Kristen M. Bailey

The applicant sought statutory accident benefits after a vehicle crashed into his house while he was sleeping in another room.

He claimed to have suffered psychological and emotional injuries as a result of the incident.

The respondent denied the claim on the basis that the applicant was not 'involved' in the accident.

The Licence Appeal Tribunal found that the applicant did not witness the accident, was not physically injured, and was not related to anyone involved in the accident.

Consequently, he did not meet the definition of an 'insured person' involved in an accident under section 3(1) of the Statutory Accident Benefits Schedule.

The application was dismissed.

The applicant sought statutory accident benefits beyond the $3,500 Minor Injury Guideline (MIG) limit following a motor vehicle accident, arguing that pre-existing back and neck issues, ocular migraines, and accident-related chronic pain and psychological injuries warranted removal from the MIG.

The Tribunal found that the applicant's pre-accident medical records did not establish an ongoing condition that would prevent maximal recovery within the MIG limit.

Furthermore, the Tribunal preferred the respondent's independent medical examination report over the applicant's physiotherapist and occupational therapist records, as the latter were not physicians capable of diagnosing chronic pain or psychological impairments.

The applicant was found to be subject to the MIG and entitled only to the remaining $38.51 of the limit, with claims for an award and costs dismissed.

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 applicant contended that her pre-existing migraines and back pain were exacerbated by the accident, and that she suffered from chronic pain and a possible concussion, warranting removal from the MIG.

The Tribunal found insufficient medical evidence to support removal from the MIG, noting the applicant's functional abilities remained intact and there was no formal diagnosis of a concussion or chronic pain syndrome.

As the MIG limits were exhausted, the disputed treatment plan was deemed not reasonable and necessary.

The applicant sought a medical benefit of $1,417.48 for a physiotherapy treatment plan following a motor vehicle accident.

The respondent insurer denied the claim, arguing the applicant's shoulder injury was not caused by the accident.

The Tribunal reviewed the medical evidence, noting the applicant did not report shoulder issues until nearly eleven months post-accident and that a neurologist attributed the shoulder issues to a pre-existing contracture from prior bilateral prophylactic mastectomies.

The Tribunal found the shoulder injury was not accident-related and dismissed the application for the treatment plan and interest.