Geoffrey L. Keating

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for occupational therapy and physiotherapy treatment plans.

The respondent denied the claims on the basis that the treatments were not reasonable and necessary.

At the hearing, the respondent raised a preliminary issue to exclude the applicant's affidavit, which the adjudicator dismissed, allowing the affidavit into evidence.

On the substantive issues, the adjudicator found that the applicant had reached maximum medical recovery and was able to perform her pre-accident activities, including full-time employment, without the need for further treatment.

The adjudicator concluded that the applicant failed to prove the treatment plans were reasonable and necessary, and dismissed the application.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB), medical benefits for chiropractic services, and various expenses.

The insurer denied the claims.

The Tribunal found the applicant failed to provide sufficient medical and financial evidence to prove a substantial inability to perform the essential tasks of her employment for the IRB.

The Tribunal also found the applicant failed to prove the medical benefits and expenses were reasonable and necessary, noting a lack of supporting medical documentation and failure to rebut the insurer's examination report.

The application was dismissed.

The applicant sought reconsideration of a Tribunal decision denying entitlement to certain chiropractic services and a psychiatric assessment following a motor vehicle accident.

The Tribunal had denied the chiropractic services because the applicant failed to attend a reasonably requested insurer's examination, triggering a statutory bar to proceeding.

The psychiatric assessment was denied because the expense was incurred before the treatment plan was submitted, contrary to the Statutory Accident Benefits Schedule.

On reconsideration, the adjudicator found no significant errors of law or fact in the original decision that would have led to a different result.

The request for reconsideration was dismissed.

The respondent insurer requested a reconsideration of a Tribunal decision which found that the applicant's injuries fell outside the Minor Injury Guideline (MIG) and that six disputed treatment plans were reasonable and necessary.

The respondent argued the Tribunal made significant errors of law by failing to consider whether the injuries were 'predominately' minor, by ruling in the applicant's favour without submissions on the reasonable and necessary test, and by failing to cite the respondent's case law.

The Vice Chair dismissed the request, finding that the Tribunal had properly weighed the medical evidence, correctly concluded the applicant sustained a mild traumatic brain injury that was not predominately minor, and was not required to explicitly cite every piece of case law considered.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming she suffered a substantial inability to perform the essential tasks of her pre-accident employment as an early childhood educator due to psychological and physical impairments.

The insurer denied the claim based on multiple insurer's examinations.

The Tribunal found that the applicant failed to meet her burden of proof, noting that her own treating psychiatrist's records indicated her depression and post-concussion syndrome had largely resolved.

The appeal for IRBs and interest was dismissed.

The applicant sought income replacement benefits following a motor vehicle accident.

The respondent insurer brought a motion to stay the proceeding because the applicant refused to attend a psychological insurer's examination.

The Tribunal found that the requested examination was reasonably necessary given the submission of new medical records by the applicant and the age of the previous assessments.

The Tribunal held that proceeding without the assessment would deny the respondent procedural fairness.

The motion was granted and the application was stayed until the applicant attends the assessment.

The applicant was injured in a motor vehicle accident and sought medical benefits for physiotherapy services.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant sustained predominantly minor injuries, as defined in the Schedule, and failed to provide compelling evidence of a pre-existing medical condition that would prevent maximal recovery within the MIG limits.

Consequently, the applicant was not entitled to the disputed treatment plan or interest.

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

The insurer denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that the appeal should be barred due to the applicant's failure to attend an insurer's examination.

The Tribunal found the appeal was not barred, as the insurer's request for an examination was made over a year after the denial and on the eve of the hearing.

The Tribunal determined the applicant was removed from the MIG due to a chronic pain condition diagnosed by an uncontroverted medical report.

The Tribunal awarded medical benefits for chiropractic treatment and clinical notes, but denied the cost of a duplicative chronic pain assessment.

The applicant was also awarded non-earner benefits from September 27, 2016, ongoing.

The applicant sought income replacement benefits following a motor vehicle accident.

The insurer suspended benefits after the applicant failed to provide requested post-accident bank records.

The Tribunal found that the insurer's request under s. 33 of the Schedule was reasonable, given surveillance evidence showing the applicant at her employer's premises and the fact that her employer was a company owned by her husband.

Because the applicant failed to comply with the reasonable request, the insurer was not liable to pay the benefits.

The application was dismissed.

The respondent insurer sought reconsideration of a decision awarding the applicant $1,000 in costs.

The costs were originally awarded because the respondent conceded the applicant's entitlement to an income replacement benefit at the start of the hearing, which the adjudicator found to be unreasonable and vexatious conduct that caused unnecessary preparation expense.

The respondent argued the adjudicator made errors of law and fact by failing to follow prior decisions, misunderstanding its position, and lacking justification for the quantum.

The Vice-Chair denied the reconsideration request, finding no significant error of law or fact, and held that the adjudicator properly exercised discretion in assessing the parties' conduct and awarding costs.

