Jenna Ng

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

The insurer denied the benefit on the basis that the applicant was employed and entitled to an income replacement benefit instead.

The applicant applied to the Tribunal more than two years after the denial.

The Tribunal found that the insurer's denial was clear, unequivocal, and contained the required dispute resolution information, thereby triggering the two-year limitation period under s. 56 of the Schedule.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act, finding significant delay and prejudice to the insurer.

The application was dismissed as statute-barred.

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

The respondent denied a treatment plan for a neurological assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained an accident-related concussion, which falls outside the definition of a minor injury, and removed him from the MIG.

The Tribunal also found the proposed neurological assessment and treatment plan to be reasonable and necessary, ordering the respondent to pay $2,000.00 plus interest.

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

The applicant argued that ongoing neck and back pain, along with psychological impairments, warranted removal from the MIG.

The Tribunal found that the applicant failed to establish a chronic pain condition or psychological impairment that would justify removal from the MIG, noting a lack of specialist referrals and the applicant's return to full-time work.

The Tribunal also found the respondent's denial notices were compliant with the Schedule.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought accident benefits from the respondent insurer.

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

The Tribunal found that the applicant demonstrated a psychological impairment, specifically a provisional diagnosis of PTSD, warranting removal from the MIG.

The Tribunal also found that the respondent's denial of a physiotherapy treatment plan was non-compliant with s. 38(8) of the Schedule, making the plan payable.

Furthermore, the Tribunal approved treatment plans for a chronic pain assessment and a psychological assessment, finding them reasonable and necessary based on the applicant's ongoing symptoms and functional limitations.

The applicant was awarded the disputed treatment plans and interest on incurred amounts.

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

The respondent denied treatment plans for psychological services and assessments, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant did not prove an accident-related psychological impairment or chronic pain syndrome with functional impairment that would warrant removal from the MIG, preferring the respondent's section 44 assessors over the applicant's assessors due to inconsistencies with contemporaneous clinical records.

However, pursuant to section 40(8) of the Schedule, the disputed benefits were deemed reasonable and necessary up to the remaining $3,500 MIG limit.

The Applicant sought her expenses and a Special Award following a successful arbitration for statutory accident benefits against the Insurer.

The Arbitrator found that the Insurer unreasonably withheld and delayed payments for Non-Earner and Medical Benefits despite compelling medical evidence from the Applicant's experts.

The Insurer's conduct, including an inadequate all-inclusive settlement offer, warranted a Special Award.

The Arbitrator ordered the Insurer to pay the Applicant's expenses fixed at $28,415.06 plus HST, and a Special Award of $13,000.00 inclusive of interest.

The applicant sought statutory accident benefits following a motor vehicle accident but failed to attend the pre-hearing and preliminary issue hearing.

Her representative had previously been removed from the record due to loss of contact.

The insurer brought a motion to dismiss the arbitration.

The arbitrator found that the applicant had abandoned her claim and dismissed the application under Rule 68 of the Dispute Resolution Practice Code, awarding $200 in costs to the insurer.