Vicky Chan

The respondent insurer sought reconsideration of a decision finding the applicant entitled to post-104 income replacement benefits.

The insurer argued the adjudicator erred in law by applying the wrong legal test for suitable alternative employment based on Burtch v. Aviva.

The adjudicator dismissed the reconsideration request, finding that the correct disability test under s. 6(2)(b) of the Schedule was applied and that any alleged error regarding the comparability of alternative employment in status and reward would not have changed the result, as the applicant was functionally unable to work in the identified alternative occupations.

The applicant was injured in a motorcycle accident and sought post-104 income replacement benefits (IRBs) and an occupational therapy assessment.

The respondent insurer denied the benefits, arguing the applicant could work in alternative occupations.

The Tribunal found that the applicant, a 63-year-old self-employed hairdresser with significant physical, cognitive, and psychological impairments, suffered a complete inability to engage in suitable alternative employment.

The Tribunal awarded the IRBs and the cost of the occupational therapy assessment, along with interest.

The applicant's request for a special award under s. 10 of Regulation 664 and costs was dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for chiropractic services and a chronic pain assessment.

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

The applicant argued that a diagnosis of chronic pain warranted removal from the MIG.

The Tribunal found that the applicant failed to demonstrate that his chronic pain resulted in functional impairment or disability, noting a lack of medical evidence and a return to full-time work.

The Tribunal concluded the applicant remained within the MIG and dismissed the claims for medical and rehabilitation benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a functional cognitive test battery and a chronic pain assessment, which the respondent insurer denied.

The Licence Appeal Tribunal found that the applicant's pre-existing chronic pain was exacerbated by the accident, making the chronic pain assessment reasonable and necessary.

However, the Tribunal denied the functional cognitive test battery, finding no evidence of a cognitive deficit unrelated to the applicant's psychological impairments.

The Tribunal also denied the applicant's request for an award under Regulation 664, as the insurer's reliance on its independent medical examinations was not unreasonable.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of several treatment plans (OCF-18s) for chiropractic and psychological treatment.

The adjudicator found that the applicant failed to prove the treatment plans were reasonable and necessary.

Medical evidence, including records from the applicant's family physician and an insurer's examination, indicated the physical injuries had resolved.

For the psychological treatment, the adjudicator found the requested re-assessments and administrative costs were not justified by the evidence or the FSCO Professional Services Guideline.

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

The applicant sought statutory accident benefits for a $1,000 orthopaedic mattress following a motor vehicle accident.

The respondent denied the benefit, relying on an insurer's examination report which concluded the mattress was unlikely to assist in managing pain.

The Tribunal found the mattress to be reasonable and necessary, noting that multiple treating practitioners and assessors documented the applicant's ongoing sleep disturbances and fatigue.

The Tribunal afforded less weight to the respondent's expert, whose opinion was inconsistent with other medical evidence.

The applicant was awarded the cost of the mattress plus interest.

The applicant requested a reconsideration of a previous decision denying an award for the respondent's delayed payment of income replacement benefits.

The applicant argued the adjudicator erred in finding the delay was an administrative error and not imprudent conduct.

The adjudicator dismissed the request, finding no significant error of fact or law that would have led to a different result, and noted the applicant was attempting to relitigate arguments that failed at the original hearing.

The applicant sought accident benefits for psychological treatment.

The insurer partially approved the treatment plan, paying the psychotherapist rate of $99.75 per hour instead of the claimed psychologist rate of $149.61 per hour, leaving a balance of $598.32.

The Tribunal found that the provider was an unregulated psychotherapist without specialized training in cognitive behavioural therapy, and the treatment plan did not propose such therapy.

The Tribunal held that the insurer's approved rate was reasonable and dismissed the claim for the balance.

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

The respondent insurer determined the injuries fell within the Minor Injury Guideline (MIG) and refused to fund certain treatment plans.

The applicant argued that pre-existing back pain and sciatica from prior accidents precluded her recovery within the MIG.

The Tribunal found no compelling evidence that the pre-existing conditions prevented recovery, noting objective medical evidence and inconsistencies in the applicant's self-reporting to assessors.

The Tribunal concluded the applicant sustained minor injuries, was subject to the $3,500 funding limit, and dismissed the claims for additional treatment and assessments as the limit was exhausted.

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

The respondent denied treatment plans for chiropractic care and occupational therapy, and the applicant sought an award for unreasonable delay in paying income replacement benefits.

The Tribunal found the treatment plans reasonable and necessary, noting they were supported by the applicant's treating practitioners and consistent with the medical evidence, while rejecting the respondent's independent medical examinations as inconsistent.

The Tribunal awarded the treatment plans and interest but declined to order an award under Regulation 664, finding the respondent's two-month delay in paying the reinstated income replacement benefit was an error promptly corrected and did not constitute unreasonable conduct.

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 applicant argued for removal from the MIG based on pre-existing jaw pain, psychological issues, and chronic pain.

The Tribunal found insufficient medical evidence to support removal from the MIG, noting a lack of chronic pain diagnosis and preferring the respondent's psychological assessment which found symptom magnification.

As the MIG limits were exhausted, the claims for treatment plans and interest were dismissed.

The applicant was struck by a vehicle in a parking lot, sustaining crush injuries to her feet.

She sought $900 for chiropractic treatment to address low back and pelvic pain, which the respondent insurer denied on the basis that the pain was caused by pre-existing arthritis rather than the accident.

The Tribunal found that the applicant's altered gait from her foot injuries caused overcompensation resulting in low back pain, satisfying the 'but for' test for causation.

The Tribunal held the treatment was reasonable and necessary, ordering the respondent to pay the $900 plus interest, but denied the applicant's request for costs.