, finding the applicant retained the functional capacity for sedentary work and did not meet the complete inability test.

The Tribunal also held that the respondent correctly deducted the applicant's maternity leave Employment Insurance benefits from her pre-104 weeks IRBs, as they constitute gross employment income under the Schedule.

Finally, the Tribunal dismissed the claim for a special award, finding the respondent's handling of the claim and temporary stoppages of benefits pending further medical information were not unreasonable.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including post-104-week income replacement benefits (IRBs), attendant care benefits, and funding for medical assessments.

The Tribunal found the applicant was entitled to ongoing IRBs, as her post-concussion syndrome and chronic pain resulted in a complete inability to engage in any employment for which she was reasonably suited.

The Tribunal also approved a neuropsychological assessment but denied a speech language pathology assessment, noting the applicant's post-accident public speaking engagements.

Claims for attendant care benefits, a special award, and costs were dismissed.

The insurer brought an application to vary a consent order that required it to pay ongoing income replacement benefits to the insured.

The insurer argued that the change in the test for entitlement to income replacement benefits at the 104-week mark constituted a material change in circumstances justifying a variation of the order.

The arbitrator dismissed the application, finding that the change in the test for entitlement, in isolation, did not constitute a material change in circumstances, especially since the insurer had consented to the order shortly before the 104-week mark without insisting on a time limit and later conceded that the insured met the post-104-week test.

The applicant was injured in a motor vehicle accident and received income replacement benefits.

Following a consent order requiring the insurer to pay ongoing benefits, the insurer unilaterally terminated the benefits based on new medical information, arguing the test for entitlement had changed at the 104-week mark.

The arbitrator found that the insurer acted unreasonably by terminating benefits in contravention of the consent order and section 287 of the Insurance Act, which requires an insurer to continue payments until a variation order is obtained.

The arbitrator ordered the insurer to pay a special award of $6,000 for unreasonably withholding payments.