Arthur Semko

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

The respondent denied the balance of a physiotherapy treatment plan on the basis that the injuries were predominantly minor.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain syndrome or that his injuries fell outside the MIG.

The Tribunal applied the AMA Guides criteria for chronic pain and found insufficient medical evidence to meet the threshold.

The application for the disputed treatment plan and interest was dismissed.

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

The respondent denied 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 chronic pain syndrome and a psychological impairment.

The Tribunal found the applicant failed to meet her burden of proof to establish either chronic pain with a functional impairment or a psychological impairment warranting removal from the MIG.

The Tribunal ordered that the applicant remains within the MIG but is entitled to the disputed treatment plans, if already incurred, up to the remaining MIG limit pursuant to s. 40(8) of the Schedule.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claims for various treatment plans and a psychological assessment under the Statutory Accident Benefits Schedule.

The applicant argued the Tribunal made significant errors of law and fact regarding the evidentiary burden for proving treatments were reasonable and necessary, and in finding the psychological assessment was duplicative.

The adjudicator dismissed the request, finding no errors of law or fact in the original decision, which correctly applied the binding precedent that the applicant bears the evidentiary onus.

The applicant was a passenger in a rear-end motor vehicle collision and sought statutory accident benefits, including non-earner benefits and funding for physiotherapy and a psychological assessment.

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

The Licence Appeal Tribunal found that the applicant failed to prove her injuries warranted removal from the MIG, noting inconsistencies between her self-reported psychological symptoms and her family doctor's clinical notes.

The Tribunal also dismissed the claim for non-earner benefits, finding the applicant could still engage in most of her pre-accident activities of daily living, albeit at a slower pace.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to a physiotherapy treatment plan and a functional impairment assessment.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary.

The medical evidence did not support a diagnosis of chronic pain under the AMA Guides criteria, and there was insufficient contemporaneous medical evidence to justify the requested treatments.

The application was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her attendant care benefits on the basis that she failed to prove her care provider sustained an economic loss.

The applicant argued that the Tribunal erred in its calculation of the care provider's pre-accident earnings by excluding a specific pay period that included holiday pay.

The Vice-Chair dismissed the request, finding that the Tribunal had properly excluded the pay period because it represented abnormally high earnings and distorted the average, and that the applicant was attempting to relitigate the matter without establishing any error of fact or law.

The applicant was injured in a motor vehicle accident when struck as a pedestrian and sought attendant care benefits from the respondent insurer.

The respondent denied the claim, and the applicant applied to the Licence Appeal Tribunal.

The Tribunal found that the applicant failed to prove on a balance of probabilities that her non-professional care provider (her spouse) sustained an economic loss as a result of providing attendant care.

The evidence showed no marked difference between the care provider's pre- and post-accident hours of work and earnings.

The application for attendant care benefits, interest, and an award under Regulation 664 was dismissed.