Priyanka Monpara

The applicant sought a non-earner benefit and a treatment plan for chiropractic services following a motor vehicle accident.

The Tribunal found the applicant was statute-barred from proceeding with the claim for a non-earner benefit because he failed to attend reasonably necessary insurer examinations without a reasonable explanation, and the insurer's notice of examination was compliant with s. 44 of the Schedule.

The Tribunal also dismissed the claim for the treatment plan, finding the applicant failed to prove it was reasonable and necessary, and that the insurer had provided a valid denial notice under s. 38(8).

Claims for interest and an award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming costs for medical cannabis and a social work assessment.

The Tribunal denied the claims for medical cannabis, finding it was not reasonable and necessary as the applicant reported deriving little benefit from it compared to other pharmaceuticals.

However, the Tribunal ordered the respondent to pay for the social work assessment because the respondent's denial letter relied on boilerplate language and failed to provide sufficient medical reasons, violating s. 38(8) of the Schedule.

Claims for an award under s. 10 of Reg. 664 were dismissed, but interest was awarded on the overdue payment for the social work assessment.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming attendant care benefits and the cost of an orthopaedic mattress.

The Licence Appeal Tribunal dismissed the application, finding no evidence that the attendant care expenses were incurred and concluding that the orthopaedic mattress was not proven to be reasonable and necessary.

The Tribunal preferred the evidence of the respondent's orthopaedic surgeon over the applicant's occupational therapist regarding the necessity of the mattress.

The applicant was a pedestrian struck by a vehicle and sought statutory accident benefits.

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

The applicant argued for removal from the MIG based on psychological impairment and chronic pain.

The Tribunal found the applicant did not meet the burden of proving a psychological injury or chronic pain with functional impairment, noting the lack of formal diagnoses and unchanged pain management post-accident.

The Tribunal also denied the claim for attendant care benefits, preferring the respondent's medical evidence that the applicant was independent in mobility and personal care.

All claims were dismissed.

The applicant requested a reconsideration of a Tribunal decision that denied her entitlement to three treatment plans for physiotherapy services and an award.

The applicant argued the adjudicator misapplied sections 49.1 and 64 of the Statutory Accident Benefits Schedule regarding unlicensed service providers and document submission waivers.

The Tribunal dismissed the request, finding that the applicant failed to raise section 49.1 at the initial hearing and was attempting to re-litigate arguments regarding section 64, thereby failing to establish an error of law or fact under Rule 18.2(b).

The applicant sought payment for a $2,421.79 physiotherapy treatment plan following a motor vehicle accident.

The respondent denied the benefit, relying on an insurer's examination report indicating the applicant had reached a treatment plateau.

The adjudicator found that the applicant failed to meet her burden of proving the treatment was reasonable and necessary, as her supporting medical reports were not contemporaneous with the treatment plan request.

The application was dismissed and no interest was payable.

The applicant insurer sought repayment of $2,845.40 paid to the respondent insured in error for occupational therapy services.

The insurer issued a cheque to the respondent instead of the service provider, which the respondent cashed.

The Tribunal found that the insurer proved the payment was made in error and that it provided proper notice within the 12-month statutory timeframe under s. 52 of the Schedule.

The respondent was ordered to repay the amount, but no interest was awarded as it was not requested in the notice or case conference.

The applicant sought payment for three physiotherapy treatment plans following a motor vehicle accident.

The respondent denied the plans because the health care provider and facility were not registered with the Health Claims for Auto Insurance (HCAI) system and the plans were not submitted through the Central Processing Agency (CPA) as required by the HCAI Guideline and the Statutory Accident Benefits Schedule.

The Tribunal found that the HCAI Guideline applied and the respondent had not waived the submission requirements.

The application for benefits, an award, and interest was dismissed.

The appellant sought to quash a Licence Appeal Tribunal (LAT) decision and a reconsideration decision, alleging procedural unfairness.

The Divisional Court dismissed the appeal and application for judicial review, finding that the appellant was given notice of the hearing, did not request an in-person hearing or accommodation, and did not raise procedural unfairness in his reconsideration request.

The court noted that the decisions do not bar the appellant's claims for attendant care benefits or a special award relating to the timing of non-earner benefits payments.

No costs were awarded.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident.

The Tribunal found that while the applicant met the medical test for pre-104 week IRBs due to chronic pain and adjustment disorder, they failed to provide the necessary financial documents, such as tax returns, to determine the quantum of the benefit.

The Tribunal also found that the applicant did not meet the more stringent post-104 week test of a complete inability to engage in suitable employment.

As no quantum could be determined, the application for IRBs and interest was dismissed.

