Selina Ferenac

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

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

The applicant applied to the Licence Appeal Tribunal, arguing she should be removed from the MIG due to chronic pain syndrome and a mild traumatic brain injury.

The Tribunal found that the applicant's expert medical evidence was not corroborated by the clinical notes and records of her family physician.

The Tribunal concluded the applicant did not meet her burden to prove her injuries warranted removal from the MIG, and dismissed the application.

The defendant insurer brought a motion to dismiss the plaintiff's claim regarding a stolen vehicle as statute-barred.

The plaintiff's vehicle was allegedly stolen in October 2023, and the insurer denied coverage in December 2023, advising of the one-year limitation period.

The plaintiff did not commence the action until May 2025.

The court found the action was commenced beyond the one-year limitation period prescribed by the Insurance Act and dismissed the claim under Rule 12.02(1).

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

The respondent insurer denied treatment plans for physiotherapy, a chronic pain assessment, and a neurological assessment.

The respondent also raised a preliminary issue that the applicant was barred from proceeding with the chronic pain assessment claim due to non-attendance at an insurer's examination.

The Tribunal found the insurer's request for the examination was not reasonably necessary due to its timing, over a year after the denial.

On the substantive issues, the Tribunal found the insurer's denial notices were deficient under s. 38(8) of the Schedule, making the physiotherapy and chronic pain assessments payable.

The Tribunal also found the neurological assessment was reasonable and necessary based on the medical evidence.

All disputed benefits were awarded with interest.

The respondent insurer requested reconsideration of a Licence Appeal Tribunal decision that granted the applicant a 15% special award on dental services, chiropractic services, and prescription eyeglasses.

The Vice-Chair found the adjudicator committed a material breach of procedural fairness by failing to provide sufficient reasons for granting an award on the chiropractic services and eyeglasses.

However, the Vice-Chair upheld the award for the dental services, finding the adjudicator provided adequate reasons based on the insurer's unexplained eight-month delay in payment.

The reconsideration was granted in part, and the decision was varied to limit the 15% award solely to the dental services.