Grace Ko

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

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

The Licence Appeal Tribunal found that the applicant suffered from chronic pain with functional impairment and psychological injuries, removing her from the MIG.

The Tribunal ordered the respondent to pay the disputed treatment plans for chiropractic services and a psychological assessment, finding them reasonable and necessary, along with interest on overdue payments.

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 Tribunal found that the applicant failed to establish on a balance of probabilities that she sustained non-minor physical or psychological impairments, or chronic pain, that would warrant removal from the MIG.

However, the Tribunal found that the respondent's denials for all but one of the treatment plans failed to comply with the notice requirements under s. 38(8) of the Schedule.

As a result, the non-compliant treatment plans were payable pursuant to s. 38(11), despite the applicant remaining within the MIG.

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 Tribunal found that the applicant failed to provide sufficient medical evidence to prove his injuries warranted removal from the MIG.

However, the Tribunal also found that the respondent's Explanation of Benefits (EOBs) denying the treatment plans failed to comply with the notice requirements under s. 38(8) of the Schedule, as they provided boilerplate language without specific medical reasons.

Consequently, under s. 38(11), the respondent was prohibited from taking the position that the MIG applied to those specific treatment plans.

The disputed treatment plans were ordered payable upon submission of invoices, along with interest.

The applicant sought attendant care benefits following a motor vehicle accident, claiming his son provided care prior to the applicant's death from pre-existing cancer.

The insurer denied the claim because the applicant never submitted an Assessment of Attendant Care Needs (Form 1).

The Tribunal dismissed the application, holding that the submission of a Form 1 is a mandatory requirement under the Statutory Accident Benefits Schedule to establish entitlement to and the quantum of attendant care benefits.

Claims for a special award and costs were also dismissed.