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Tribunal approves chronic pain assessment but denies income replacement and psychological benefits for lack of evidence.
The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits, psychological treatment, and a chronic pain assessment.
The Tribunal denied the income replacement benefits as the applicant failed to meet her evidentiary burden.
The psychological treatment claims were also denied because the incurred services did not align with the approved plans.
However, the Tribunal approved the chronic pain assessment, finding sufficient medical evidence to warrant an investigation into the applicant's ongoing pain symptoms.
Claims for a special award and costs were dismissed.
Application for accident benefits dismissed; injuries fell within MIG and applicant continued working full-time.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and she was not entitled to non-earner benefits (NEBs).
The Tribunal first found the applicant was not barred from proceeding despite missing a second insurer's examination, as it was not reasonably necessary.
On the merits, the Tribunal held the applicant's injuries were predominantly minor, noting her psychological symptoms had resolved according to her family doctor.
The Tribunal also dismissed the claim for NEBs, finding the applicant continued to work full-time and did not suffer a complete inability to carry on a normal life.
The application was dismissed.
Application for accident benefits dismissed as applicant failed to prove treatment plans were reasonable and necessary.
The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to treatment plans for custom orthotics, a Functional Abilities Evaluation, and a vocational assessment.
The respondent denied the benefits based on Insurer's Examinations which concluded the treatments and assessments were not reasonable and necessary.
The Tribunal found that the applicant failed to provide sufficient contemporaneous medical evidence to support the treatment plans and preferred the respondent's expert evidence.
The application was dismissed, and claims for an award and interest were denied.
Application for accident benefits dismissed due to lack of causation, insufficient evidence, and non-compliance.
The applicant sought income replacement benefits (IRBs) and medical and rehabilitation benefits following a motor vehicle accident.
The adjudicator found that the applicant failed to prove she suffered a substantial inability to perform the essential tasks of her pre-accident employment, noting inconsistencies in her reported employment and a lack of supportive medical evidence linking her physical and psychological impairments to the accident.
Furthermore, the applicant was found non-compliant with section 33 of the Schedule for failing to provide requested employment and income documentation.
The adjudicator also dismissed the claims for physiotherapy, psychological services, and a chronic pain program, finding the applicant did not establish that the treatments were reasonable and necessary or that she suffered from accident-related chronic pain.
The application was dismissed in its entirety.
Application for accident benefits dismissed; injuries fell within the Minor Injury Guideline.
The applicant, a minor struck by a car while riding a bicycle, sought statutory accident benefits including a non-earner benefit and funding for chiropractic treatment plans.
The respondent insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found the applicant failed to prove his injuries warranted removal from the MIG, as medical evidence indicated only soft tissue injuries.
The Tribunal also dismissed the claims for a non-earner benefit, finding insufficient evidence of a complete inability to carry on a normal life, and found the treatment plans were not payable.
Non-earner benefits application dismissed; applicant failed to prove complete inability to carry on normal life.
The applicant sought a non-earner benefit following a motor vehicle accident.
The respondent denied the benefit and requested insurer examinations under section 44 of the Schedule.
The adjudicator found that the applicant failed to meet her evidentiary burden to prove a complete inability to carry on a normal life, as she provided no comparative evidence of her pre- and post-accident activities and relied solely on an OCF-3.
The adjudicator accepted the conclusions of the respondent's insurer examination assessors and dismissed the application, including claims for interest and an award.
Application for accident benefits dismissed due to lack of medical evidence and contradictory surveillance footage.
The applicant sought statutory accident benefits, including income replacement benefits, attendant care benefits, and a treatment plan for psychological services following a motor vehicle accident.
The applicant was represented by his spouse and failed to provide any medical documentation or expert testimony to support his claims.
The adjudicator relied on the respondent's section 44 assessment reports and surveillance evidence, which contradicted the applicant's claimed impairments and demonstrated his ability to perform daily activities independently.
Application for statutory accident benefits dismissed as proposed treatments and assessments were not reasonable and necessary.
The applicant sought various statutory accident benefits following a motor vehicle accident, including physiotherapy services, an attendant care assessment, and a functional ability evaluation.
The respondent denied the benefits, relying on insurer's examinations which indicated the applicant had reached maximal recovery and returned to work.
The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that the proposed treatment plans and assessments were reasonable and necessary.
The Tribunal dismissed all claims for benefits, interest, a section 10 award, and costs.
Applicant removed from Minor Injury Guideline due to chronic pain; medication expenses awarded but chiropractic denied.
The insurer denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found the applicant suffered from accident-related chronic pain with functional impairment, warranting removal from the MIG.
The Tribunal awarded the claimed medication expenses as reasonable and necessary for pain management and associated mental health challenges.
However, the claim for chiropractic services was denied due to insufficient evidence of reasonableness and necessity.
No interest was awarded.
Application for accident benefits dismissed; injuries fell within Minor Injury Guideline and funding limit exhausted.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming chronic pain warranted removal from the Minor Injury Guideline (MIG).
The adjudicator found the applicant provided insufficient medical evidence of chronic pain or functional impairment, preferring the respondent's physiatry assessment which concluded the injuries were minor.
As the applicant's injuries fell within the MIG and the $3,500 funding limit was exhausted, the claim for a $1,475.35 chiropractic and physiotherapy treatment plan was dismissed.
Applicant removed from Minor Injury Guideline due to pre-existing conditions; special award granted for unreasonable denial.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits.
The respondent insurer denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant's documented pre-existing lower back and bilateral knee conditions precluded maximal medical recovery within the MIG, removing him from its limits.
The Tribunal approved treatment plans for chiropractic services, medical devices, and a functional ability assessment, finding them reasonable and necessary.
