Jennifer Hoffman

The respondent insurer requested a reconsideration of a Tribunal decision which found that the applicant had a reasonable explanation for the late submission of his Application for Accident Benefits (OCF-1).

The insurer argued that the adjudicators erred in their assessment of the applicant's credibility and the reasonableness of his explanation, specifically regarding when he retained counsel and his post-accident medical complications.

The Tribunal dismissed the request for reconsideration, finding that the insurer was attempting to re-litigate findings of fact and had failed to establish any error of law or fact that would warrant varying the decision.

The applicant sought a determination that he sustained a catastrophic impairment following a motor vehicle accident that resulted in a knee injury, which subsequently became infected with necrotizing fasciitis leading to a leg amputation.

The respondent argued the infection was caused by strep throat, not the accident.

Applying the 'but for' test for causation, the Tribunal accepted the applicant's expert evidence that the accident caused the initial trauma which allowed the infection to enter the knee.

The Tribunal found the applicant sustained a catastrophic impairment but denied the claim for a section 10 award as no supporting evidence was provided.

The applicant sought statutory accident benefits after injuring his right leg while being placed in the back seat of a police vehicle.

The respondent insurer denied the claim, arguing the incident was not an 'accident' and that the applicant was statute-barred for providing late notice.

The Tribunal found that the incident met the definition of an accident, as being a seated passenger in a police vehicle is an ordinary use, and the vehicle's use was the dominant feature of the injury, which ultimately led to a below-the-knee amputation.

The Tribunal also found the applicant had a reasonable explanation for the late notice due to his severe medical complications and lack of sophistication.

The applicant was awarded $2,200.00 for an orthopaedic assessment.

The applicant was injured in a motor vehicle accident and sought medical benefits for chiropractic treatment.

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

The applicant argued that pre-existing injuries from a prior accident should remove him from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence of a pre-existing condition that would prevent him from achieving maximum medical recovery under the MIG.

Consequently, the applicant's injuries were deemed predominantly minor, and the disputed treatment plans were found not reasonable or necessary.