Karman Dhuga

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, which the respondent insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing that chronic pain and psychological impairments warranted removal from the MIG.

The Tribunal found that the applicant failed to prove on a balance of probabilities that she suffered from chronic pain with functional impairment or a psychological condition caused by the accident.

The Tribunal preferred the respondent's medical examination reports, which were based on physical and psychological assessments, over the applicant's evidence.

Consequently, the applicant remained subject to the MIG limit, and her claims for disputed treatment plans, interest, and an award were dismissed.

The applicant sought a determination of catastrophic impairment under Criterion 8 of the SABS following a motor vehicle accident, along with a treatment plan for CAT assessments and an award.

The Tribunal found that the applicant suffered from moderate impairments in activities of daily living and social functioning, but did not meet the threshold of three marked impairments or one extreme impairment required for a catastrophic designation.

The Tribunal noted that the applicant's physical limitations, rather than her psychological symptoms, primarily restricted her activities of daily living.

The claims for the treatment plan, interest, and an award were dismissed.

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

The respondent denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that he did not qualify for an income replacement benefit.

The Licence Appeal Tribunal found that the applicant failed to provide compelling medical evidence to warrant removal from the MIG.

Furthermore, the Tribunal concluded the applicant did not prove a substantial inability to perform the essential tasks of his pre-accident employment as an Uber driver, noting inconsistent effort during functional testing.

All claims, including a treatment plan for chiropractic services, interest, and an award, were dismissed.

The applicant sought a determination that she sustained a catastrophic impairment due to a mental or behavioural disorder following a motor vehicle accident.

The adjudicator found that the applicant's pre-existing physical and cognitive conditions, including brain lesions and diabetes, were the primary cause of her functional limitations.

The adjudicator rejected the applicant's psychiatric expert evidence, finding it overstated her pre-accident functioning and improperly conflated physical and mental impairments.

The application was dismissed, as the applicant failed to demonstrate a marked impairment in three or more domains of function.

The applicant sought payment for a multidisciplinary catastrophic impairment (CAT) assessment totaling $25,779.25 following a 2013 motor vehicle accident.

The Tribunal held that entitlement to a CAT assessment is a qualified right governed by section 15 of the Schedule, requiring each constituent assessment to be reasonable and necessary, rather than a substantive right under section 25.

Reviewing the medical evidence, the Tribunal found the applicant displayed normal range of motion, functioned independently, and had minimal ongoing treatment, which was inconsistent with the severity of impairment required for a CAT designation.

The application was dismissed, along with claims for interest and a special award.

The defendant insurer moved for summary judgment to dismiss the plaintiff's claim under the uninsured provisions of his automobile insurance policy.

The plaintiff alleged the accident was caused by an unidentified vehicle, but his own evidence and initial reports contradicted this, attributing the rear-end collision to his own faulty driving.

The court found no corroborating material evidence of an unidentified vehicle's involvement, as required for claims over $200,000, and insufficient evidence to establish a triable issue for claims under $200,000.

The motion was granted, and the action dismissed.

The applicant was injured in a motor vehicle accident and sought Income Replacement Benefits (IRBs) and medical benefits for chiropractic services.

The insurer terminated IRBs and denied further treatment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and he was able to return to work.

The Tribunal found the applicant's self-reporting to be unreliable, noting he had returned to work multiple times without disclosing it to the insurer or medical assessors.

Relying on independent medical examinations and surveillance evidence, the Tribunal concluded the applicant did not suffer a substantial inability to perform the essential tasks of his employment and his injuries were treatable within the MIG.

The application was dismissed.

The applicant insurer sought repayment of $1,371.43 in Income Replacement Benefits (IRB) paid to the respondent, alleging the respondent was working during the period he received the benefits.

The respondent did not attend the hearing.

The Tribunal found that the respondent was employed during the disputed period and that his failure to report his return to work, combined with subsequent false statements to medical assessors, constituted wilful misrepresentation.

As a result, the 12-month limitation period for seeking repayment did not apply, and the respondent was ordered to repay the benefits plus interest.

The applicant sought income replacement benefits (IRBs) and a medical benefit following a motor vehicle accident.

The Tribunal found the applicant was entitled to IRBs for the period where income documentation was provided, though the insurer had already paid the outstanding amount based on an accountant's calculation.

The claim for IRBs for the subsequent period was dismissed because the applicant failed to provide required income documentation.

The Tribunal awarded the medical benefit because the insurer failed to provide medical reasons for its denial as required by section 38(8) of the Schedule.

Interest was awarded on the overdue medical benefit.