10 total
Application for accident benefits dismissed; ongoing pain attributed to pre-existing degenerative disc disease.
The applicant sought a Non-Earner Benefit and payment for various treatment and assessment plans following a motor vehicle accident.
The respondent denied the benefits, arguing the applicant's ongoing pain was caused by pre-existing degenerative disc disease rather than the accident.
The Tribunal agreed with the respondent, finding that MRI results and independent medical examinations confirmed the symptoms were degenerative.
The Tribunal also found insufficient evidence of a psychological impairment caused by the accident.
The application was dismissed in its entirety, including claims for an award and interest.
Application not barred; insurer's notices of examination failed to provide required medical and other reasons.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent insurer raised a preliminary issue, arguing the application should be barred under s. 55 of the Schedule because the applicant failed to attend scheduled occupational therapy and neurology insurer's examinations.
The Tribunal found that the respondent's notices of assessment failed to provide the mandatory medical and other reasons for the examinations, as required by s. 44(5)(a) of the Schedule.
Because the notices were non-compliant, the applicant was not obligated to attend the examinations and is not barred from proceeding to a hearing.
Insurer's failure to provide updated medical reasons after removing applicant from MIG renders treatment plans payable.
The applicant sought various statutory accident benefits following a motor vehicle accident.
The respondent initially denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
After the applicant was removed from the MIG, the respondent failed to provide updated denial notices with medical reasons for several treatment plans.
The Tribunal applied the Divisional Court's decision in Suarez, holding that the defective notices could not be cured, and ordered those treatment plans payable once incurred.
The Tribunal also evaluated the substantive reasonableness and necessity of the remaining treatment plans, granting entitlement to psychological and occupational therapy based on the applicant's exacerbated pre-existing conditions, while denying further physical therapy and neurological assessments.
The claim for a special award was dismissed as the insurer's reliance on its assessors was not unreasonable.
Minor's settlement approval dismissed due to outdated medical evidence and excessive proposed contingency fees.
The court was asked to approve a settlement for a minor plaintiff, Allythiah Thomas, arising from a motor vehicle accident.
The proposed settlement allocated $50,000 to Allythiah's claim and included legal fees based on a 30% contingency fee.
The court declined to approve the settlement due to concerns regarding the lack of an up-to-date expert medical report confirming the plaintiff's maximum medical recovery and future prognosis.
Additionally, the court found the proposed 30% contingency fee inappropriate given the minimal disbursements incurred by counsel, suggesting a range of 10% to 15% would be more suitable.
Application for accident benefits dismissed; injuries fall within the Minor Injury Guideline and IRB quantum unproven.
The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that his injuries fell within the Minor Injury Guideline (MIG).
The applicant also claimed entitlement to an income replacement benefit (IRB) and a chiropractic treatment plan.
The Tribunal found that the applicant's injuries were predominantly minor, preferring the insurer's examination report over the applicant's medical evidence, which lacked insight on causation.
The Tribunal also dismissed the IRB claim, finding the applicant failed to establish entitlement after returning to work and failed to prove the claimed quantum based on his actual net income.
The application was dismissed.
Application for accident benefits dismissed; applicant failed to prove psychological or functional impairment warranting MIG removal.
The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant argued she should be removed from the MIG due to psychological impairment and chronic pain with functional impairment.
The Tribunal found that the applicant failed to establish a psychological impairment, preferring the respondent's expert who conducted a more thorough review of the medical records.
The Tribunal also found that while the applicant experienced chronic pain, she failed to demonstrate an accompanying functional impairment, as she had returned to full-time work and remained independent in her daily activities.
As the applicant remained within the MIG and the funding limit was exhausted, the claims for treatment plans, interest, and an award were dismissed.
Application for accident benefits dismissed and costs awarded after applicant failed to attend hearing.
At the hearing, the applicant failed to attend and his counsel had no instructions or evidence to present.
The Tribunal denied the applicant's requests for adjournment.
Because the applicant failed to provide submissions or evidence, he did not meet his onus to prove entitlement to the benefits.
The application was dismissed, and the respondent was awarded $500 in costs due to the applicant's frivolous conduct in failing to participate meaningfully in the proceedings.
Infant's derivative Family Law Act claim dismissed because the primary plaintiff's main injury claim was previously dismissed.
The defendants brought a motion to dismiss the infant plaintiff's derivative claim under the Family Law Act.
The main injury claim of the infant's father had previously been dismissed after the plaintiffs failed to appoint new counsel or file a notice of intention to act in person.
The court held that a derivative claim cannot continue if the primary plaintiff's claim has been dismissed.
The motion was granted and the infant plaintiff's action was dismissed.
Hot tea spill in vehicle deemed not an 'accident' due to intervening acts breaking causation.
The applicant sought statutory accident benefits after spilling hot tea on herself while in her vehicle.
She had purchased the tea at a drive-through and, upon noticing the lid was not secure, attempted to secure it while stopped at a red light, causing the tea to spill.
The respondent denied the claim, arguing the incident did not meet the definition of an 'accident' under the Schedule due to intervening acts.
The adjudicator agreed with the respondent, finding that the fast food employee's failure to secure the lid and the applicant's subsequent attempt to secure it were intervening acts that broke the chain of causation.
The use or operation of the vehicle was not the direct cause of the injuries.
Reconsideration granted; limitation period for IRBs subject to discoverability and not triggered by premature denial.
The applicant requested a reconsideration of a preliminary issue decision that found his claim for post-104 income replacement benefits (IRBs) was statute-barred due to a pre-emptive denial by the insurer.
The adjudicator granted the reconsideration, applying the recent Court of Appeal decision in Tomec v. Economical.
The adjudicator found that the limitation period is tied to the accrual of the cause of action and subject to discoverability.
Because the applicant was working full-time and not eligible for IRBs at the time of the pre-emptive denial, the cause of action had not yet accrued.
The preliminary decision was reversed, allowing the applicant to proceed with his claim.