10 total
Application for accident benefits dismissed; applicant failed to prove injuries warranted removal from Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that her injuries fell within the Minor Injury Guideline (MIG).
The applicant claimed entitlement to a non-earner benefit, various treatment plans, and an award for unreasonable delay.
The Tribunal found that the applicant failed to prove on a balance of probabilities that she suffered from a pre-existing condition, physical injuries, psychological impairment, or chronic pain with functional impairment that would warrant removal from the MIG.
The Tribunal also dismissed the claim for a non-earner benefit due to a lack of evidence regarding the applicant's pre- and post-accident activities.
As the applicant remained subject to the MIG, the treatment plans were not considered, and the application was dismissed in its entirety.
Insurer ordered to pay ongoing IRBs and a 30% special award for unreasonable delay.
The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs).
The respondent insurer terminated the IRBs based on section 44 assessments.
The Tribunal found that the applicant suffered a substantial inability to perform the essential tasks of his employment, which involved heavy physical labour, and ordered the respondent to pay IRBs of $400 per week ongoing.
The Tribunal also found that the respondent unreasonably delayed adjusting the claim and awarded the applicant a 30% special award under section 10 of Regulation 664, amounting to $2,280.00.
The applicant's request for costs was denied.
Application for accident benefits dismissed; injuries fell within Minor Injury Guideline and income replacement denied.
The applicant sought statutory accident benefits following a motor vehicle accident.
The insurer denied benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from accident-related chronic pain or psychological impairments warranting removal from the MIG, preferring the evidence of the insurer's assessors.
The Tribunal also dismissed the claim for an income replacement benefit, finding insufficient evidence of the applicant's pre-accident self-employment as a social worker or inability to perform his duties as an Uber driver.
The application was dismissed.
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline limit.
The applicant sought statutory accident benefits following a motor vehicle accident, arguing her injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain syndrome with functional impairment.
The Licence Appeal Tribunal found the applicant's medical records and a section 44 physiatry assessment did not support a finding of functional impairment, noting she had returned to work without restrictions.
The Tribunal concluded the applicant's injuries were predominantly minor, dismissing the claims for additional treatment plans and assessments beyond the $3,500 MIG limit.
Application for non-earner and medical benefits dismissed; injuries fell within the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit and medical benefits outside the Minor Injury Guideline (MIG).
The Licence Appeal Tribunal found that the applicant failed to establish a complete inability to carry on a normal life, as medical evidence demonstrated she could independently perform most activities of daily living and had returned to part-time work.
Furthermore, the applicant did not provide sufficient evidence that a pre-existing lumbosacral spine pathology precluded her maximal recovery within the MIG.
The application was dismissed, and the disputed treatment plans were denied as the MIG funding limit was exhausted.
Application for accident benefits dismissed; injuries subject to MIG and no entitlement to non-earner benefits.
The applicant sought statutory accident benefits following a 2018 motor vehicle accident.
The respondent denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant failed to establish that his chronic pain, psychological impairments, or pre-existing conditions warranted removal from the MIG, noting that his chronic back pain and functional limitations pre-dated the accident and were not exacerbated by it.
The Tribunal also dismissed the claim for non-earner benefits, finding the applicant did not suffer a complete inability to carry on a normal life as his pre-accident activities were already severely limited by a prior accident.
All claims for treatment plans, assessments, interest, and an award were dismissed.
Application for accident benefits partially granted for a heating pad; remaining treatment plans and award denied.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic, occupational therapy, and speech therapy treatment plans, as well as an award for unreasonably withheld payments.
The Licence Appeal Tribunal found that the applicant failed to prove the chiropractic and speech therapy plans were reasonable and necessary, noting a lack of objective medical evidence and the duplicative nature of the speech therapy assessment.
The Tribunal partially approved the occupational therapy plan, awarding $150 for a heating pad, but denied the remainder.
The claim for an award under Regulation 664 was dismissed, as the insurer's conduct was not unreasonable.
Orthopaedic assessment and psychological treatment found reasonable and necessary; functional abilities evaluation and special award denied.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming costs for an orthopaedic assessment, a functional abilities evaluation, and psychological treatment.
The respondent insurer denied the benefits, relying on its own independent medical examinations.
The Licence Appeal Tribunal found that the orthopaedic assessment and psychological treatment were reasonable and necessary, noting the applicant's ongoing chronic pain and psychological symptoms, which were exacerbated by the accident.
The Tribunal dismissed the claim for the functional abilities evaluation, finding it redundant given the orthopaedic assessment.
The Tribunal also dismissed the applicant's claim for a special award, finding the insurer did not unreasonably withhold or delay payments.
Application for non-earner benefit dismissed as applicant failed to prove complete inability to carry on normal life.
The applicant sought a non-earner benefit under the Statutory Accident Benefits Schedule following a motor vehicle accident.
The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove a complete inability to carry on a normal life.
Medical evidence and surveillance demonstrated that the applicant had substantially returned to his pre-accident routine, including working as a plumber and engaging in social and leisure activities.
Claims for interest and a special award were consequently dismissed.
Insurer ordered to pay for a massage therapy chair as a reasonable and necessary medical benefit.
The applicant was injured in a motor vehicle accident and sought a medical and rehabilitation benefit of $6,177.64 for a massage therapy chair, which the insurer denied.
The Licence Appeal Tribunal found that the applicant met the onus of proving the massage chair was reasonable and necessary for pain relief and to support physical activity, preferring the evidence of the applicant's occupational therapist and physiatrist over the insurer's experts.
The Tribunal ordered the insurer to pay for the massage chair and associated warranty, along with interest on the overdue payment.
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