Gjergji Laloshi

The applicant sought statutory accident benefits for psychological impairments following the death of his step-son in a motorcycle accident.

The respondent insurer raised two preliminary issues: whether a step-parent qualifies as an 'insured person' under the Schedule, and whether the applicant was barred from claiming benefits under s. 61 because he was receiving Workplace Safety and Insurance Act (WSIA) benefits for PTSD related to his work as a paramedic.

The Tribunal applied a purposive approach to statutory interpretation, finding that the undefined term 'child' in the Schedule includes a step-child, making the applicant an insured person.

The Tribunal also found the applicant was not barred by s. 61, as the basis for his WSIA claim (work-related trauma) differed from his accident benefits claim (psychological injuries from the step-son's death).

The matter was ordered to proceed to a substantive hearing.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a chronic pain assessment, chronic pain treatment, and transportation expenses.

The respondent insurer denied the treatment plans.

The Licence Appeal Tribunal found the chronic pain assessment and treatment plans were reasonable and necessary, preferring the evidence of the applicant's assessor over the insurer's assessor, who failed to review the applicant's clinical notes and records.

The Tribunal ordered the respondent to pay for the assessment and treatment plans, plus interest.

The claim for transportation expenses was dismissed for lack of supporting evidence.

The applicant sought statutory accident benefits for physical and psychological treatment plans following a motor vehicle accident.

The respondent denied the plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) or were not accident-related.

The Tribunal found the respondent validly denied one physiotherapy plan submitted while the applicant was still subject to the MIG.

However, the Tribunal approved the remaining physical and psychological treatment plans, finding them reasonable and necessary to treat the applicant's ongoing accident-related chronic pain and psychological impairments.

Interest was awarded on overdue payments.