Julianne Brimfield

The applicant was involved in a motor vehicle accident and received income replacement benefits from the respondent insurer.

The respondent later discovered evidence suggesting the applicant was not employed at the time of the accident and sought repayment of $20,400.00, alleging wilful misrepresentation.

The applicant failed to participate in the written hearing.

The Tribunal found that the applicant wilfully misrepresented his pre-accident employment status, noting contradictory pay stubs, admissions of non-employment, and failure to provide requested financial disclosure.

The Tribunal ordered the applicant to repay the $20,400.00 plus interest.

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

The respondent insurer determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied several treatment plans for chiropractic and massage therapy services.

The Licence Appeal Tribunal found the applicant failed to prove her soft-tissue injuries warranted removal from the MIG.

As the applicant had exhausted the $3,500 MIG limit, the application for the disputed treatment plans and interest was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

The insurer denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffers from chronic pain syndrome, removing him from the MIG and entitling him to $65,000 in medical and rehabilitation benefits.

However, the Tribunal dismissed the claim for a non-earner benefit, finding the applicant did not suffer a complete inability to carry on a normal life.

The Tribunal also denied the proposed chiropractic and massage therapy services but granted the cost of a chronic pain assessment.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming she sustained a concussion, psychological injuries, and exacerbation of a pre-existing condition that warranted removal from the Minor Injury Guideline (MIG).

The respondent denied the claims, relying on insurer examinations which concluded the injuries were predominantly minor.

The Tribunal found the applicant failed to provide sufficient medical evidence, such as a formal diagnosis or neurological testing, to prove she suffered a concussion or other non-minor injuries.

The Tribunal concluded the applicant's injuries fell within the MIG, dismissing her claims for treatment plans outside the $3,500 limit, interest, and a special award.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries warranted removal from the Minor Injury Guideline (MIG) due to pre-existing arthritis, cervical spine degeneration, and psychological impairments.

The Tribunal found the applicant failed to provide compelling evidence of a pre-existing condition documented prior to the accident that would prevent maximal recovery within the MIG.

The Tribunal also found insufficient evidence of a psychological impairment.

As the MIG limit was exhausted, the disputed treatment plans were not payable.

The applicant's claim for a non-earner benefit was dismissed because he had resumed his normal activities of daily living and did not suffer a complete inability to carry on a normal life.

The application was dismissed.

The applicant sought statutory accident benefits for psychological injuries arising from his mother's death in a 2016 motor vehicle accident.

The respondent insurer denied the claim, arguing the applicant failed to notify it of his intention to apply within the timelines under section 32(1) of the Schedule.

The Tribunal found that the applicant had notified the respondent of the accident in a timely manner when seeking death and funeral benefits, triggering the respondent's obligation under section 32(2) to provide application forms and information.

Because the respondent failed to prove it met this obligation, and the applicant provided a credible explanation that he was unaware he could make a claim, the Tribunal held the applicant had a reasonable explanation for the delay under section 34.

The applicant was permitted to proceed with his claim.

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 argued for removal from the MIG based on chronic pain, relying on a consultation report.

The Tribunal gave limited weight to that report, preferring the evidence of the applicant's treating pain management physician, who did not diagnose Chronic Pain Syndrome.

The Tribunal found the applicant's injuries were predominantly minor.

As the $3,500 MIG limit was exhausted, the claims for treatment plans were dismissed.

The claim for a non-earner benefit was also dismissed as the applicant failed to demonstrate a complete inability to carry on a normal life.

The applicant sought statutory accident benefits following a 2015 motor vehicle accident.

The respondent denied a treatment plan for chiropractic services, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to establish a causal link between her ongoing shoulder and arm pain and the accident, noting intervening injuries and degenerative changes.

As the applicant's injuries were predominantly minor and she had exhausted her $3,500 MIG limit, the claim for further treatment was dismissed.

Claims for interest and costs were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and a medical benefit for physiotherapy.

The respondent denied the claims, arguing the applicant's injuries were predominantly minor and that he failed to meet the test for a non-earner benefit.

The Tribunal dismissed the application, finding the applicant failed to comply with requests for medical documentation under s. 33 of the Schedule and failed to submit a properly signed disability certificate in a timely manner.

Furthermore, the Tribunal found the applicant was not truthful with assessors regarding his extensive pre-existing chronic pain conditions, drawing an adverse inference from his failure to produce family doctor records.

The Tribunal concluded the applicant did not suffer a complete inability to carry on a normal life and failed to prove his injuries warranted treatment beyond the $3,500 Minor Injury Guideline limit.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits (IRBs), removal from the Minor Injury Guideline (MIG), and funding for psychological and physiotherapy treatment plans.

The Licence Appeal Tribunal found that the applicant failed to prove a substantial inability to perform the essential tasks of her pre-accident employment as a nail specialist, dismissing the IRB claim.

However, based on psychological assessments diagnosing adjustment disorder and anxiety, the Tribunal determined the applicant's injuries fell outside the MIG.

