3 total
Applicant entitled to chronic pain assessment; no award for delay as insurer appropriately adjusted file.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent initially denied treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
Prior to the hearing, the respondent removed the applicant from the MIG and approved the disputed psychological treatment plans based on new medical evidence.
The Tribunal found the applicant was entitled to a physiatry/chronic pain assessment, as her ongoing pain complaints and the respondent's own assessments demonstrated a need for further investigation.
The Tribunal declined to order an award for unreasonable delay, finding the respondent appropriately adjusted the file as medical evidence evolved.
Applicant awarded partial accident benefits and a 25% special award for insurer's unreasonable failure to pay approved plans.
The applicant sought various medical and rehabilitation benefits following a 2018 motor vehicle accident.
The Licence Appeal Tribunal found the applicant was entitled to a treatment plan for cognitive behaviour therapy, a plan for cognitive therapy and concussion-focused counseling, and a psychiatric assessment, as these were supported by medical evidence or previously approved by the respondent.
Claims for a new mattress, optometric services, an EMG assessment, a sleep study, and expenses submitted on OCF-6 forms were denied for lack of contemporaneous medical support or because they were incurred prior to approval.
The Tribunal also ordered the respondent to pay a 25% special award under s. 10 of Regulation 664 for its stubborn and inflexible conduct in failing to pay for the CBT and psychiatric assessment plans that it had already approved.
Spilling hot tea in a parked vehicle due to an improperly secured lid is not an accident.
The applicant sought statutory accident benefits after spilling hot tea on herself while entering her parked vehicle.
The respondent denied benefits, arguing the incident was not an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.
The Tribunal applied the purpose and causation tests, finding that while the purpose test was met, the causation test failed.
The Tribunal concluded that the improperly secured lid by the restaurant employee was an intervening act and the direct cause of the injuries, not the use or operation of the vehicle.
The application was dismissed.
