Adrianna Klukowska

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

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

The Tribunal found that the applicant sustained a concussion, which is not a minor injury, removing her from the MIG.

However, the Tribunal dismissed claims for income replacement benefits, attendant care benefits, and several treatment plans, largely due to a lack of evidence connecting the impairments to the subject accident rather than a subsequent accident.

Two optometric treatment plans were approved.

The Tribunal also granted a 25% award against the insurer for unreasonably maintaining the MIG position despite uncontroverted evidence of a concussion.

The applicant, who sustained catastrophic impairments after being struck by a vehicle as a pedestrian, sought statutory accident benefits for alternative housing in Canada and flights from Romania to Toronto.

The applicant had moved to Romania with her parents post-accident but wished to return to Canada for rehabilitation.

The Licence Appeal Tribunal dismissed the claims, finding the applicant failed to substantiate the cost of the requested two-bedroom apartment compared to her pre-accident accommodations, and failed to establish that the flights were essential for her rehabilitation under the Statutory Accident Benefits Schedule.

Claims for an award and interest were also dismissed.

The insurer applied to the Licence Appeal Tribunal for repayment of $5,142.86 in Income Replacement Benefits (IRBs) paid to the insured, alleging wilful misrepresentation regarding pre- and post-accident employment.

The insured failed to participate in the written hearing.

The Tribunal found that the insurer met its notice obligations and proceeded in the insured's absence.

The Tribunal concluded that the insured wilfully misrepresented her employment and income, and failed to comply with production requests.

The insurer was awarded repayment of the full amount of IRBs plus interest.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that had approved a $2,460 orthopaedic assessment treatment plan.

The Vice-Chair granted the reconsideration, finding that the initial adjudicator committed a material breach of procedural fairness by failing to provide adequate reasons for why the treatment plan was reasonable and necessary, focusing instead on the Minor Injury Guideline.

Upon rehearing the matter, the Vice-Chair dismissed the application for the treatment plan.

The Vice-Chair concluded that the applicant failed to establish that an orthopaedic assessment conducted entirely over the telephone, without any visual or video component, was reasonable and necessary to identify impairments or increase range of motion.

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

The respondent denied funding for physiotherapy and a psychological assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant failed to demonstrate a psychological injury or chronic pain condition caused by the accident.

The Tribunal concluded the applicant sustained a minor injury subject to the $3,500 funding limit, and dismissed the claims for the disputed treatment plans, interest, and an award.

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

The respondent insurer denied a $2,460 treatment plan for an orthopedic assessment, arguing the applicant's injuries were predominantly minor and subject to the $3,500 limit under the Minor Injury Guideline (MIG).

The Tribunal found that the applicant had developed chronic pain syndrome, satisfying four of the six criteria under the AMA Guides, which warranted removal from the MIG.

The Tribunal concluded the proposed orthopedic assessment was reasonable and necessary, ordering the respondent to pay the treatment plan amount plus interest.

The applicant sought income replacement benefits following a motor vehicle accident, which the respondent insurer denied.

The applicant applied to the Licence Appeal Tribunal.

Subsequently, the respondent requested section 44 insurer's examinations, which the applicant failed to attend.

The respondent argued the application should be barred under section 55(1)2 of the Schedule.

The Tribunal held that section 55(1)2 prohibits making an application, not continuing one already in progress.

However, because the applicant failed to attend rescheduled examinations without a reasonable explanation, the scope of the hearing was limited to determining entitlement up to the date of non-compliance.

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

The insurer held that her injuries fell within the Minor Injury Guideline (MIG) and denied treatment plans for a psychological pre-screen and assessment.

The Tribunal found that the applicant failed to prove on a balance of probabilities that her psychological impairments and headaches would not have occurred but for the accident.

The medical evidence showed a history of headaches pre-dating the accident and failed to establish a causal link between the accident and her symptoms.

The Tribunal concluded the applicant's injuries were predominantly minor and she remains subject to the $3,500 MIG limit, though she is entitled to any remaining funds within that limit.

The applicant sought entitlement to statutory accident benefits following a motor vehicle accident, specifically claiming costs for a chronic pain assessment and a chronic pain program.

The Tribunal found that the treatment plans were not reasonable and necessary, preferring the recent insurer's examination report over the applicant's older medical report.

The Tribunal noted the applicant was fully functional, working full-time, and had not utilized previously approved treatment.

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