Kenway Yu

The applicant insurer sought repayment of $7,710.19 in Income Replacement Benefits (IRBs) paid to the respondent, alleging wilful misrepresentation of post-accident income.

The respondent argued the application was statute-barred by a two-year limitation period and that any repayment should be deducted from future benefits rather than paid as a lump sum.

The Tribunal found the application was not statute-barred, as the limitation period in section 56 of the Schedule applies to an insurer's refusal to pay, not a claim for repayment.

The Tribunal concluded the respondent wilfully misrepresented his post-accident income and failed to comply with production requests.

The insurer was awarded a lump sum repayment of $7,710.19 plus interest.

TD General Insurance Company applied to the Licence Appeal Tribunal for a lump sum repayment of $17,581.64 in overpaid Income Replacement Benefits (IRBs) from the respondent after he was retroactively approved for Canada Pension Plan Disability benefits.

The respondent argued for repayment via ongoing IRB deductions, but his IRBs had been suspended under section 57 of the Schedule for failing to attend treatment.

The Tribunal found that because IRBs were not currently being paid, the insurer was entitled to a lump sum repayment under section 52(4) of the Schedule, along with interest under section 52(5).

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for various treatment plans and assessments.

The respondent denied the plans.

The Tribunal found the applicant was entitled to a functional abilities evaluation and a worksite/occupational demands assessment, as they were reasonable and necessary and not duplicative of the insurer's own assessments.

However, the Tribunal denied the plans for an in-home assessment, a chronic pain assessment, and physical therapy, finding them to be duplicative or unsupported by the medical evidence.

The claim for an award under s. 10 of Reg. 664 was dismissed.

The applicant was injured in a motor vehicle accident and sought a non-earner benefit (NEB) under the Statutory Accident Benefits Schedule.

The respondent denied the claim, and the applicant applied to the Licence Appeal Tribunal.

Applying the Heath framework, the adjudicator compared the applicant's pre- and post-accident activities.

The adjudicator found that the applicant's subjective complaints were inconsistent with surveillance evidence and medical assessments, which showed she remained physically active, socialized, and performed various activities of daily living.

The application was dismissed, as the applicant failed to prove a complete inability to carry on a normal life.

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

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

The Tribunal found that the applicant's physical injuries were predominantly soft-tissue strains and that she failed to establish on a balance of probabilities that she suffered from a psychological impairment or chronic pain that would warrant removal from the MIG.

As the applicant had exhausted the $3,500 MIG limit, the disputed treatment plans for chiropractic services and a psychological assessment were not payable.

The application was dismissed, and claims for an award and interest were denied.

The applicant, who has a pre-existing diagnosis of autism, sought statutory accident benefits following a motor vehicle accident.

She claimed entitlement to a non-earner benefit, various medical benefits including occupational therapy, physical therapy, and a chronic pain assessment, as well as an award and interest.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to establish a complete inability to carry on a normal life, as there was insufficient evidence comparing her pre- and post-accident activities.

The Tribunal preferred the respondent's expert evidence, which indicated no objective ongoing accident-related impairments and found the disputed treatment plans were either duplicative or not reasonable and necessary.

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

The central issue was whether her injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain, psychological injuries, or a pre-existing condition.

The Tribunal found that the applicant failed to meet her burden of proving her injuries warranted removal from the MIG.

Her evidence regarding chronic pain did not meet the AMA Guides criteria, her psychological symptoms were not formally diagnosed, and there was insufficient evidence that her pre-existing shoulder tear prevented maximal recovery within the MIG limits.

As the MIG limits were exhausted, no further benefits, interest, or awards were payable.

The applicant sought entitlement to a non-earner benefit and various medical and rehabilitation benefits following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant was statute-barred from claiming the non-earner benefit and several treatment plans because she failed to attend required section 44 insurer's examinations prior to applying to the Tribunal.

The remaining treatment plans were denied because they were either incurred before submission or the applicant failed to provide sufficient medical evidence to prove they were reasonable and necessary.

The application was dismissed in its entirety.

The applicant sought non-earner benefits and funding for various treatment plans following a 2016 motor vehicle accident.

The adjudicator found that the applicant did not submit a completed disability certificate until February 2019, precluding non-earner benefits prior to that date.

For the period after February 2019, the adjudicator dismissed the claim because the applicant provided highly inconsistent evidence regarding his pre-accident employment and activities, making it impossible to apply the Heath test to determine if he suffered a complete inability to carry on a normal life.

The adjudicator also dismissed the claims for the treatment plans, finding one statute-barred and all of them lacking contemporaneous medical evidence to prove they were reasonable and necessary.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a 2014 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 chronic pain and a pre-existing psychological condition.

The Tribunal found the applicant sustained predominantly minor soft tissue injuries and failed to prove chronic pain or that her pre-existing depression precluded recovery within the MIG limits.

The Tribunal also denied the cost of an accounting report, finding it was not reasonable and necessary as the applicant's income calculation was straightforward.

The application was dismissed.