Darcie Sherman

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

The respondent insurer denied benefits and scheduled an insurer's examination (IE) to assess entitlement.

The applicant failed to attend the IE.

The Tribunal held a preliminary issue hearing to determine if the applicant was barred from proceeding under s. 55(1) of the Schedule.

The Tribunal found the IE was reasonably necessary and properly noticed, and the applicant's explanations for non-attendance were not compelling.

Consequently, the applicant was barred from proceeding to a hearing, and the application was dismissed.

The applicant, a pedestrian injured in a motor vehicle accident, sought medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The respondent insurer denied a treatment plan for chiropractic services and a chronic pain assessment, arguing the $65,000 non-catastrophic policy limit was exhausted.

The Tribunal found the insurer's denial notices failed to comply with section 38(8) of the Schedule, as the limit was not fully exhausted at the time of the denials.

The Tribunal concluded both treatment plans were reasonable and necessary.

The insurer was ordered to pay the chiropractic treatment plan in full and the chronic pain assessment up to the remaining policy limit, plus interest.

The applicant's request for a special award was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits and a treatment plan for an ocular assessment.

The Licence Appeal Tribunal dismissed the application.

The adjudicator found the applicant failed to prove that the attendant care services provided by her mother were 'incurred' under s. 3(7)(e) of the Schedule, as no evidence of economic loss was provided.

Furthermore, the proposed ocular assessment was deemed not reasonable and necessary, as it was recommended by a chiropractor outside their scope of practice and unsupported by the applicant's treating specialists or the respondent's s. 44 neurological assessment.

The applicant requested a reconsideration of a decision denying her treatment plans for chiropractic services and massage therapy, as well as the cost of an orthopaedic assessment.

She argued the Tribunal made an error of law or fact by disregarding evidence and that new evidence (the independent assessor's clinical notes) should be considered.

The adjudicator dismissed the request, finding no error of law or fact and noting that the requested clinical notes did not exist, meaning there was no new evidence that could have affected the result.

The applicant requested a reconsideration of a decision finding that her accident-related impairments fell within the Minor Injury Guideline (MIG) and that she was not entitled to further medical benefits as the MIG limits were exhausted.

The applicant argued the adjudicator erred in law and fact by failing to find she suffered from chronic pain and by not properly considering certain medical evidence.

The adjudicator denied the request, finding no error in the weighing of the medical evidence, which did not corroborate the chronic pain diagnosis.

The adjudicator also held that arguments regarding pre-existing conditions were improperly raised for the first time on reconsideration.

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

The insurer denied funding for physiotherapy, a psychological assessment, and an orthopaedic assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained a psychological impairment, removing her from the MIG.

The Tribunal ordered the insurer to pay for the psychological assessment, less transportation costs, but dismissed the claims for physiotherapy and the orthopaedic assessment as the applicant failed to prove they were reasonable and necessary.

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

The respondent denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she suffered from chronic pain and psychological impairments that removed her from the MIG.

The Tribunal found that the applicant's physical injuries were soft tissue in nature and that her claims of chronic pain and psychological injury were not corroborated by the contemporaneous medical records of her family physician.

As the applicant failed to prove her injuries warranted treatment beyond the MIG, and the $3,500 limit had been exhausted, the disputed treatment plans were not payable.

The claims for interest and an award were also dismissed.

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

The respondent insurer determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied further medical benefits and assessments.

The applicant argued that his pre-existing degenerative disc disease and chronic pain warranted removal from the MIG.

The Tribunal found that the applicant failed to prove his pre-existing condition prevented maximal recovery under the MIG limits.

Furthermore, the Tribunal rejected the applicant's chronic pain assessment, finding it contradicted by the treating physician's clinical notes and records.

As the applicant's injuries were predominantly minor and the $3,500 MIG limit was exhausted, the disputed treatment plans were not payable.

The application was dismissed.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision.

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

The Tribunal found that the applicant suffered predominantly minor soft tissue injuries, relying on the respondent's Insurer's Examination report and the clinical notes of the applicant's family physician, which indicated the injuries had largely resolved.

Because the $3,500 MIG limit had already been exhausted, the disputed treatment plans were not payable.

Claims for an award and interest were also dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claims for an income replacement benefit and a treatment plan for physiotherapy.

The applicant argued that the Tribunal made errors of fact and law, including failing to consider certain medical evidence and misinterpreting employment records.

The adjudicator found that the applicant was attempting to re-litigate issues already decided and had not demonstrated any significant legal or evidentiary mistake.

