Karla Gnanasegaram

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

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

The applicant argued the insurer was precluded from relying on the MIG due to prior approvals, and alternatively, that her pre-existing obesity and alleged post-concussion syndrome removed her from the MIG.

The Tribunal held the insurer provided proper notice and was not precluded from applying the MIG.

The Tribunal further found the applicant failed to provide compelling evidence that her obesity was a documented pre-existing condition that prevented recovery within the MIG cap, or that she suffered a concussion caused by the accident.

The appeal was dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) beyond the date the insurer terminated them.

The adjudicator found that the applicant suffered a substantial inability to perform the essential tasks of his pre-accident employment as a gas station owner/operator, as his accident-related impairments prevented him from working the required hours.

The applicant was awarded IRBs for the disputed period, subject to a deduction of 70% of his post-accident employment income.

The insurer was entitled to a repayment of overpaid IRBs based on this deduction, and the applicant was awarded interest on overdue payments.

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

The respondent insurer brought a preliminary motion to bar the application because the applicant failed to attend independent medical examinations (IEs) under s. 44 of the Schedule and failed to provide requested information under s. 33.

The Tribunal found the applicant was barred from proceeding with his appeal for medical benefits and examination costs due to his unexcused failure to attend the IEs.

However, the insurer was liable to pay non-earner benefits for a specific period due to its failure to provide proper notice of election of benefits, though it could withhold payments for the subsequent period of the applicant's non-compliance with s. 33.

The applicant, who was injured in a motor vehicle accident while a passenger on a motorcycle, sought a medical benefit of $2,200 for a psychological assessment.

The respondent insurer denied the claim.

The Tribunal found that the applicant failed to prove on a balance of probabilities that the assessment was reasonable and necessary.

The Tribunal preferred the evidence of the respondent's psychological assessor, who found only mild symptoms and no identifiable impairment, over the applicant's evidence, which included an inappropriate diagnosis of acute stress disorder 18 months post-accident.

The application was dismissed.

The applicant was injured in a rear-end motor vehicle collision and sought statutory accident benefits for chiropractic treatment and a physiatry assessment.

The respondent insurer denied the claims 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 Tribunal found that the applicant's physical injuries, including a partial rotator cuff tear, were minor injuries under the Schedule.

The Tribunal preferred the evidence of the respondent's experts over the applicant's physiatrist, finding no compelling evidence of a pre-existing condition or psychological injury that would preclude recovery within the MIG.

The application was dismissed.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal order that allowed the applicant to summons the claims adjuster who handled the disputed claim.

The insurer argued it should have received a copy of the motion materials and an opportunity to respond.

The Executive Chair dismissed the request for reconsideration, finding that Rules 8 and 4.3 of the Tribunal's Common Rules of Practice & Procedure permitted the applicant to request the summons on an ex parte basis.

The applicant sought statutory accident benefits following a motor vehicle accident but failed to attend multiple pre-hearing discussions and the preliminary issue hearing.

The arbitrator dismissed the application for arbitration due to the applicant's failure to appear and present evidence.

The insurer was awarded $750.00 in expenses for preparing for and participating in the proceedings.

The Applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

The Insurer denied benefits on the basis that her policy had been cancelled for non-payment of premiums prior to the accident, and she knew or ought to have known she was driving without insurance.

The Arbitrator found that the Applicant, who had been away from home caring for her mother and touring with her children, did not receive the registered mail notice of cancellation.

The Arbitrator concluded that the Applicant did not know, and a reasonable person in her circumstances ought not to have known, that the policy was cancelled.

Therefore, she was not precluded from receiving benefits under section 30 of the Schedule.