April C. Snow

The applicant sought payment for various treatment plans for psychological therapy, physiotherapy, occupational therapy, and assessments following a motor vehicle accident.

The Licence Appeal Tribunal found that the psychological treatment plans were funded at the appropriate rate for a psychotherapist, rather than a psychologist.

The Tribunal also found that the remaining physical therapy and assessment plans were not reasonable and necessary, as the applicant had reached maximum medical recovery and further assessments would be duplicative.

The claims for a special award and interest were dismissed.

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

The respondent denied several 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 minor and that he failed to establish a pre-existing condition or psychological impairment warranting removal from the MIG.

However, the Tribunal found that the respondent failed to comply with the notice requirements under section 38(8) of the Schedule for several treatment plans.

As a result, the respondent was ordered to pay for physiotherapy services incurred during the period of non-compliance and for psychological services due to a defective denial notice that merely referenced a section 44 report without providing it to the applicant.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident.

The respondent insurer denied the claim and argued the applicant was statutorily barred from proceeding to the Tribunal because the submitted Disability Certificate (OCF-3) indicated he did not suffer a substantial inability to perform his pre-accident employment, rendering it 'incomplete' under section 36 of the Schedule.

The Tribunal rejected this argument, finding that an OCF-3 is complete if it is fully filled out and signed by a health practitioner, regardless of whether it supports eligibility for the benefit.

The applicant was permitted to proceed with his application.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRB) and the cost of a forensic accounting report.

The applicant also sought a determination that his injuries warranted treatment outside the Minor Injury Guideline (MIG).

The Tribunal found it lacked jurisdiction to make a standalone MIG determination without a connected claim for medical benefits.

The Tribunal also dismissed the IRB claim because the applicant submitted his disability certificate after the period claimed.

Finally, the Tribunal denied the cost of the forensic accounting report, finding it was not reasonable and necessary given its high cost relative to the small IRB claim.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his injuries, including chronic pain, warranted treatment outside the Minor Injury Guideline (MIG).

The respondent denied the treatment plans, arguing the injuries were minor.

The Licence Appeal Tribunal found that the applicant failed to prove he suffered from non-minor injuries or chronic pain with functional impairment.

The Tribunal preferred the comprehensive insurer's examination report over the applicant's medical evidence.

As the applicant remained within the MIG and its $3,500 limit was exhausted, the claims for treatment plans, an award, and interest were dismissed.

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

The respondent denied the benefits.

The Tribunal dismissed the application, finding that the applicant failed to meet her burden of proving the treatment plans were reasonable and necessary.

Crucially, the applicant failed to submit the actual treatment plans (OCF-18s) into evidence, making it impossible for the Tribunal to assess them.

Furthermore, the Tribunal preferred the respondent's medical evidence, including multiple insurer examinations, which concluded the applicant had reached maximum medical improvement and did not require the disputed treatments.

The applicant requested a reconsideration of a Tribunal decision that denied four treatment plans for chiropractic and kinesiology treatment.

The applicant argued the adjudicator erred in fact and law regarding the interpretation of clinical notes, the reasons for the cessation of neck pain complaints, and the consistency of functional impairment evaluations.

The Tribunal dismissed the request, finding that the applicant was attempting to relitigate issues that had already failed at the hearing and had not met the high threshold for reconsideration under Rule 18.

The applicant was injured in a rear-end motor vehicle accident and sought entitlement to four treatment plans (OCF-18s) for chiropractic and kinesiology treatment totaling over $12,000.

The respondent denied the plans based on an insurer's examination which concluded the treatment was not reasonable and necessary.

The Tribunal found that the applicant had already received extensive physical therapy with minimal improvement, and that the proposed treatment was excessive and unlikely to achieve its stated goals.

The Tribunal also noted inconsistencies in the applicant's evidence regarding his post-accident limitations.

The application for the treatment plans was dismissed.

The applicant sought statutory accident benefits for a TMJ assessment and dental services following a rear-end motor vehicle accident.

The respondent denied the benefits on the basis that they were not reasonable and necessary, and raised the issue of causation.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that the accident was a necessary cause of her TMJ impairments, noting a history of pre-existing TMJ pain.

The Tribunal concluded that the requested cost of examination and medical benefits were not reasonable and necessary, and dismissed the application.