Dr. Verity John

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to treatment plans for chiropractic services, a chronic pain program, and an orthopaedic assessment outside the Minor Injury Guideline (MIG).

The applicant argued that a concussion, chronic pain syndrome, and psychological impairments warranted removal from the MIG.

The Tribunal preferred the respondent's expert evidence, finding that the applicant's dizziness pre-dated the accident, his pain complaints were likely degenerative, and his psychological testing was normal.

The Tribunal concluded the applicant's injuries were predominantly minor, and since the MIG limit was exhausted, the disputed treatment plans were not payable.

Claims for an award and interest were also dismissed.

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

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG) limit, as she failed to establish that pre-existing conditions, chronic pain, or psychological impairments warranted removal.

The Tribunal also dismissed the applicant's claim for an income replacement benefit (IRB), finding she did not prove a substantial inability to perform the essential tasks of her employment during the pre-104-week period.

Claims for a treatment plan, an award, and costs were also dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including a determination of catastrophic impairment under Criterion 8 (mental and behavioural disorders).

The Tribunal found that the applicant did not sustain a catastrophic impairment, as she did not demonstrate marked impairments in three out of four domains of functioning.

The Tribunal preferred the evidence of the respondent's assessors, who found the applicant capable of living independently and managing daily activities.

The applicant's claims for attendant care benefits, housekeeping benefits, and various treatment plans were also dismissed, as she failed to prove they were reasonable and necessary or incurred in accordance with the Schedule.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The Licence Appeal Tribunal considered whether the applicant was entitled to pre-104 week and post-104 week income replacement benefits (IRBs), various treatment plans, interest, and a special award.

The Tribunal found that the applicant, a self-employed massage therapist, suffered a substantial inability to perform the essential tasks of her employment and was entitled to pre-104 week IRBs.

However, the Tribunal rejected the applicant's claim that her self-employment income was $30,000, finding the supporting documentation unreliable, and instead calculated the IRBs at $169.00 per week based on her originally declared income.

The applicant failed to establish entitlement to post-104 week IRBs.

The Tribunal approved several treatment plans, including occupational therapy, rehabilitation support worker sessions, psychotherapy, an attendant care assessment, and a rollator walker, finding them reasonable and necessary based on the medical evidence, including supportive reports from the respondent's own occupational therapy assessor.

Other treatment plans were denied for lack of evidence.

The Tribunal awarded interest on overdue payments but denied the request for a special award, concluding the insurer's reliance on its own medical reports was not unreasonable.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the denial of treatment plans for physiotherapy, psychotherapy, and multiple assessments.

The Tribunal found that the applicant failed to prove the physiotherapy and assessments were reasonable and necessary, noting a lack of clinical notes and preferring the respondent's medical assessments.

However, the Tribunal granted the outstanding balance for psychotherapy services, finding the proposed 1.5-hour sessions reasonable as recommended by the assessing psychologist.

Interest was awarded on the overdue psychotherapy benefits.

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.

The applicant sought income replacement benefits and approval for various treatment plans following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove on a balance of probabilities that he suffered a substantial inability to perform the essential tasks of his employment or a complete inability to engage in any employment.

The Tribunal preferred the respondent's medical evidence, noting inconsistencies in the applicant's expert reports and relying on the applicant's successful completion of a three-month accounting work placement.

The claims for treatment plans, an award, and interest were also dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including attendant care and various medical and rehabilitation benefits.

The respondent denied the benefits, and the applicant applied to the Licence Appeal Tribunal.

The Tribunal found that the applicant was not entitled to ongoing attendant care benefits, as the medical evidence demonstrated he was mostly independent in his activities of daily living and failed to prove the expenses were incurred.

The Tribunal granted one physiotherapy treatment plan for $4,022.42, finding it reasonable and necessary for pain reduction, despite the respondent's argument that the injuries fell within the Minor Injury Guideline.

The remaining claims for further treatment, assessments, and treatment provider mileage were dismissed as they were either duplicative, not reasonable and necessary, or not payable under the Schedule.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule, which the respondent insurer denied.

The applicant applied to the Licence Appeal Tribunal to dispute the denials of treatment plans for physiotherapy, a neuro-optometric assessment, an orthopaedic assessment, and a functional abilities evaluation.

The Tribunal found that the disputed treatment plans were not reasonable and necessary, relying heavily on the respondent's insurer's examinations which concluded the applicant had reached maximum medical recovery and required no further intervention.

One physiotherapy treatment plan had already been approved by the respondent prior to the hearing.

The Tribunal dismissed the claims for the remaining benefits, interest, a special award, and costs.

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

The respondent denied several treatment plans, and the applicant argued the denials were procedurally defective under the Schedule.

The Tribunal found the respondent's initial notices for two psychological treatment plans were non-compliant, entitling the applicant to the outstanding balances incurred during the period of non-compliance.

However, the Tribunal dismissed the claims for chiropractic treatment and an attendant care assessment, finding the applicant failed to prove the chiropractic treatment was reasonable and necessary, and that the attendant care assessment was improperly incurred prior to the submission of the treatment plan.

The applicant, who sustained a catastrophic impairment in a motor vehicle accident and remains in a persistent vegetative state, sought funding for occupational therapy and a speech-language therapy assessment.

The respondent denied the treatments as not reasonable and necessary.

Prior to the decision, the respondent agreed to pay for the speech-language assessment.

The Tribunal found that the occupational therapy services were reasonable and necessary, noting the applicant's potential for improvement and the relatively minor cost of the treatment plan.

The applicant was awarded the balance of the occupational therapy services and interest on overdue amounts.

The applicant was a pedestrian struck by a motor vehicle and sought statutory accident benefits.

The respondent insurer denied four treatment plans for chiropractic, massage, and physiotherapy, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) limit of $3,500.

The respondent also brought a preliminary motion to admit late medical reports, which the Tribunal denied due to non-compliance with a case conference order.

On the substantive issues, the Tribunal found that the applicant sustained a concussion and post-concussion syndrome, which are not defined as minor injuries under the Schedule, thereby removing her from the MIG.

The Tribunal preferred the emergency hospital records diagnosing a concussion over the respondent's insurer examinations conducted months later.

The Tribunal concluded that the four treatment plans totaling over $9,000 were reasonable and necessary to assist the applicant in recovering from her injuries, and awarded interest on the overdue benefits.