Ryland MacDonald

The applicant sought statutory accident benefits after being struck in the head by an industrial ceiling fan while standing on the roof of a trailer to perform routine maintenance.

The respondent denied the claim on the basis that the incident was not an 'accident' under s. 3(1) of the Schedule.

The Tribunal applied the two-part purpose and causation test.

While the purpose test was met, the causation test failed because the ceiling fan was an intervening act that broke the chain of causation and was not a normal risk associated with maintaining a trailer.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits, various medical and rehabilitation assessments, and reimbursement for damaged items.

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal found the applicant failed to prove a substantial inability to perform the essential tasks of his employment for the pre-104 week period, and failed to provide requested documentation for the post-104 week period.

The Tribunal also found the applicant failed to prove the disputed treatment plans and assessments were reasonable and necessary, as they were either duplicative, unsupported by medical evidence, or previously approved.

The applicant passed away prior to the commencement of an application for statutory accident benefits.

The application was commenced by counsel without an estate trustee having been appointed.

The Licence Appeal Tribunal found that the application was not properly constituted and was an irremediable nullity, as a deceased person cannot pursue accident benefits and no lawfully authorized representative was appointed.

The application was dismissed as an abuse of process, and the respondent's request for costs was denied.

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

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

The Tribunal found that the applicant suffered from chronic pain with functional impairment, supported by ongoing treatments and specialist assessments, warranting removal from the MIG.

The Tribunal approved the treatment plan for a chronic pain assessment but denied the claims for an attendant care assessment and chiropractic services, finding them not reasonable and necessary.

Interest was awarded on the approved chronic pain assessment.

The applicant sought accident benefits following a motor vehicle accident, claiming her injuries fell outside the Minor Injury Guideline (MIG) due to chronic lower back pain resulting from accident-related weight gain.

The applicant also sought non-earner benefits, arguing she was unable to return to her pre-accident work as a Personal Support Worker.

The Tribunal found the applicant failed to prove her injuries fell outside the MIG, noting her weight gain was not demonstrably caused by functional limitations from the accident.

The Tribunal also dismissed the claim for non-earner benefits, finding the applicant's current duties as a foster parent were inconsistent with a complete inability to carry on a normal life.

As the MIG limits were exhausted, the disputed treatment plans were denied.

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

The respondent denied the claims for physiotherapy and massage therapy on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's concussion diagnosis took him out of the MIG.

Furthermore, the Tribunal held that the respondent failed to provide proper medical reasons for denying the treatment plans under s. 38(8) of the Schedule.

As a result, the respondent was ordered to pay for the incurred expenses from the 11th business day after receiving the plans until a proper denial is provided, excluding a period of non-compliance with a s. 33 request.

The claims for the treatment plans being reasonable and necessary on their merits were dismissed, as was the claim for a special award.

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

The respondent denied funding for chiropractic treatment and a psychological assessment on the basis that the applicant's injuries fell within the Minor Injury Guidelines (MIG).

The applicant argued he suffered from chronic pain and psychological injuries warranting removal from the MIG.

The Tribunal found the applicant did not meet the criteria for chronic pain under the AMA Guides and lacked compelling evidence of a psychological impairment.

The application was dismissed, and the applicant was held to the $3,500 MIG funding limit.

The applicant sought a catastrophic impairment (CAT) designation following a 2011 motor vehicle accident.

The applicant claimed a marked impairment in multiple domains due to mental and behavioural disorders.

The Tribunal found that the applicant's impairments largely pre-dated the accident, stemming from a 2007 workplace injury and subsequent incidents.

The Tribunal concluded that the accident only mildly exacerbated the pre-existing conditions and did not significantly impede useful functioning.

The application for CAT designation was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's denial of six treatment plans for physiotherapy, assistive devices, and a chronic pain assessment.

The Tribunal excluded the applicant's late-disclosed clinical notes and records due to prejudice to the respondent.

On the merits, the Tribunal found the applicant failed to demonstrate that the treatment plans were reasonable and necessary, noting a lack of supporting objective medical evidence and physician recommendations.

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

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 he should be removed from the MIG due to psychological impairments and chronic pain.

