Aleah Thomas

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that he suffered from chronic pain and should be removed from the MIG.

The Tribunal found that the applicant failed to establish that his pain met the threshold for chronic pain or that it resulted in a functional impairment.

Consequently, the applicant's injuries were deemed predominantly minor and subject to the $3,500 MIG limit.

The claims for chiropractic treatment plans and interest were 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 argued she should be removed from the MIG due to psychological impairments and chronic pain with functional limitations.

The Tribunal found that the applicant's ongoing complaints were largely attributable to a prior 2015 accident and that she failed to establish a causal link between the current accident and her chronic pain or psychological issues.

The Tribunal concluded the applicant's injuries were predominantly minor, dismissing the claims for treatment plans, medical expenses, interest, and an award.

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

The matter proceeded to a written hearing, but the applicant failed to file any written submissions or evidence by the deadline.

As the applicant bore the onus of demonstrating removal from the Minor Injury Guideline and entitlement to the disputed treatment plans, the Tribunal found she failed to meet her burden.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought approval for a treatment plan for massage therapy, physiotherapy, and chiropractic services.

The insurer denied the plan, arguing the applicant's injuries were pre-existing and that he had reached maximum medical recovery.

The Tribunal applied the 'but for' test and found the accident was a necessary cause of the applicant's ongoing impairments.

Preferring the evidence of the applicant's treating chiropractor over the insurer's medical examiner, the Tribunal concluded the treatment plan was reasonable and necessary.

The applicant was awarded the treatment plan amount plus interest.

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

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

The Tribunal found that the applicant suffered from accident-related psychological impairments, including PTSD and depression, which removed her from the MIG.

The Tribunal ordered the insurer to pay for the disputed physiotherapy services and a psychological assessment, finding them reasonable and necessary.

The applicant was also awarded interest on overdue payments.

However, the Tribunal dismissed the applicant's claims for a special award under s. 10 of Regulation 664 and for costs, finding the insurer's conduct did not meet the high threshold of bad faith or unreasonableness.

The applicant sought entitlement to statutory accident benefits for chiropractic services and a neurological assessment following a 2018 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, noting a lack of corroborating clinical notes from her family physician and accepting the respondent's independent medical examination reports.

The application was dismissed, and no award for unreasonable delay was granted.

The applicant sought entitlement to statutory accident benefits for chiropractic services and an orthopaedic assessment following a 2018 motor vehicle accident.

The respondent denied the treatment plans, arguing the applicant's shoulder impairment was not caused by the accident.

The Tribunal found that the applicant's shoulder instability emerged three years post-accident and was caused by an intervening event at home.

Relying on the insurer's examination and clinical notes, the Tribunal concluded the treatment plans were not reasonable and necessary.

The application was dismissed.

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

The respondent denied a treatment plan for psychological services, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to provide sufficient medical evidence to prove her physical or psychological injuries warranted removal from the MIG.

Consequently, the applicant was not entitled to the disputed treatment plan or interest.

The application was dismissed.

The applicant sought payment of $724.00, representing the unpaid balance of a treatment plan for psychological services, arguing the provider should be paid $145.00 per hour instead of the $99.75 approved by the insurer.

The Tribunal found the applicant failed to prove the provider had specialized training in psychological treatment modalities (such as CBT, DBT, or MBSR) that would justify a higher hourly rate akin to a psychologist.

The Tribunal upheld the insurer's partial approval at $99.75 per hour and dismissed the claims for the balance, interest, and a special award.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

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

The applicant argued that the respondent's denial notices were non-compliant with s. 38(8) and s. 44(5) of the Schedule, and therefore the treatment plans should be payable.

The Tribunal found that the respondent's denial notices provided clear and sufficient medical reasons by stating the injuries were predominantly minor and fell within the MIG.

The Tribunal also found that the applicant failed to provide medical evidence to prove her injuries warranted removal from the MIG.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a $2,400 chiropractic treatment plan and removal from the Minor Injury Guideline (MIG) on the basis of chronic pain.

The respondent denied the benefits, arguing the injuries were minor.

The Tribunal found that the applicant's medical records, which showed long periods without reports of back pain or functional impairment, contradicted her expert's diagnosis of chronic pain syndrome.

Applying the AMA Guides criteria, the Tribunal concluded the applicant failed to establish chronic pain with functional impairment.

The application was dismissed, and the applicant was found to remain within the MIG, disentitling her to the disputed treatment plan, interest, and an award.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to occupational therapy, chiropractic services, and a psychological assessment.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove on a balance of probabilities that the proposed treatment plans were reasonable and necessary.

The Tribunal noted a lack of compelling contemporaneous medical evidence supporting the physical treatments and found that the applicant's psychological complaints were largely related to pre-existing conditions and interpersonal stressors rather than the accident.

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

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the chronic pain assessment was reasonable and necessary as he did not meet the AMA Guides criteria.

The Tribunal also denied the psychological services claim because the applicant provided no meaningful submissions to support the unapproved portion of the treatment plan.

Claims for an award and interest were consequently dismissed.

The applicant sought entitlement to a $9,024.34 treatment plan for a chronic pain program following a motor vehicle accident, along with interest and an award for unreasonable delay.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to meet her evidentiary burden to prove the treatment was reasonable and necessary.

The adjudicator noted the applicant's case was hampered by a lack of contemporaneous evidence and a failure to properly pinpoint evidence within the submitted medical reports as required by the case conference report and order.

Consequently, the claims for interest and an award were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain, psychological impairments, and pre-existing conditions including diabetes.

The Tribunal found that the applicant's ongoing complaints were consistent with pre-existing issues from a prior accident and that he did not meet the criteria for chronic pain under the AMA Guides.

The Tribunal concluded the applicant suffered predominantly minor injuries, and having exhausted the MIG limits, he was not entitled to the disputed treatment plan or interest.

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

The insurer denied treatment plans for psychological services and an assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the insurer's medical examinations were conducted without reviewing the applicant's treating medical records.

Relying on the applicant's medical evidence, the Tribunal concluded the applicant sustained chronic pain and psychological impairments that removed her from the MIG.

The disputed treatment plans were deemed reasonable and necessary, and interest was awarded.

The applicant's claim for a special award under s. 10 of O. Reg. 664 was dismissed.