Amanda R.M. Faulkner

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

The respondent denied benefits and closed the file after the applicant failed to submit a completed OCF-1 application within 30 days of receiving the forms.

The applicant submitted the OCF-1 over nine months late, citing language barriers and his daughter's personal issues as reasons for the delay.

The Tribunal found the explanation unreasonable, noting the applicant's prior experience with accident benefits and the daughter's ongoing communication with the adjuster.

The application was dismissed as statute-barred under section 55(1)1 of the Schedule.

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

The respondent denied benefits because the applicant failed to submit an application for benefits (OCF-1) within the 30-day time limit prescribed by section 32(5) of the Schedule.

The applicant submitted the form over nine months late, arguing that language barriers and family issues provided a reasonable explanation for the delay.

The Tribunal applied the Horvath test and found the explanation unreasonable, noting the applicant's daughter had communicated with the insurer multiple times and the applicant was familiar with the process from a prior accident.

The Tribunal concluded the applicant was statute-barred under section 55(1)1 of the Schedule and dismissed the application.

The applicant sought various medical and rehabilitation benefits following a 2015 motor vehicle accident.

The Licence Appeal Tribunal reviewed treatment plans for psychological services, an audiometric assessment, an optometric assessment, and a driving assessment.

The Tribunal found that the applicant failed to prove the psychological, audiometric, and optometric plans were reasonable and necessary, largely relying on the respondent's section 44 medical examination reports.

However, the Tribunal approved the driving assessment, finding it reasonable and necessary to address the applicant's well-documented driving anxiety.

The applicant sought income replacement benefits (IRBs) and the cost of prescription medications following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the claim for IRBs because the applicant failed to file a 2016 income tax return, meaning his pre-accident income was deemed to be nil under section 4(5) of the Statutory Accident Benefits Schedule.

The claim for prescription medications was also dismissed as the respondent had already paid the amount.

No interest was payable.

The respondent insurer requested a reconsideration of a Tribunal decision that found the applicant entitled to a chronic pain assessment.

The insurer argued the Tribunal erred in law by failing to consider the proposed assessor's qualifications, by not giving significant weight to its medical doctor's paper review over the applicant's chiropractor, and by finding the insurer waived the requirement for signed treatment plans under s. 38(3) of the Schedule.

The Tribunal dismissed the request, finding no error in the original adjudicator's weighing of the medical evidence.

Furthermore, the Tribunal upheld the finding that the insurer implicitly waived the signature requirement by scheduling a s. 44 examination and responding to the unsigned OCF-18 without raising the issue until the hearing.

The applicant filed a Request for Reconsideration of a Tribunal decision that denied her entitlement to non-earner benefits (NEBs), medical benefits, and interest following a motor vehicle accident.

The applicant argued the Tribunal erred in law by failing to properly apply the legal test for NEBs and erred in fact by failing to properly consider medical evidence.

The Vice Chair found that the Tribunal correctly applied the test for NEBs as set out in the Schedule and the principles from Heath and Galdamez.

The Vice Chair also found no error in the Tribunal's weighing of the medical evidence.

The Request for Reconsideration was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for psychological assessments, psychological treatment, and physiotherapy.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to discharge the burden of proving that the proposed treatments and assessments were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's experts, who found minimal psycho-emotional distress and no objective evidence of physical impairment, over the conflicting and inconsistent reports of the applicant's experts.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming $1,765.20 for a chronic pain assessment.

The respondent insurer denied the claim based on a paper review by a physiatrist who opined that further psychological treatment alone was sufficient.

The Tribunal found the applicant's evidence, including assessments from treating practitioners and a chronic pain assessment report, to be more persuasive than the insurer's paper review.

The Tribunal held that the chronic pain assessment was reasonable and necessary, and awarded the cost of the examination along with interest on the overdue payment.

The respondent's procedural defence regarding an unsigned treatment plan was dismissed as the insurer had waived the requirement by scheduling an examination.