The Tribunal preferred the respondent's psychological assessment, finding no psychological impairment, and concluded the applicant did not meet the AMA Guides criteria for chronic pain.

The application was dismissed, and the applicant was found to be subject to the MIG funding limits.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and several physiotherapy treatment plans.

The matter proceeded to a written hearing.

The applicant failed to file any submissions or evidence by the deadlines set in a case conference report and a subsequent motion order.

Due to the applicant's failure to meet her evidentiary burden, the Licence Appeal Tribunal dismissed the application in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her injuries warranted treatment outside the Minor Injury Guideline (MIG) due to chronic pain, psychological issues, and exacerbation of a pre-existing condition.

The insurer denied the disputed treatment plans, arguing the injuries were predominantly minor.

The Tribunal found the applicant failed to meet her burden of proving her injuries fell outside the MIG, preferring the insurer's medical examination reports over the applicant's unsupported treatment plans.

As the $3,500 MIG limit had been exhausted, the application for the disputed treatment plans and interest was dismissed.

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

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

The Tribunal found that the applicant failed to demonstrate that her post-accident diagnosis of dural AV fistula, alleged psychological condition, or pre-existing conditions warranted removal from the MIG.

Furthermore, the Tribunal held that the applicant was not entitled to a non-earner benefit, as she had resumed most of her normal activities of daily living and did not suffer a complete inability to carry on a normal life.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits for chiropractic treatment, an orthopaedic assessment, and a psychological assessment.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the monetary limits had been exhausted.

The Tribunal found that the applicant failed to prove that his pre-existing shoulder injury, left knee injury, or alleged psychological condition warranted removal from the MIG.

As the MIG limits were exhausted, the claims for treatment and assessments were dismissed, along with the claim for interest.

The applicant sought non-earner benefits and medical benefits for physiotherapy following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to meet her onus to demonstrate a complete inability to carry on a normal life, as she provided no pre-accident documentation to compare with her post-accident abilities.

The Tribunal also determined that the applicant's injuries were predominantly minor sprains and strains, subject to the Minor Injury Guideline limit, and dismissed the claims for treatment plans as they were not submitted for the hearing.

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

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

The Tribunal found that the applicant failed to establish that his injuries warranted removal from the MIG, noting a lack of evidence of chronic pain syndrome or functional impairment.

As the MIG limits were exhausted, the disputed treatment plans were not payable and the application was dismissed.

The applicant sought accident benefits following a motor vehicle accident.

The respondent denied a $2,200 psychological assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's injuries, which included a torn meniscus and an exacerbation of pre-existing persistent depressive disorder, were not predominantly minor.

The Tribunal also found that the applicant's pre-existing psychological condition would prevent maximal recovery if subject to the MIG.

The Tribunal ordered the respondent to pay for the psychological assessment and interest on the overdue amount.

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

The insurer denied the treatment plan, arguing it was unsigned and not reasonable or necessary.

The Tribunal found that the insurer failed to raise the signature issue in a timely manner and that the applicant subsequently provided a signed copy.

Furthermore, the insurer's denial notices failed to provide sufficient medical reasons as required by s. 38(8) of the Schedule.

Consequently, under s. 38(11), the treatment plan became payable starting on the 11th business day after receipt, along with interest.

The applicant sought statutory accident benefits after being shot in the hand by her husband while sitting on a stopped ATV during a hunting trip.

The respondent insurer denied the claim on the basis that the incident did not meet the definition of an 'accident' under the Statutory Accident Benefits Schedule.

The Tribunal held a preliminary issue hearing and found that while the purpose test was met, the causation test was not.

The shooting was an intervening act that broke the chain of causation, and the use or operation of the ATV did not directly cause the applicant's impairment.

The application was dismissed.

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

The respondent denied medical benefits, attendant care, and the cost of a psychological assessment 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 psychological impairments, chronic pain, and a pre-existing shoulder injury.

The Tribunal found that the applicant failed to provide compelling medical evidence to support her removal from the MIG.

Furthermore, the Tribunal concluded that the disputed treatment plans and assessment were not reasonable and necessary, and dismissed the claim for attendant care benefits due to a lack of evidence.