Dale Stuckless

The respondent requested reconsideration of a Licence Appeal Tribunal decision that awarded the applicant an income replacement benefit (IRB) and a vocational assessment treatment plan.

The respondent argued the Tribunal erred in its assessment of medical evidence regarding causation and the post-104 week IRB test.

The Vice-Chair dismissed the IRB grounds, finding the respondent was attempting to re-litigate the evidence.

However, the Vice-Chair found the Tribunal committed a legal error by approving the vocational assessment based on its relevance to the IRB determination rather than its necessity for the applicant's recovery.

The reconsideration was granted in part, and a written re-hearing was ordered solely for the vocational assessment treatment plan.

The applicant sought statutory accident benefits following a motor vehicle accident, including post-104 week income replacement benefits (IRBs) and various treatment plans.

The Tribunal found that the applicant suffered a complete inability to engage in any employment for which he was reasonably suited due to a severe shoulder injury requiring surgery, exacerbated by the accident, and awarded IRBs at the optional rate of $1,000 per week.

The Tribunal denied most of the disputed treatment plans for lack of supporting medical evidence, but approved a vocational assessment relevant to the IRB claim.

The request for a special award was dismissed as the insurer's denial was not found to be unreasonable, though interest was awarded on overdue benefits.

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

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued he suffered from chronic pain warranting removal from the MIG.

The Tribunal found the medical evidence did not support a diagnosis of chronic pain with functional impairment, noting the applicant failed to meet the criteria under the AMA Guides.

As the injuries were predominantly minor and the MIG limits were exhausted, the application for benefits and interest was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident involving her husband.

The respondent insurer raised a preliminary issue that the applicant was barred from proceeding because she failed to submit her application (OCF-1) within 30 days of receiving the forms, as required by section 32(5) of the Schedule.

However, the respondent's submissions focused entirely on section 32(1) regarding late reporting of injuries, which was not the issue identified in the case conference report and order.

The adjudicator found it inappropriate to dismiss the application based on submissions that did not address the specific narrow issue in dispute, and ruled that the applicant was not barred from proceeding.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found they sustained predominantly minor injuries and were not entitled to medical benefits for physiotherapy and a psychological assessment.

The applicant argued the Tribunal erred in fact and law regarding the insurer's late response to the treatment plans and whether the expenses were incurred.

The adjudicator dismissed the request, finding no error of law or fact that would have led to a different result, as the expenses were not incurred prior to the proper notice of denial.

The applicant sought statutory accident benefits for physiotherapy and a chronic pain assessment following a motor vehicle accident.

The insurer denied the treatment plans, arguing the applicant's physical impairments were minor.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, noting that her family doctor's records did not mention the accident or support ongoing physical impairments.

The Tribunal preferred the evidence of the insurer's examination and dismissed the application.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits for a chiropractic treatment plan.

The respondent denied the claim, arguing the applicant's injuries were pre-existing and not worsened by the accident.

The Tribunal found that the accident exacerbated the applicant's pre-existing shoulder and back injuries.

The proposed treatment plan was deemed reasonable and necessary to improve the applicant's outcomes and return her to pre-accident levels of activity.

The applicant was awarded the claimed medical benefits and interest on overdue payments.

The applicant sought death and funeral benefits from the respondent insurer after her spouse died from smoke inhalation in his motor vehicle.

The fire investigation report concluded the fire was intentionally set by the deceased using a cigarette lighter, a dishtowel, and gasoline.

The Tribunal applied the two-part test for an 'accident' under section 3 of the Statutory Accident Benefits Schedule.

The Tribunal found that the incident did not meet the purpose test, as the vehicle was used as a venue and mechanism for suicide, which is an aberrant use.

Furthermore, the incident did not meet the causation test, as the intentional setting of the fire was an independent intervening act that broke the chain of causation.

The application was dismissed.

The applicant sought statutory accident benefits for physiotherapy and a psychological assessment following a motor vehicle accident.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and were not reasonable or necessary.

The Tribunal found that the applicant did not suffer from a psychological impairment, pre-existing condition, or chronic pain that would remove him from the MIG.

The Tribunal further held that the requested treatment plans were not reasonable or necessary.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought non-earner benefits and attendant care benefits from the respondent insurer.

The respondent raised preliminary issues regarding the applicant's failure to submit a disability certificate and an assessment of attendant care needs (Form 1).

The Tribunal held that under section 36(3) of the Statutory Accident Benefits Schedule, the applicant is not entitled to non-earner benefits for any period prior to the submission of a completed disability certificate.

Furthermore, under section 42, the applicant is not entitled to attendant care benefits because a Form 1 was never submitted.

The preliminary issues were resolved in favour of the respondent.

Following a two-week jury trial for damages arising from a motor vehicle collision, the jury awarded the plaintiff $15,000 in general damages for a minor soft tissue strain.

The trial judge was required to determine whether the plaintiff met the statutory threshold under s. 267.5(5) of the Insurance Act.

The court found that while the plaintiff suffered a permanent impairment from a soft tissue injury to his left shoulder, the impairment was neither 'serious' nor 'important' as it did not substantially interfere with his employment or usual activities of daily living.

The plaintiff's claim for general damages was therefore dismissed.