Fayola Benjamin

The applicant sought statutory accident benefits following a motor vehicle accident, claiming catastrophic impairment under Criteria 7 and 8 of the Schedule due to vascular dementia and other impairments.

The respondent denied the benefits, noting the applicant had already reached the non-catastrophic funding limit.

The Licence Appeal Tribunal found that the applicant failed to meet the burden of proving catastrophic impairment, as the medical evidence did not establish a 55% whole person impairment under Criterion 7 or a marked impairment in three domains under Criterion 8.

Consequently, the claims for additional medical benefits, interest, and a section 10 award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain and psychological impairments.

The Licence Appeal Tribunal found the applicant did not meet the burden of proof for removal from the MIG.

The medical evidence, including clinical notes and records, did not support a diagnosis of chronic pain with functional impairment or a psychological condition caused by the accident.

Furthermore, surveillance evidence contradicted the applicant's claims of functional limitation.

As the applicant remained in the MIG and the limits were exhausted, the disputed treatment plans were not considered, and the application was dismissed.

The applicant was involved in a rear-end motor vehicle accident and sought statutory accident benefits, which the respondent insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that a full-thickness tear in his right shoulder, chronic pain, and psychological impairments warranted treatment outside the MIG.

The Tribunal found that the shoulder tear pre-dated the accident and that the applicant did not meet the criteria for chronic pain or a psychological impairment.

Consequently, the applicant's injuries were deemed minor, and the disputed treatment and assessment plans were not reasonable and necessary as they exceeded the $3,500 MIG funding limit.

The application was dismissed.

The applicant sought a determination that she sustained a catastrophic impairment due to psychological injuries following a motor vehicle accident, along with payment for assessment costs.

The Tribunal found the applicant to be an unreliable historian, noting significant inconsistencies between her testimony and her pre-accident psychiatric records which documented pre-existing depression, poor memory, and suicidal thoughts.

The Tribunal placed little weight on the applicant's expert reports because they relied on her incomplete self-reporting.

The application was dismissed as the applicant failed to prove she suffered marked impairments in three domains of functioning as a result of the accident.

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 that he did not meet the test for an income replacement benefit (IRB).

The Tribunal found that the applicant failed to prove his injuries fell outside the MIG, as the medical evidence, including insurer examinations, supported a diagnosis of soft tissue injuries.

Consequently, the claims for physiotherapy were dismissed as the MIG limits were exhausted.

The Tribunal also dismissed the claim for an IRB, finding the applicant did not establish a substantial inability to perform the essential tasks of his pre-accident employment as an Uber driver.