Ilona Agivaeva

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

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

The applicant argued for removal from the MIG based on a pre-existing condition, chronic pain, and psychological impairment.

The Tribunal found the applicant did not meet her onus to prove her injuries fell outside the MIG, preferring the insurer's medical evidence and noting an intervening slip and fall accident.

However, the Tribunal found the respondent failed to provide a timely notice under s. 38(8) of the Schedule for a $768.25 physiotherapy treatment plan, making the respondent liable for incurred amounts starting on the 11th business day after submission.

The application was otherwise dismissed.

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).

The applicant argued for removal from the MIG due to psychological injury, chronic pain, and physical injuries including a fractured rib and radiculopathy.

The Tribunal found that the applicant failed to provide sufficient medical evidence linking the psychological symptoms, chronic pain, or physical injuries to the accident.

The Tribunal also found the respondent's denial letters complied with the Schedule.

The application was dismissed, and the applicant was held to the MIG.

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

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

The applicant contended that he developed chronic pain with functional impairment warranting removal from the MIG.

The Tribunal found that the applicant failed to provide sufficient medical evidence, such as a formal diagnosis or particulars of functional impairment, to establish chronic pain.

The Tribunal concluded the injuries were predominantly minor, and therefore the disputed treatment plans for a chronic pain assessment and physiotherapy were not payable.

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

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

The applicant argued that pre-existing conditions, including cervical radiculopathy and carpal tunnel syndrome, prevented her recovery within the MIG framework.

The Tribunal found that while the applicant had documented pre-existing conditions, there was no medical evidence demonstrating that these conditions precluded her recovery within the MIG.

Consequently, the applicant's impairments were deemed predominantly minor, and her claims for a physiotherapy treatment plan, a psychological assessment, and interest were dismissed.

The applicant sought a determination of catastrophic impairment and entitlement to various treatment plans following a motor vehicle accident.

The Tribunal found that the applicant did not meet the 55% whole person impairment threshold under either Criterion 6 (physical) or Criterion 7 (combined physical and psychological), assessing his physical impairment at 37% and combined impairment at 43%.

The Tribunal denied the claim for outstanding catastrophic impairment assessments, finding them duplicative.

However, the Tribunal granted the cost of a NuStep cross trainer, finding it reasonable and necessary for the applicant's rehabilitation.

The Tribunal also granted the cost of a neurovisual assessment because the insurer's denial notice failed to comply with the requirements of s. 38(8) of the Schedule.

The applicant's request for costs was dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought non-earner benefits (NEBs) and various medical benefits from the respondent insurer.

The Tribunal found the applicant did not meet the test for a complete inability to carry on a normal life, as medical evidence and independent examinations showed she remained generally functional.

The Tribunal denied NEBs and several treatment plans, but granted entitlement to one chiropractic treatment plan and the full cost of a psychological assessment, finding them reasonable and necessary.

Interest was awarded on the overdue payments for the approved plans.

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

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

The applicant argued she should be removed from the MIG due to chronic pain, psychological injuries, and a pre-existing condition of pregnancy.

The Tribunal found insufficient medical evidence to support a diagnosis of chronic pain or a psychological impairment, preferring the respondent's comprehensive psychological assessment over the applicant's provisional screening report.

The Tribunal also found no compelling evidence that the applicant's pregnancy prevented maximal recovery under the MIG.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a chiropractic treatment plan and a chronic pain assessment.

The insurer denied the benefits, arguing they were not reasonable and necessary.

The Licence Appeal Tribunal found that the chiropractic treatment plan was not reasonable and necessary, as the applicant had already received similar treatment for two years with little improvement.

However, the Tribunal found the chronic pain assessment was reasonable and necessary as a diagnostic tool to evaluate the applicant's ongoing pain symptoms following hand fractures sustained in the accident.

The applicant was awarded the cost of the chronic pain assessment plus interest.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that her diagnosis of sciatica and chronic pain warranted removal from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence, such as a formal diagnosis or evidence of functional impairment, to justify removal.

The insurer's examination report diagnosing minor injuries was accepted.

As the MIG limits were exhausted, the disputed treatment plan was deemed not reasonable and necessary, and the application was dismissed.

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

The respondent insurer denied the benefits, arguing the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG) limit.

The Tribunal found that the applicant's physical and psychological injuries were predominantly minor and that she did not suffer from chronic pain or a pre-existing condition that would warrant removal from the MIG.

As the MIG limits were exhausted, the application for treatment plans and interest was dismissed.

The applicant sought medical benefits for chiropractic treatment, physiotherapy, an MRI, and an orthopaedic assessment following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's injuries were pre-existing.

The Licence Appeal Tribunal found that the applicant sustained a torn rotator cuff as a result of the accident.

The Tribunal held that the treatment plans for chiropractic and physiotherapy were reasonable and necessary, but the proposed MRI and orthopaedic assessment were not, as the injury had already been identified via ultrasound.

The applicant was also awarded interest on overdue payments.

The applicant sought reconsideration of a LAT decision that denied her claims for psychological, chiropractic, and massage therapy benefits.

She argued the adjudicator erred in fact and law, violated procedural fairness, and sought to introduce a new letter from her supervising psychologist to validate her psychological assessment report.

The adjudicator waived the late filing of the reconsideration request but dismissed it on the merits.

The adjudicator found the new letter did not meet the test for new evidence and would not have changed the outcome, as the original decision reasonably relied on the applicant's own statements to the insurer's assessor that she did not want or need the claimed treatments.