Justine O. Lee Young

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

The respondent insurer denied treatment plans for physical therapy and a psychological assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The Tribunal found that the applicant failed to provide compelling medical evidence that her pre-existing back condition prevented her from achieving maximal recovery within the MIG, or that she sustained an accident-related psychological impairment outside the MIG.

As the MIG limits were exhausted, the disputed treatment plans were not payable, and claims for interest and an award for unreasonable delay were dismissed.

The applicant was involved in a motor vehicle accident and sought non-earner benefits from the respondent insurer.

The insurer denied the benefits after an examination under oath, and the applicant did not dispute the denial until over four years later.

The insurer raised a preliminary issue that the claim was statute-barred under s. 56 of the Statutory Accident Benefits Schedule.

The adjudicator found that the applicant failed to dispute the denial within the two-year limitation period and provided no reasonable explanation for the delay.

The adjudicator declined to grant an extension of time under s. 7 of the Licence Appeal Tribunal Act, finding that the delay was unreasonable and caused prejudice to the insurer.

The claim for non-earner benefits was dismissed as statute-barred.

The applicant, who was twelve years old when struck by a car while crossing the street, sought statutory accident benefits for chiropractic and psychological services.

The respondent denied the chiropractic services based on an independent medical examination concluding the physical injuries were predominantly minor and required no further passive treatment.

The respondent partially approved the psychological services based on an assessment recommending shorter sessions, but agreed to pay the balance during the hearing.

The Tribunal dismissed the claim for chiropractic services as the applicant failed to provide medical evidence proving they were reasonable and necessary.

The Tribunal awarded interest on the psychological services but denied a special award under s. 10 of Regulation 664, finding the respondent did not act unreasonably in relying on its medical assessments.

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

The insurer denied two treatment plans for a Chronic Pain Assessment and a Psychological Assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's pre-existing psychological impairments, which were exacerbated by the accident, warranted removal from the MIG.

The Tribunal approved the Psychological Assessment as reasonable and necessary but denied the Chronic Pain Assessment, finding insufficient evidence to meet the criteria for chronic pain syndrome.

Interest on the benefits was denied as the expenses had not been incurred.