3 total
Application for accident benefits dismissed; applicant's injuries fell within the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident.
The insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the requested treatments were not reasonable and necessary.
The applicant argued for removal from the MIG based on psychological impairments and chronic pain.
The Tribunal found the applicant's injuries were predominantly minor, noting her active lifestyle including weightlifting and combat sports contradicted claims of chronic pain and functional impairment.
The Tribunal also found the insurer's denial notices complied with section 38(8) of the Schedule, and the applicant failed to prove the disputed assessments were reasonable and necessary.
The application was dismissed.
Applicant barred from pursuing accident benefits claims due to failure to attend section 44 insurer examinations.
The applicant sought income replacement benefits and medication expenses for cannabis following a motor vehicle accident.
The insurer raised a preliminary issue that the applicant was barred from proceeding because he failed to attend multiple scheduled section 44 insurer examinations.
The Licence Appeal Tribunal agreed, finding that the insurer's requests for examinations were reasonable and its denials were clear and unequivocal.
Because the applicant failed to attend the required examinations, he was barred from pursuing his claims before the Tribunal.
Applicant statute-barred from pursuing chronic pain benefit for failing to attend reasonably necessary insurer's examination.
The applicant sought statutory accident benefits for a chronic pain programme following a motor vehicle accident.
The insurer denied the benefit and requested an insurer's examination (IE) under s. 44 of the Schedule.
The applicant refused to attend, arguing that she had already undergone numerous IEs and that the request was unreasonable.
The Tribunal found that the IE request was reasonably necessary because the chronic pain programme constituted a new benefit claim.
As the applicant failed to provide a reasonable excuse for non-attendance, she was statute-barred under s. 55(1)2 from proceeding with her application for the chronic pain programme until she attended the IE.
The insurer's request for costs was denied.