The applicant sought various medical and rehabilitation benefits following a motor vehicle accident.

The respondent denied the treatment plans, and the applicant applied to the Licence Appeal Tribunal.

The applicant did not make submissions on whether the benefits were reasonable and necessary, but instead argued entitlement on a purely statutory basis, claiming the respondent failed to comply with the mandatory notice provisions in section 38(8) of the Schedule.

The Tribunal found that the respondent either complied with the notice provisions or, where responses were late, the applicant failed to prove that any goods or services were incurred during the period of non-compliance.

The application was dismissed, and claims for interest and an award were denied.

In a personal injury trial arising from a motor vehicle accident, the defendant brought a mid-trial motion to preclude the plaintiff's accounting expert from testifying.

The expert calculated the plaintiff's loss of income based on hypothetical scenarios regarding her unreported tip income as a server.

The defendant argued the reports lacked objective data and were prejudicial.

The court dismissed the motion, finding the expert evidence met the Mohan criteria for admissibility and that the jury could be trusted to evaluate the factual assumptions underpinning the expert's calculations.

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) and the $3,500 limit had been exhausted.

The applicant argued for removal from the MIG due to a pre-existing back condition, chronic pain, and psychological impairments.

The Tribunal found the applicant failed to provide compelling evidence of a pre-existing condition precluding recovery within the MIG, largely due to non-compliance with production orders.

The Tribunal also preferred the respondent's in-person medical assessments over the applicant's virtual assessments, concluding the applicant did not suffer from chronic pain or a psychological impairment caused by the accident.

The application was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that dismissed his application for statutory accident benefits due to his non-attendance at the hearing.

The applicant sought reconsideration under Rule 18.2(c) of the Licence Appeal Tribunal Rules, 2023, submitting two new operative summaries.

The Tribunal dismissed the request, finding that the applicant failed to provide any submissions explaining how the new medical reports met the high threshold for reconsideration or would have affected the original decision.

The applicant was involved in a motor vehicle accident and received income replacement benefits (IRBs) from the respondent insurer.

The respondent subsequently sought repayment of $19,424.24, alleging the applicant wilfully misrepresented her employment status by failing to disclose her return to work and receipt of Employment Insurance benefits.

The Tribunal found that the applicant's failure to disclose this income constituted wilful misrepresentation.

Preferring the respondent's accounting report, the Tribunal concluded the applicant was overpaid and ordered her to repay $19,424.24 to the respondent.

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

A four-day videoconference hearing was scheduled, but the applicant failed to attend or provide a reason for his absence.

The adjudicator proceeded in the applicant's absence pursuant to section 7(1) of the Statutory Powers Procedure Act.

As the applicant presented no evidence to meet his burden of proof, the application for benefits was dismissed.

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

The Tribunal determined that the applicant was self-employed at the time of the accident, and therefore her pre-104 income replacement benefit (IRB) must be calculated based on her last completed taxation year, resulting in a nil entitlement.

The Tribunal awarded post-104 IRB at $185.00 per week for a brief period not paid by the respondent.

The Tribunal also awarded the cost of completing an OCF-19 and interest on an approved OCF-18 for chiropractic services, but denied a treatment plan for physical and massage therapy as the applicant failed to prove it was reasonable and necessary.

Claims for a special award and costs were dismissed.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision.

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

The Tribunal found the applicant's injuries fell outside the MIG because he sustained a concussion and a psychological impairment.

The Tribunal awarded the cost of a psychological assessment but denied the claims for physiotherapy, non-earner benefits, and attendant care benefits, finding the applicant did not meet the respective tests for entitlement.

Claims for a special award and costs were also dismissed.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident.

The respondent denied the benefit, arguing the applicant failed to provide requested financial and employment documents, including income tax returns and collateral benefits information, necessary to calculate potential deductions.

The Tribunal found that the applicant failed to comply with section 33(1) of the Schedule and a prior Tribunal order to produce these documents.

Consequently, the respondent was not liable to pay the IRB, and the application was dismissed.

The applicant sought accident benefits following a motor vehicle accident.

The respondent determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and partially denied a physiotherapy treatment plan because the $3,500 MIG limit had been exhausted.

The applicant argued for removal from the MIG on the basis of chronic pain with functional impairment.

The Tribunal found the medical evidence, including clinical notes and an insurer's examination, supported a diagnosis of soft-tissue injuries rather than accident-related chronic pain.

The applicant failed to demonstrate a functional impairment.

As the applicant remained within the MIG and the limit was exhausted, the claims for the treatment plan, interest, and an award were dismissed.