Claudia Batista

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

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

The Tribunal found that while the applicant did not suffer a psychological injury warranting removal from the MIG, he did establish a chronic pain condition that placed his claims outside the MIG.

The Tribunal approved the treatment plan for chiropractic services as reasonable and necessary, but denied the treatment plan for a psychological assessment.

Interest was awarded on the overdue payments for the approved chiropractic treatment.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits after a delay caused by an initial application for employment insurance.

The Tribunal found the applicant had a reasonable explanation for the delay and was not disentitled to benefits.

The Tribunal held the applicant suffered a substantial inability to perform the essential tasks of his pre-accident employment due to a neck injury and fractured finger, entitling him to income replacement benefits for the first 104 weeks.

However, he did not meet the complete inability test for post-104 week benefits.

The Tribunal also ordered the insurer to pay several disputed medical and rehabilitation benefits, noting the insurer had incorrectly adjusted the claim under the Minor Injury Guideline despite the applicant's fractured finger.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a job demands analysis.

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

The Licence Appeal Tribunal found that the applicant's injuries were not predominantly minor, relying on medical evidence of a labral tear and a pre-existing C7 nerve root condition that would prevent maximal recovery under the MIG.

The Tribunal ordered the respondent to pay the remaining balance of the treatment plan and interest on the overdue payment, but denied the applicant's request for costs.

The insurer, having successfully defended an appeal regarding its standing to participate in an arbitration despite failing to file a timely response, sought its expenses of the appeal in the amount of $1,582.

The Director's Delegate declined to award expenses to either party.

Although the insurer was successful, the Delegate found that the insurer's nearly year-long delay in filing a response and the novelty of the legal issue regarding standing justified a departure from the general rule that costs follow the event.

The applicant was injured in a 2009 motor vehicle accident and sought statutory accident benefits.

The insurer denied the benefits and raised a preliminary issue that the applicant failed to commence arbitration within the two-year limitation period under s. 281.1(1) of the Insurance Act.

The applicant failed to attend the preliminary issue hearing.

The arbitrator found that the applicant bore the burden of proving entitlement and presented no evidence to show the arbitration was commenced within two years of the denial.

The application for arbitration was dismissed.

The appellant appealed an arbitrator's decision to allow the respondent insurer an additional 20 days to file a Response to Arbitration.

The appellant argued the insurer lacked standing due to the late response and that the arbitrator had no power to grant relief.

The Director's Delegate dismissed the appeal, finding that the arbitrator had the discretion under the Dispute Resolution Practice Code to impose a new timetable for compliance and that the insurer had standing to participate until ordered otherwise.