The insurer requested a reconsideration of a Licence Appeal Tribunal decision that denied its request for repayment of $6,059.23 in Income Replacement Benefits (IRBs) paid to the insured.

The insurer argued that the Tribunal erred by failing to deduct corporate losses from the insured's pre-accident self-employment income when calculating the quantum of IRBs payable.

The Vice-Chair agreed, finding that under section 7(2) of the Statutory Accident Benefits Schedule, losses from self-employment must be used to reduce pre-accident employment income.

After deducting the corporate losses and post-accident income, the insured's IRB entitlement was zero.

The reconsideration was granted, and the insured was ordered to repay the $6,059.23 overpayment.

The applicant sought statutory accident benefits for occupational therapy services and devices following a motor vehicle accident.

The respondent denied the benefits on the basis that the treatment plans were not reasonable and necessary.

The Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, preferring the evidence of the respondent's occupational therapist whose findings were consistent with other assessors.

The Tribunal also found the respondent's denials were valid and dismissed the claims for interest and an award for unreasonable delay.

The applicant sought statutory accident benefits for chiropractic treatments and assessments following a motor vehicle accident.

The Tribunal found the applicant entitled to a $3,349.08 chiropractic treatment plan, as medical evidence supported that pain reduction was a reasonable and necessary goal.

However, a subsequent $2,585.50 chiropractic plan was denied because the applicant failed to attend a reasonably necessary insurer examination, precluding her from proceeding to a hearing on that issue.

A psychiatric assessment was denied because it was incurred before the treatment plan was submitted.

The respondent conceded entitlement to a physiatry assessment.

Interest was awarded on the overdue benefits.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for a treatment plan proposing physiotherapy and massage therapy.

The respondent insurer denied the treatment plan based on an insurer's examination.

The adjudicator found that the applicant failed to prove the treatment plan was reasonable and necessary, noting that the applicant had reached maximum medical improvement, the treatment goals were unattainable, and previous treatment had not resulted in pain reduction.

The application for benefits, interest, and costs was dismissed.

The applicant sought a medical and rehabilitation benefit of $2,661.57 for physiotherapy following a motor vehicle accident, along with interest and an award for unreasonable delay.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide any medical evidence or argument to prove the treatment was reasonable and necessary.

The insurer's examination concluded the treatment was not required, and the applicant's criticisms of the insurer's claims adjustment process did not substitute for positive medical evidence.

Consequently, the claims for interest and an award were also dismissed.

The applicant sought income replacement benefits following a motor vehicle accident.

The parties disputed the applicant's gross income in the four weeks preceding the accident, with the applicant claiming $1,500 and the insurer claiming $750.

The Tribunal reviewed payroll slips, cheques, and tax documents, finding the applicant's evidence unreliable and inconsistent.

Relying primarily on the applicant's T4 and Notice of Assessment, the Tribunal concluded on a balance of probabilities that the applicant earned $750 in the four weeks prior to the accident.

The appeal was dismissed.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, as well as post-104 week income replacement benefits (IRB), which the respondent insurer denied.

The Licence Appeal Tribunal found that the applicant likely suffered a concussion and continued to experience dizziness, cognitive impairments, and psychological difficulties.

The Tribunal determined that the proposed treatment plans for occupational therapy, physiotherapy, and speech language therapy were reasonable and necessary, with the exception of a weighted vest.

Furthermore, the Tribunal concluded that the applicant met the test for post-104 week IRB, as her ongoing impairments rendered her completely unable to engage in any employment for which she was reasonably suited.

The respondent was ordered to pay the disputed benefits and interest.

The applicant sought attendant care benefits following a motor vehicle accident.

The respondent insurer initially paid the benefits but terminated them after an insurer's examination by an occupational therapist concluded there was no ongoing need.

The applicant argued the expenses should be deemed incurred because the respondent unreasonably withheld payment.

The Tribunal found that the respondent's reliance on its assessor's report was not unreasonable and dismissed the application, finding the applicant was not entitled to the disputed benefits.

The applicant sought coverage for four chiropractic treatment plans following a motor vehicle accident.

The respondent denied the plans based on an insurer's examination which concluded the applicant had reached maximum medical recovery.

The adjudicator found that the applicant had significant pre-existing conditions and provided inconsistent reporting regarding his symptoms and ability to work.

Accepting that the applicant's recovery had plateaued, the adjudicator concluded the treatment plans were not reasonable and necessary.

The appeal was dismissed.

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

The respondent denied several treatment plans and income replacement benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant sustained a mild traumatic brain injury and psychological impairments, removing him from the MIG.

The Tribunal approved all six disputed treatment plans as reasonable and necessary.

Furthermore, the Tribunal awarded income replacement benefits, finding the applicant was substantially unable to perform the essential tasks of his employment as a produce clerk.

The applicant's claim for a special award for unreasonable delay was dismissed due to his own delays in providing documentation.