Lisa Bishop

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and attendant care benefits from the respondent insurer.

The Tribunal determined the quantum of IRBs payable, finding that post-accident employment income and CPP disability benefits were deductible, and applied the age 65 adjustment formula.

The claim for attendant care benefits was dismissed as the applicant's limitations were found to be caused by pre-existing conditions and unrelated post-accident strokes rather than the accident.

The Tribunal awarded the applicant interest on outstanding IRBs and a 35% special award under O. Reg. 664, finding the respondent unreasonably delayed payment of IRBs after August 2018 despite having sufficient information to calculate the amounts owed.

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

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

The applicant argued that pre-existing shoulder injuries and headaches should remove him from the MIG.

The Tribunal found that the applicant failed to provide sufficient medical documentation to establish a pre-existing condition that would prevent him from achieving maximal medical recovery within the MIG.

As the applicant had already exhausted the $3,500 MIG limit, the claims for further physiotherapy and interest were dismissed.

The applicants claimed to have been injured in a motor vehicle accident and applied for statutory accident benefits.

The respondent insurer denied the claims, alleging the accident was staged and the applicants wilfully misrepresented material facts.

Following a preliminary issue hearing, the adjudicator found that the applicants failed to prove on a balance of probabilities that an accident occurred within the meaning of s. 3(1) of the Schedule.

The adjudicator drew an adverse inference from the failure of key witnesses to testify and noted numerous inconsistencies in the evidence.

Concluding that the accident was staged, the adjudicator ordered the applicants to repay the medical and non-earner benefits they had received, but declined to order repayment of the insurer's adjusting costs.

The applicant sought statutory accident benefits, including non-earner benefits and medical benefits for psychological services, following a minor rear-end motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove a complete inability to carry on a normal life.

The Tribunal preferred the respondent's independent medical examination reports over the applicant's expert reports, noting that the applicant's experts relied heavily on self-reporting which was contradicted by the applicant's own prior testimony and employment records indicating he was laid off due to a shortage of work rather than disability.

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

The insurer denied the claims on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal dismissed the application, finding that the applicant had not met the onus of proving the treatments and assessments were reasonable and necessary, noting the applicant had been discharged from a clinic due to being pain-free and lacked corroborating medical evidence for the psychological complaints.

Claims for interest and an award for unreasonable delay were also dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits for physiotherapy.

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

The Tribunal found that the applicant suffered an accident-related psychological impairment, removing her from the MIG.

The Tribunal further held that the proposed physiotherapy treatment plans were reasonable and necessary for her recovery, and awarded the disputed benefits along with interest.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits, attendant care benefits, and various treatment plans.

The Tribunal found that the insurer failed to properly deny the non-earner benefits and a psychological assessment treatment plan in accordance with the Statutory Accident Benefits Schedule, entitling the applicant to those benefits for the period of the insurer's non-compliance.

However, the applicant failed to prove a complete inability to carry on a normal life for the ongoing period.

The Tribunal also awarded a 25% penalty under O. Reg. 664 due to the insurer's unreasonable delay in adjusting the claim, particularly given the applicant's known vulnerability due to pre-existing schizophrenia.

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

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

The Tribunal found that the applicant's pre-existing psychological condition was exacerbated by the accident, removing her psychological impairments from the MIG and entitling her to a psychological assessment.

However, the applicant failed to prove her physical injuries were outside the MIG, so her claims for physiotherapy and an attendant care assessment were denied.

The claim for an award for unreasonable withholding of benefits was also dismissed.

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

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

The Tribunal found that the applicant's diagnosed psychological injury (Adjustment Disorder) removed them from the MIG, despite the applicant's reported disinterest in psychological treatment.

While the Tribunal approved the psychological assessment and treatment plans, it denied the physiotherapy, assistive devices, and chronic pain plans, finding them not reasonable and necessary based on the medical evidence.

The Tribunal also ordered the respondent to pay an award of $1,110.95 under O. Reg. 664 for unreasonably withholding the psychological benefits by misinterpreting the Schedule.

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

The insurer denied the claims on the basis that the applicant's injuries were predominantly minor and subject to the $3,500 funding limit under the Minor Injury Guideline (MIG).

The applicant argued that she sustained psychological injuries and chronic pain that removed her from the MIG.