Consequently, the Tribunal approved the $2,200 psychological assessment but denied the $4,115.12 physiotherapy plan, preferring the respondent's physiatrist evidence that further physical treatment was unwarranted.

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

The respondent denied certain benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 treatment limit had been exhausted.

The applicant argued she had a pre-existing back condition, a psychological impairment, and chronic pain that removed her from the MIG.

The Tribunal found insufficient evidence of a pre-existing condition that prevented maximal recovery, and preferred the respondent's psychological assessments showing symptom amplification over the applicant's evidence.

The Tribunal concluded the injuries were predominantly minor, the disputed treatment plans were not payable, and no interest was owed.

The application was dismissed.

The applicant sought statutory accident benefits following two motor vehicle accidents.

The adjudicator held that the applicant was precluded from claiming an income replacement benefit for the second accident because he had elected to receive a non-earner benefit, an election that is final under s. 35(3) of the Schedule.

For the first accident, the applicant failed to prove a complete inability to engage in employment to qualify for a post-104 income replacement benefit.

Furthermore, the adjudicator found that the applicant's injuries from both accidents fell within the Minor Injury Guideline, as he failed to demonstrate that pre-existing conditions, chronic pain, or psychological impairments prevented him from achieving maximum medical recovery within the guideline's limits.

All claims were dismissed.

The applicant sought accident benefits following a motor vehicle accident.

The respondent denied a medical benefit for hospital expenses, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) limit of $3,500, which had been exhausted.

The applicant argued for removal from the MIG based on pre-existing psychological and physical conditions, as well as chronic pain.

The Tribunal found the applicant's physical injuries were predominantly minor soft tissue injuries.

The Tribunal also held that the applicant failed to provide compelling evidence that her pre-existing conditions prevented maximal medical recovery within the MIG, or that she suffered from functionally disabling chronic pain.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his pre-existing chronic back pain was exacerbated.

He disputed the respondent's denial of treatment plans for acupuncture, physiotherapy, hydrotherapy, and personal training.

The Tribunal found that while the accident was a necessary cause of his current pain complaints, the applicant failed to prove the treatment plans were reasonable and necessary.

The evidence, including the applicant's own statements to medical professionals, indicated that he found the proposed treatments painful, unhelpful, or was not interested in participating in them.

The application was dismissed in its entirety.

The applicant sought further statutory accident benefits, including treatment plans, after a prior Tribunal decision found his injuries were predominantly minor and subject to the $3,500 coverage limit.

The respondent raised a preliminary issue that the claim was barred by res judicata.

The Tribunal held that while res judicata does not strictly prevent an insured from bringing new evidence of a worsening condition under the Schedule, the applicant failed to provide conclusive new evidence of deterioration.

The medical records showed his condition was largely unchanged since the prior decision.

The claims for treatment plans were dismissed.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision, including a non-earner benefit and various medical and rehabilitation benefits for chiropractic, physiotherapy, assistive devices, and an in-home assessment.

The Tribunal found that the applicant failed to prove on a balance of probabilities that she suffered a complete inability to carry on a normal life, noting her evidence was inconsistent and uncorroborated.

The Tribunal also dismissed the claims for medical and rehabilitation benefits, relying on insurer's examinations and finding that the proposed treatment plans were not reasonable and necessary given the lack of functional improvement from prior treatments.

The application was dismissed in its entirety.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) from the respondent insurer.

The insurer denied the IRBs and brought a preliminary motion arguing that the applicant's subsequent application to the Tribunal was statute-barred for missing the two-year limitation period under section 56 of the Statutory Accident Benefits Schedule.

The Tribunal found that the limitation period expired on a Saturday, meaning it was deemed to expire on the next business day.

Because the applicant filed her application on that next business day, the application was within the limitation period and she was permitted to proceed with her claim.

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

The respondent denied certain benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG due to a pre-existing condition (degenerative disc disease).

The Tribunal found that while the applicant had a pre-existing condition, she failed to provide compelling medical evidence that it would prevent her from achieving maximal recovery if subject to the MIG limits.

Consequently, the applicant was not entitled to the disputed medical benefit, interest, or a special award.

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

The respondent insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant contended that chronic pain and psychological impairments warranted removal from the MIG.

The Tribunal found that the applicant's physical injuries were predominantly minor sprains and strains.

The Tribunal rejected the applicant's claims of chronic pain and psychological impairment, preferring the respondent's psychiatric expert whose opinion aligned with the treating family physician's records.

As the MIG limit was exhausted, the disputed treatment plans and interest were denied.

The Cooperators General Insurance Company appealed a preliminary decision of the Licence Appeal Tribunal (LAT) finding that the claimant was a 'dependant' and thus an insured under the policy.

The claimant argued the appeal was premature as the hearing on the merits was scheduled for a later date.

The Divisional Court agreed, dismissing the appeal as premature to avoid fragmented administrative proceedings and inefficiency.