Martin Forget

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including a determination of catastrophic impairment under Criterion 8 (mental and behavioural disorders).

The Tribunal found that the applicant did not sustain a catastrophic impairment, as she did not demonstrate marked impairments in three out of four domains of functioning.

The Tribunal preferred the evidence of the respondent's assessors, who found the applicant capable of living independently and managing daily activities.

The applicant's claims for attendant care benefits, housekeeping benefits, and various treatment plans were also dismissed, as she failed to prove they were reasonable and necessary or incurred in accordance with the Schedule.

The applicant sought reconsideration of a Tribunal decision finding she was not catastrophically impaired.

She argued the Tribunal breached procedural fairness by allowing the respondent to cross-examine its own expert neurologist and by rejecting the expert's 5% whole person impairment rating for headaches without notice.

She also argued the Tribunal misapprehended evidence regarding her incontinence.

The Vice-Chair dismissed the request, finding the applicant had notice of the respondent's challenges to the expert's report, the Tribunal was entitled to reject ratings not supported by the AMA Guides, and the evidence supported the finding that there was no post-accident exacerbation of incontinence.

The applicant sought a determination of catastrophic impairment and entitlement to various treatment plans following a 2019 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant sustained a catastrophic impairment under Criterion 8 (mental and behavioural disorders), noting marked impairments in social functioning, concentration, persistence and pace, and adaptation.

However, the Tribunal denied all claimed treatment plans because the applicant failed to direct the panel to medical evidence supporting their reasonableness and necessity.

The respondent's claim for repayment of previously funded services was also dismissed for lack of evidence.

The applicant sought a determination that he sustained a catastrophic impairment as a result of a motor vehicle accident, along with entitlement to various attendant care benefits and treatment plans.

The Licence Appeal Tribunal evaluated the applicant's impairments under Criterion 7 (Whole Person Impairment) and Criterion 8 (mental and behavioural disorders).

The Tribunal rejected several of the applicant's physical impairment ratings due to a lack of causal evidence and methodological flaws, concluding the applicant did not meet the 55% WPI threshold.

Under Criterion 8, the Tribunal found the applicant had only mild impairments in activities of daily living and social functioning, failing to meet the threshold of three marked or one extreme impairment.

As the applicant was not catastrophically impaired and had exhausted his non-CAT limits, the claims for attendant care and treatment plans were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming catastrophic impairment under Criterion 7.

The respondent denied the benefits.

The Tribunal found the applicant was not catastrophically impaired, as her Whole Person Impairment rating was 48%, falling short of the 55% threshold.

The Tribunal rejected the WPI ratings for incontinence and headaches provided by the respondent's own expert, finding the incontinence was pre-existing and did not worsen post-accident.

Claims for psychological services, case management, interest, and a section 10 award were also dismissed.

The Tribunal initiated a review of an initial decision and a reconsideration decision under Rule 18.5 of the Licence Appeal Tribunal Rules.

The Vice-Chair found that the adjudicator in the initial hearing committed a material breach of procedural fairness by admitting the respondent's expert medical reports without requiring the expert to attend for cross-examination.

Because the adjudicator relied heavily on these reports to deny several treatment plans, the breach was material.

Both the initial and reconsideration decisions were cancelled, and the matter was sent for a rehearing.

The respondent insurer requested a reconsideration of a Tribunal decision finding the applicant catastrophically impaired.

The insurer alleged a reasonable apprehension of bias because the hearing adjudicator had a background in autism advocacy, which was relevant to the causation analysis of the applicant's impairments.

The Tribunal dismissed the request, finding the insurer improperly waited until after an unfavourable decision to raise the bias allegation.

Furthermore, the adjudicator's subject matter expertise did not displace the strong presumption of impartiality.

The insurer's remaining arguments regarding factual errors were dismissed as mere disagreements with the Tribunal's weighing of evidence.

The applicant requested a reconsideration of a decision that found she was not catastrophically impaired under criterion 8.

The applicant argued the Tribunal acted outside its jurisdiction, breached procedural fairness by limiting her testimony and allegedly diagnosing malingering, and erred in law by failing to follow the Pastore framework.

The Vice-Chair dismissed the request, finding that the original decision correctly applied the 'but for' test for causation, offered reasonable accommodations during testimony, and properly followed the legal tests without making an unauthorized medical diagnosis.

The applicant, who had pre-existing autism, was involved in a motor vehicle accident while riding her bike.

She sought a determination of catastrophic impairment and various statutory accident benefits.

The respondent denied the benefits, arguing her impairments were solely related to her pre-existing autism.

The Tribunal found that the accident was a necessary cause of her worsened psychological condition, leading to an extreme impairment in adaptation.

The applicant was deemed catastrophically impaired and awarded ongoing attendant care benefits and partial occupational therapy costs, but denied past attendant care benefits and other treatment plans.

The applicant sought statutory accident benefits following a 2015 motor vehicle accident, claiming catastrophic impairment under criterion 8 (mental or behavioural disorder) and entitlement to an income replacement benefit (IRB) and a chiropractic treatment plan.

The Tribunal dismissed the application, finding the applicant was not catastrophically impaired because her self-reported functional impairments were inconsistent with her history and objective findings, suggesting malingering or exaggeration.

The Tribunal also denied the IRB claim, finding the applicant failed to prove a complete inability to engage in employment, noting she had worked for 10-11 months post-accident.

Claims for the treatment plan, an award, interest, and costs were also dismissed.