However, treatment plans for an attendant care assessment and a psychological assessment were denied for lack of compelling medical evidence.
The Tribunal also ordered the respondent to pay a special award of $1,714.36 under s. 10 of Regulation 664, finding that the insurer unreasonably withheld benefits by ignoring the pre-accident medical evidence.
Physiotherapy and physiatry assessment granted based on treating records; neurological assessment denied due to normal prior exam.
The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to physiotherapy services, a physiatry assessment, and a neurological assessment.
The respondent denied the benefits, relying on s. 44 assessments that concluded the applicant's injuries fell within the Minor Injury Guideline.
The Tribunal found the physiotherapy and physiatry assessment reasonable and necessary based on consistent clinical records from the applicant's treating practitioners.
However, the Tribunal denied the neurological assessment, noting a prior normal neurological consultation and a lack of compelling evidence of neurological impairment.
The applicant was awarded interest on overdue benefits but denied a special award under s. 10 of Reg. 664.
Applicant removed from Minor Injury Guideline due to concussion; partial treatment plans approved.
The respondent denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant sustained a concussion, removing her from the MIG.
The Tribunal approved treatment plans for chiropractic services and vestibular physiotherapy, finding them reasonable and necessary based on consistent medical evidence of ongoing physical and vestibular symptoms.
However, claims for an occupational therapy assessment and a psychological assessment were dismissed, as the applicant remained independent in her activities of daily living and lacked objective evidence of a psychological injury.
Interest was awarded on the overdue benefits for incurred expenses.
Tribunal awards funding for nutritional and chronic pain assessments but dismisses remaining accident benefit claims.
The applicant sought various statutory accident benefits following a motor vehicle accident, including attendant care benefits, treatment plans for chiropractic and psychological services, assistive devices, and several assessments.
The Tribunal found that while the applicant demonstrated a need for attendant care benefits during the disputed period, he failed to prove the expenses were incurred, rendering them not payable.
The Tribunal granted the treatment plans for a nutritional assessment and a chronic pain assessment, finding them reasonable and necessary based on the applicant's reported symptoms and medical records.
The remaining claims were dismissed for lack of evidence or because the Tribunal lacked jurisdiction over items not proven to have been submitted to or denied by the insurer.
Applicant's injuries found to be predominantly minor; claims for treatment plans outside MIG dismissed.
The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant's physical injuries were predominantly minor soft tissue injuries and that she failed to provide compelling evidence of a psychological impairment that would warrant removal from the MIG.
Consequently, the applicant was not entitled to the disputed treatment plans, interest, or an award for unreasonable delay.
Applicant's injuries deemed minor; treatment plans beyond the $3,500 Minor Injury Guideline limit denied.
The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent insurer's determination that his injuries fell within the Minor Injury Guideline (MIG).
The applicant claimed physical injuries including whiplash and soft tissue sprains, as well as psychological impairments such as an adjustment disorder.
The Licence Appeal Tribunal found that the applicant's physical injuries were captured by the minor injury definition and that he failed to provide compelling medical evidence of a pre-existing condition or a psychological impairment warranting removal from the MIG.
Consequently, the applicant was held to the $3,500 MIG limit and denied the disputed treatment plans beyond that cap, though he was awarded interest on any overdue payments within the limit.
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline.
The respondent denied treatment plans for physiotherapy and psychological services on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant failed to prove his injuries warranted removal from the MIG, rejecting claims of chronic pain and psychological impairment.
The Tribunal also excluded late-produced medical records due to the applicant's failure to comply with a Case Conference Report and Order.
The application for benefits, interest, and an award was dismissed.
Reconsideration allowed in part to correct disputed dates, but ongoing income replacement benefits denied.
The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found his injuries fell within the Minor Injury Guideline (MIG) and denied his claim for ongoing Income Replacement Benefits (IRB).
The applicant argued the Tribunal breached procedural fairness, ignored new medical evidence, and erred in fact regarding the MIG and the IRB dispute period.
The adjudicator found no breach of procedural fairness and held that the new evidence could have been obtained prior to the hearing.
While the adjudicator agreed the Tribunal made a factual error regarding the dates in dispute for the IRB claim, upon reviewing the evidence for the corrected period (February 26, 2020 to April 23, 2023), the adjudicator concluded the applicant failed to prove a substantial inability to perform the essential tasks of his employment.
The reconsideration was allowed in part to correct the dates, but the claim for ongoing IRB was dismissed.
Accident benefits claim dismissed; injuries fell within Minor Injury Guideline and non-earner benefits test unmet.
The applicant sought accident benefits following a 2011 motor vehicle accident, applying for them nine years later in 2020.
The adjudicator found that the applicant's injuries fell within the Minor Injury Guideline (MIG), rejecting claims of a psychological impairment that would warrant removal from the MIG.
The claim for non-earner benefits was dismissed as the applicant failed to submit the required disability certificate within the 104-week post-accident period and did not demonstrate a complete inability to carry on a normal life.
A treatment plan for physiotherapy was also denied because the applicant had not incurred the expenses and failed to prove the treatment was reasonable and necessary given the time elapsed since the accident.
Application for removal from the Minor Injury Guideline dismissed due to insufficient evidence of chronic pain or psychological impairment.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming chronic pain and psychological impairments warranted removal from the Minor Injury Guideline (MIG).
The Licence Appeal Tribunal found the applicant failed to provide compelling medical evidence of chronic pain syndrome or psychological impairment caused by the accident.
The Tribunal preferred the respondent's section 44 assessments, which found the applicant's injuries were minor and did not result in functional impairment.
The application was dismissed, and the disputed treatment plans were denied.
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