The adjudicator also declined to admit new evidence that could have been produced at the original hearing.

The request for reconsideration was denied.

The applicant sought income replacement benefits and a physiotherapy treatment plan following a motor vehicle accident.

The Tribunal found that the applicant did not suffer a substantial inability to perform the essential tasks of her pre-accident employment within 104 weeks of the accident, nor a complete inability to engage in any employment thereafter.

The Tribunal preferred the respondent's multidisciplinary insurer examination reports over the applicant's expert reports, noting that the applicant's experts relied heavily on uncorroborated self-reporting and failed to address her pre-accident job duties.

The claim for the physiotherapy treatment plan, an award under Regulation 664, and interest were also dismissed.

The applicant sought income replacement benefits following a 2013 motor vehicle accident.

The respondent insurer denied the benefits in March 2014 after the applicant returned to work.

The applicant stopped working in 2015 but did not file an application with the Tribunal until November 2019.

The Tribunal found the application was statute-barred under s. 56 of the Statutory Accident Benefits Schedule, as it was commenced more than two years after the clear and unequivocal denial.

The Tribunal also declined to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act, finding no bona fide intention to appeal within the limitation period, excessive delay, prejudice to the respondent, and lack of merit.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident, which the respondent insurer denied based on insurer's examinations.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove a substantial inability to perform the essential tasks of his self-employment.

The Tribunal preferred the respondent's medical evidence, noting that the applicant's own clinical records indicated he had returned to work shortly after the accident and lacked objective medical evidence to support his claim.

Claims for interest and an award for unreasonable delay were also dismissed.

The applicant sought a determination that he sustained a catastrophic impairment as a result of a motor vehicle accident, along with claims for income replacement benefits, medical benefits for physiotherapy, housekeeping benefits, and cost of examinations.

The Tribunal found that the applicant's shoulder impairments were largely due to pre-existing conditions and natural degeneration, not the accident.

The Tribunal rejected the applicant's whole person impairment rating of 55%, finding that the assessors improperly included a 3% rating for medication use related to a pre-existing heart condition and an 18% rating for speculative future surgery.

The Tribunal also dismissed the claim for income replacement benefits, finding the applicant was not actively self-employed at the time of the accident due to a recent heart attack.

All claims were dismissed.

The applicant sought payment for three assessments (two psychological and one physiatry) following a motor vehicle accident.

The Tribunal dismissed the claims for the psychological assessments, finding them to be a duplication of services and noting the applicant failed to provide evidence or submissions demonstrating they were reasonable and necessary.

The Tribunal dismissed the claim for the physiatry assessment for lack of jurisdiction, as the treatment plan had not been submitted or denied prior to the application being filed.

Claims for interest and an award were also dismissed.

The applicant sought income replacement benefits (IRBs) and the cost of prescription medications following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the claim for IRBs because the applicant failed to file a 2016 income tax return, meaning his pre-accident income was deemed to be nil under section 4(5) of the Statutory Accident Benefits Schedule.

The claim for prescription medications was also dismissed as the respondent had already paid the amount.

No interest was payable.

The applicant sought a non-earner benefit and a medical rehabilitation benefit following a motor vehicle accident.

The insurer denied the benefits, arguing the applicant did not suffer a complete inability to carry on a normal life and that the treatment was not reasonable and necessary.

The Tribunal dismissed the application, finding the applicant failed to meet the stringent test for a non-earner benefit, largely due to a lack of detailed comparison between her pre- and post-accident functioning and the impact of her pre-existing conditions.

The Tribunal also found the proposed treatment plan was not reasonable and necessary, preferring the insurer's medical evidence that the applicant had reached maximum medical improvement.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits.

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

The Tribunal found that the applicant's chronic pain and psychological impairments warranted removal from the MIG.

The Tribunal also held that the disputed physiotherapy treatment plan was reasonable and necessary, and awarded interest on overdue benefits.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, housekeeping and home maintenance benefits, and various medical and rehabilitation benefits.

The Licence Appeal Tribunal dismissed the claims for housekeeping benefits because the applicant had not sustained a catastrophic impairment.

The claim for a non-earner benefit was dismissed as the applicant's pre-existing psychological conditions and post-accident activities demonstrated she did not suffer a complete inability to carry on a normal life.

The Tribunal granted the claim for a chronic pain program in part, finding it reasonable and necessary, but dismissed the remaining claims for physiotherapy and a psychological assessment as duplicative.

The claim for a special award under O. Reg 664 was also dismissed.