The respondent insurer brought a motion to bar the applicant from proceeding with her application for statutory accident benefits under s. 55(1)2 of the Schedule.

The applicant had attended an initial psychiatric insurer's examination but left before it was completed, citing discomfort with the assessor.

The applicant subsequently refused to attend rescheduled examinations with different assessors, arguing they were too intrusive.

The Tribunal found that the insurer was entitled to a complete examination and that the applicant failed to provide a reasonable explanation for her non-attendance.

The motion was granted and the application was barred from proceeding.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found his injuries fell within the Minor Injury Guideline (MIG) and denied his claim for ongoing Income Replacement Benefits (IRB).

The applicant argued the Tribunal breached procedural fairness, ignored new medical evidence, and erred in fact regarding the MIG and the IRB dispute period.

The adjudicator found no breach of procedural fairness and held that the new evidence could have been obtained prior to the hearing.

While the adjudicator agreed the Tribunal made a factual error regarding the dates in dispute for the IRB claim, upon reviewing the evidence for the corrected period (February 26, 2020 to April 23, 2023), the adjudicator concluded the applicant failed to prove a substantial inability to perform the essential tasks of his employment.

The reconsideration was allowed in part to correct the dates, but the claim for ongoing IRB was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claims for various statutory accident benefits, including attendant care, housekeeping, and medical treatments.

The applicant argued that the adjudicator committed a material breach of procedural fairness, demonstrated institutional bias, and made several errors of law and fact.

The Tribunal dismissed the request, finding no reasonable apprehension of bias or breach of procedural fairness.

The Tribunal also concluded that the adjudicator made no errors of law or fact, noting that the applicant was improperly attempting to use the reconsideration process to reweigh the evidence.

The applicant sought a determination that he sustained a catastrophic impairment under Criterion 8 (mental and behavioural disorders) following a 2012 motor vehicle accident.

The Tribunal found that the applicant's multidisciplinary catastrophic impairment evaluation was conducted in compliance with section 45(2)1 of the Schedule.

However, the Tribunal concluded that the applicant did not sustain a Marked (Class 4) impairment in the domain of Adaptation.

The Tribunal preferred the evidence of the respondent's experts, finding that the applicant's self-reporting was unreliable and that his psychological impairments did not significantly impede his useful functioning.

The respondent insurer requested a reconsideration of a Tribunal decision which found that the applicant was not catastrophically impaired and could change her election from a non-earner benefit to an income replacement benefit.

The insurer argued the Tribunal made errors of fact and law in finding the initial election invalid.

The Tribunal dismissed the request, finding no error of fact, as the applicant qualified for the income replacement benefit and thus did not meet the criteria for the non-earner benefit.

Furthermore, the Tribunal found no error of law in its determination that the insurer's failure to comply with the mandatory 10-day notice requirement under s. 35(1) of the Schedule rendered the applicant's election not final.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied various statutory accident benefits, including attendant care, home modifications, and occupational therapy.

The applicant argued the Tribunal violated procedural fairness, made errors of fact, relied on false evidence from an occupational therapist, and that new medical evidence was available.

The Vice-Chair dismissed the request, finding no procedural unfairness in separating the hearings, no errors in weighing the evidence, that the occupational therapist's prior disciplinary record did not render her evidence false, and that the new medical report would not have changed the outcome as it relied on self-reporting previously deemed unreliable.

The applicant sought various statutory accident benefits following a motor vehicle accident, including attendant care benefits, housekeeping and home maintenance, multiple treatment plans, medical cannabis, and botox injections.

The Licence Appeal Tribunal dismissed the application in its entirety.

The adjudicator found that the applicant's claims for attendant care and housekeeping were inconsistent with her pre- and post-accident level of function, noting she continued to work full-time and her family performed most household chores.

The requested treatment plans and medical expenses were deemed not reasonable and necessary, as they were unsupported by the contemporaneous medical evidence and the applicant failed to provide adequate information to the insurer.

Claims for an award and interest were also dismissed as no benefits were overdue.

The applicant requested a reconsideration of a decision finding he was not catastrophically impaired.

He argued the adjudicator made an error of law and violated procedural fairness by failing to properly apply the AMA Guides regarding concentration, persistence, and pace, as well as activities of daily living and social functioning.

The adjudicator dismissed the request, finding the original decision complied with the methodology in the Guides and that no significant legal or evidentiary mistake was made.

The applicant sought a determination of catastrophic impairment and entitlement to attendant care benefits following a motor vehicle accident that resulted in a traumatic brain injury.

The central issue was whether the applicant's brain injury restricted his ability to work such that he met the criteria for catastrophic impairment under the GOS-E Guideline.

The Tribunal found that the applicant was capable of working in a reduced capacity, as evidenced by his post-accident construction work and his role teaching martial arts to children, and therefore did not meet the threshold for catastrophic impairment.

The Tribunal also dismissed the claim for attendant care benefits, finding the applicant to be highly functional both physically and cognitively, and denied the claim for interest.

The applicant requested a reconsideration of a decision finding she was not catastrophically impaired under Criterion 8 of the Schedule.

The applicant argued the adjudicator erred in law and fact by misapplying the Schedule, rejecting expert psychiatric opinions, misapplying the causation test, and ignoring evidence of deterioration.

The Tribunal dismissed the request, finding no errors of law or fact that would have changed the outcome.

The adjudicator noted that assigning weight to evidence and preferring certain evidence over expert opinions falls within the adjudicator's role and does not constitute an error of law.