Hilary Doyle

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

The respondent initially placed the applicant in the Minor Injury Guideline and denied treatment plans based on section 44 assessments.

After receiving further medical documentation, the respondent voluntarily removed the applicant from the guideline and approved the disputed treatment plans.

The applicant sought a special award under section 10 of Regulation 664, arguing the 90-day delay in adjusting the file was unreasonable.

The Tribunal dismissed the claim for an award, finding the insurer's reliance on its assessors and subsequent good-faith adjustment of the file upon receiving new evidence did not constitute excessive or imprudent delay.

The applicant was awarded interest on the overdue benefits.

The applicant sought entitlement to various treatment plans for chiropractic services, yoga therapy, assistive devices, and a nutritional assessment following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to meet his evidentiary burden.

Specifically, the applicant failed to provide copies of the disputed treatment plans, making it impossible to determine the exact services, goals, and costs proposed.

The Tribunal also found insufficient medical evidence to support the reasonableness and necessity of the claimed benefits.

Claims for interest and a special award were consequently dismissed.

The applicant sought statutory accident benefits for hearing aids costing $5,620.00 following a motor vehicle accident.

The respondent denied the expense.

The Tribunal found that the hearing aids were not reasonable and necessary, as medical records indicated the hearing loss was primarily due to guitar playing noise exposure rather than the accident.

Furthermore, the applicant failed to submit a treatment plan prior to incurring the expense, contrary to section 38(2) of the Schedule, and no exceptions applied.

The application was dismissed.

The applicant sought payment for various treatment plans and expenses for chiropractic, psychological, and acupuncture services following a motor vehicle accident, as well as an award for unreasonable delay.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide contemporaneous medical evidence or sufficient submissions to meet her burden of proving the treatments were reasonable and necessary.

As no benefits were payable, claims for interest and a punitive award were also dismissed.

The applicant sought payment for the unapproved balances of two treatment plans for social work services following a motor vehicle accident.

The respondent had approved the plans but reduced the provider's hourly rate from $139.00 to $100.00.

The Tribunal found that the provider, a registered social worker, was qualified to provide psychotherapy and Cognitive Behavioural Therapy, and that her services were comparable to those of a psychologist.

The Tribunal ordered the respondent to pay the unapproved balances of $1,014.00 and $1,348.00, plus interest.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to psychological services and a chronic pain assessment.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary.

The psychological treatment plan lacked properly identified goals, and there was no evidence supporting the need for a follow-up chronic pain assessment two years after the initial one.

The application was dismissed, with no entitlement to interest or an award for unreasonable delay.

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

The respondent denied several treatment plans, and the applicant applied to the Licence Appeal Tribunal.

The applicant argued that the respondent's explanation of benefits (EOB) notices were non-compliant with s. 38(8) of the Schedule, triggering payment under s. 38(11).

The Tribunal found that while one EOB was non-compliant, a subsequent EOB rectified the issue before the expense was incurred.

The remaining EOBs were found to be clear, unequivocal, and compliant with s. 38(8).

As the applicant provided no evidence regarding the reasonableness and necessity of the treatment plans, the application was dismissed in its entirety.

The applicant sought payment for various treatment plans (psychological, chiropractic, and orthopaedic assessment) following a motor vehicle accident.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to meet his burden of proving the treatment plans were reasonable and necessary.

The applicant relied on an OCF-3 that was inconsistent with contemporaneous hospital records, and failed to provide sufficient medical evidence or submissions to support the claimed expenses.

The application was dismissed in its entirety, including claims for interest and an award.

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

The matter proceeded to a written hearing.

The applicant's representative withdrew, and the applicant indicated he would proceed self-represented but failed to file any written submissions or evidence.

The Tribunal proceeded with the hearing and found that the applicant failed to meet his onus to demonstrate entitlement to removal from the Minor Injury Guideline or to the disputed medical benefits.

The application was dismissed.

The applicant sought accident benefits following a motor vehicle accident, arguing she should be removed from the Minor Injury Guideline (MIG) due to chronic pain and psychological injuries.

The Licence Appeal Tribunal found the applicant failed to meet her burden of proof, noting inconsistencies in the medical evidence and a lack of formal psychological diagnosis.

The Tribunal held the applicant to the MIG, rendering the disputed treatment plan for chiropractic services moot, and denied claims for interest and a special award.