Karina Dziuba

The applicant sought entitlement to three multidisciplinary treatment plans and interest following a motor vehicle accident.

The respondent denied the plans, arguing the applicant had not established chronic pain syndrome and had already received extensive treatment.

The Tribunal found the treatment plans were reasonable and necessary, noting the applicant had been diagnosed with chronic myofascial pain and psychological conditions linked to his ongoing pain.

The Tribunal also found the applicant had not received extensive treatment due to financial constraints and pandemic-related gaps in care, and that the limited treatment received was beneficial.

The applicant was awarded the treatment plans and interest.

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

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

The Tribunal first excluded late-filed medical records due to the applicant's failure to comply with production deadlines without a valid excuse.

On the merits, the Tribunal found the applicant failed to establish chronic pain syndrome or a psychological impairment warranting removal from the MIG.

As the applicant remained within the MIG, the disputed treatment plans were denied, and the application was dismissed.

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

The respondent denied claims for a non-earner benefit, physiotherapy, and translation services.

The Tribunal found that the applicant was statute-barred from proceeding with the claims for the non-earner benefit, the first physiotherapy plan, and the translation services because he failed to dispute the clear and unequivocal denials within the two-year limitation period under s. 56 of the Schedule.

The Tribunal also found that the applicant failed to prove the second physiotherapy plan was reasonable and necessary, and that the respondent's denial of that plan complied with s. 38(8).

The application was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied entitlement to three treatment plans for massage, chiropractic, and physiotherapy treatments.

The applicant argued the Tribunal breached procedural fairness by failing to address his key argument that the physical treatments would help him cope with his somatic pain disorder.

The Vice-Chair agreed, finding the original decision lacked sufficient reasons on this central issue, thereby breaching procedural fairness under Rule 18.2(a).

The reconsideration was granted, and the disputed treatment plans and interest issues were remitted to a new adjudicator for a rehearing based on the existing written record.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that found the applicant's injuries fell outside the Minor Injury Guideline and awarded treatment plans.

The respondent argued the Tribunal made a material error of fact by failing to consider its written submissions, which were uploaded but lost due to a technical portal error.

The adjudicator granted the reconsideration request, acknowledging the factual error.

However, upon reviewing the respondent's submissions, the adjudicator found they did not provide sufficient medical evidence to contradict the applicant's diagnoses of PTSD and depression.

The original decision was confirmed.

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

The respondent denied two treatment plans for physiotherapy 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 applicant argued for removal from the MIG based on a pre-existing psychological condition, her age, and an accident-related psychological impairment.

The Tribunal found insufficient medical evidence to support a pre-existing condition that would preclude recovery within the MIG, noting that age alone is not a pre-existing condition.

The Tribunal also gave limited weight to the applicant's psychological report due to its lack of objective testing and reliance on self-reporting.

The application was dismissed, and the applicant was held to the MIG limits.

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

The respondent denied the claims for chiropractic services and a psychological assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been exhausted.

The applicant argued he suffered from psychological injuries and a chronic pain condition that removed him from the MIG.

The Tribunal found the applicant's evidence insufficient to establish a psychological injury or chronic pain condition, noting he missed no time from work and had minimal medical treatment.

The Tribunal concluded the applicant sustained a minor injury subject to the MIG, dismissed the claims for medical benefits, and denied the requests for interest and an award.

The applicant sought $3,638.00 for a chiropractic treatment plan following a motor vehicle accident.

The respondent insurer denied the plan, relying on an insurer's examination by an orthopedic surgeon who concluded the applicant sustained only minor soft tissue injuries.

The Tribunal found the applicant failed to prove the treatment was reasonable and necessary, noting a lack of objective medical evidence, a significant pre-existing workplace injury, and the persuasiveness of the insurer's examination.

The application was dismissed.

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

The respondent denied benefits, arguing the applicant failed to submit the OCF-1 application within the 30-day prescribed time limit.

The Tribunal found that the applicant notified the respondent of the accident within the required seven days.

Furthermore, the Tribunal held that the applicant had a reasonable explanation for the delayed submission of the OCF-1, as the respondent had granted extensions and continued to process the claim without clearly communicating that the file was closed.

The applicant was permitted to proceed with his application.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming for dental services, prescription glasses, a special award, and costs.

The Tribunal found the applicant entitled to $9,509.40 for incurred dental services, which the respondent had previously approved.

The claim for prescription glasses was denied as the applicant failed to prove they were damaged in the accident.

Claims for a special award and costs were also dismissed, though interest was awarded on the overdue dental payment.