Matthew D Reid

The insurer applied to the Licence Appeal Tribunal seeking repayment of income replacement benefits (IRBs) paid to the respondent, alleging wilful misrepresentation of post-accident employment.

The adjudicator found no wilful misrepresentation, as the respondent's singing activities did not generate proven income and she had disclosed her temporary spa employment to the insurer's medical examiner.

However, the insurer was entitled to repayment of $907.54 for overpayments made within the 12 months prior to its notice.

The adjudicator also determined that the respondent's injuries fell outside the Minor Injury Guideline (MIG) due to a concussion diagnosis supported by contemporaneous clinical notes.

The respondent was awarded costs for an accounting report and an oculo-visual assessment, but claims for a psychological assessment, chiropractic treatment, and a special award were dismissed.

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

The insurer denied benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG due to a psychological injury and a pre-existing anxiety condition.

The Tribunal found insufficient contemporaneous medical evidence to establish an accident-related psychological impairment or that a pre-existing condition prevented her maximal recovery.

The applicant's injuries were deemed predominantly minor, but she was entitled to the disputed psychological assessment up to the remaining MIG limit.

The applicant sought accident benefits following a 2016 motor vehicle accident.

The insurer classified the injuries as minor and denied a chiropractic treatment plan of $1,096.00 once the $3,500.00 funding limit was exhausted.

The applicant argued his pre-existing multiple sclerosis and back pain, along with a concussion and adjustment disorder, warranted removal from the Minor Injury Guideline.

The Tribunal found insufficient evidence linking the psychological disorder or concussion to the accident, and no evidence that the accident worsened his pre-existing conditions.

The application was dismissed.