Francesco Vumbaca

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

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

The Tribunal found that the Applicant failed to prove she suffered from an accident-related psychological injury or chronic pain condition that would remove her from the MIG.

Consequently, the disputed treatment plans were denied as they fell outside the MIG limit.

The Tribunal also dismissed the claim for income replacement benefits, drawing an adverse inference from the Applicant's failure to produce her employment and employment insurance files.

Claims for interest and a section 10 award were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to various treatment plans for physical and psychological impairments.

The respondent denied the plans, arguing a lack of corroborating medical evidence and that certain costs, such as PPE, were administrative overhead.

The Tribunal found that the applicant failed to meet the burden of proving the treatment plans were reasonable and necessary, noting the absence of contemporaneous clinical notes from a family physician.

The Tribunal also held that PPE costs are captured by administrative overhead under the Professional Services Guideline.

The application was dismissed in its entirety.

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

The respondent denied the treatment plans, arguing the injuries were minor.

The Licence Appeal Tribunal found that the applicant failed to prove he suffered from non-minor injuries or chronic pain with functional impairment.

The Tribunal preferred the comprehensive insurer's examination report over the applicant's medical evidence.

As the applicant remained within the MIG and its $3,500 limit was exhausted, the claims for treatment plans, an award, and interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to treatment plans for chiropractic services, a psychological assessment, and a chronic pain assessment.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the policy limits were exhausted.

The Tribunal found that the applicant failed to prove her chronic pain and psychological impairments were accident-related or severe enough to warrant removal from the MIG.

As the MIG limits were exhausted, the claims for treatment plans, a section 10 award, and interest were dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits for psychological and neurological assessments.

The respondent insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and its $3,500 funding limit.

The Licence Appeal Tribunal found that the applicant did not sustain a concussion, psychological injury, or chronic pain as a result of the subject accident, noting that any ongoing symptoms were likely attributable to a subsequent accident.

The Tribunal concluded the applicant sustained a minor injury subject to the MIG, dismissed the claims for the disputed assessment plans, and denied claims for an award and interest.

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

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

The applicant argued for removal from the MIG due to chronic pain and psychological impairments.

The Tribunal found that the applicant failed to provide sufficient objective medical evidence to establish chronic pain or a psychological impairment warranting removal from the MIG.

The Tribunal preferred the evidence of the respondent's assessors, noting a lack of ongoing medical treatment or complaints in the clinical records.

As the $3,500 MIG limit was exhausted, the disputed treatment plans were not payable.

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

The applicant requested a reconsideration of a decision denying her non-earner benefits due to her failure to submit a completed OCF-3 disability certificate.

She argued the Tribunal violated procedural fairness and made errors of law and fact in interpreting section 36 of the Schedule and weighing evidence.

The Tribunal dismissed the request, finding no errors of law, fact, or procedural fairness, and noted that dissatisfaction with the result or a desire to re-argue the case are not valid grounds for reconsideration.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs) and various medical treatment plans.

The insurer initially placed the applicant in the Minor Injury Guideline (MIG) and denied several treatment plans, later removing her from the MIG for psychological impairments but terminating IRBs based on insurer examinations.

The Licence Appeal Tribunal found that the applicant was not entitled to further IRBs, as she did not suffer a substantial inability to perform her essential tasks as an Uber driver, noting she was enrolled in a full-time massage therapy program.

The Tribunal upheld the insurer's denial of most treatment plans under s. 38(5) of the Schedule, but approved one physiotherapy plan and the balance of a psychological assessment.

Claims for an award for unreasonable delay were dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and medical benefits from her insurer.

The insurer initially classified her injuries under the Minor Injury Guideline (MIG) and denied several treatment plans, later removing her from the MIG for psychological impairments but terminating IRBs based on insurer examinations.

The Licence Appeal Tribunal found that the applicant was not entitled to further IRBs, as she failed to prove a substantial inability to perform her essential tasks as an Uber driver, noting she was enrolled in a full-time massage therapy program.

The Tribunal upheld the insurer's denial of early treatment plans under section 38(5) of the Schedule but approved one physiotherapy plan and the balance of a psychological assessment, along with applicable interest.

The claim for an award for unreasonable delay was dismissed.