The Tribunal found that the applicant's psychological evidence was refuted by the insurer's expert and contemporaneous medical records, and that she did not meet the criteria for chronic pain.

The Tribunal concluded that the applicant's injuries were predominantly minor, and therefore she was not entitled to the claimed medical benefits or interest.

The respondent insurer requested a reconsideration of a Tribunal decision that found the applicant entitled to treatment plans for a psychological assessment and psychological treatment, and ordered the respondent to pay interest.

The adjudicator dismissed the reconsideration request regarding the treatment plans, finding no significant error of fact or law.

However, the adjudicator granted the reconsideration regarding the calculation of interest, varying the decision to order interest payable 10 days from the submission of the treatment plan in accordance with the Schedule.

The applicant's request for costs was dismissed.

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

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

The Licence Appeal Tribunal found that the applicant's physical injuries were minor and had resolved, as evidenced by normal imaging and his return to work.

The Tribunal rejected the applicant's claim of chronic pain syndrome, finding he did not meet the AMA Guides criteria.

Claims for Income Replacement Benefits, attendant care, and various treatment plans were dismissed because the applicant failed to prove impairments beyond the MIG or an inability to work.

The Tribunal also dismissed claims for an award under O. Reg. 664, noting that technical deficiencies in the insurer's notices do not automatically entitle an applicant to benefits.

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

The insurer denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued her injuries were outside the MIG due to physical injuries, psychological distress, and pre-existing conditions.

The Tribunal found the physical injuries met the definition of minor injuries and that the applicant failed to provide compelling evidence of a psychological impairment or a pre-existing condition that would prevent maximal recovery within the MIG limit.

The application for attendant care benefits, medical benefits, cost of examinations, an award, and interest was dismissed.

The applicant sought statutory accident benefits for physiotherapy and a chronic pain assessment following a motor vehicle accident.

The insurer denied the treatment plans, citing a gap in treatment and an insurer's examination concluding the shoulder injury was not causally linked to the accident.

The Licence Appeal Tribunal found the treatment plans were reasonable and necessary, noting the applicant's ongoing pain and the lack of explanation from the insurer's assessor regarding causation.

The Tribunal ordered the insurer to pay for the physiotherapy and chronic pain assessment with interest, but denied the applicant's request for a bad faith award.

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

The insurer paid for treatment up to the $3,500 limit under the Minor Injury Guideline (MIG) but denied further funding for physiotherapy and a psychological assessment.

The Tribunal found that the applicant's injuries were predominantly minor and that there was no compelling evidence of a psychological injury to warrant removing the applicant from the MIG.

The claims for additional benefits, interest, a special award, and costs were dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found he sustained predominantly minor injuries and was subject to the Minor Injury Guideline.

The applicant argued the Tribunal failed to address his argument regarding the insurer's non-compliance with notice requirements under s. 38(8) of the Statutory Accident Benefits Schedule.

The Associate Chair allowed the reconsideration request, finding that the Tribunal's failure to address the live and consequential issue of the sufficiency of the insurer's notices amounted to a denial of natural justice and procedural fairness.

The matter was ordered to be reheard in writing by a different adjudicator.

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

The insurer brought a motion to bar the application on the basis that the applicant failed to attend nine scheduled insurer's examinations.

The Tribunal found that the applicant failed to attend the examinations without a reasonable explanation and that the insurer provided adequate notice.

The Tribunal declined to exercise its discretion to permit the application to proceed.

The insurer's request for reimbursement of cancellation fees was dismissed for lack of jurisdiction, and its request for costs was denied.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's denial of treatment plans for psychological services and a psychological assessment.

The Tribunal found the psychological services reasonable and necessary to assist with pain management and driving anxiety.

The Tribunal also approved the cost of the psychological assessment, rejecting the insurer's argument that the fee was unreasonable for lacking an hourly breakdown, as it fell within the Schedule limit.

The Tribunal awarded interest on the overdue benefits, noting inconsistencies in the insurer's medical examinations, but denied the applicant's request for a special award under O. Reg. 664, finding no evidence that the insurer unreasonably withheld or delayed payments.

The applicant was injured in a motor vehicle accident and sought various medical, rehabilitation, and attendant care benefits.

The respondent insurer denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The Licence Appeal Tribunal found that the applicant's physical and psychological injuries were predominantly minor and did not warrant removal from the MIG.

As the $3,500 limit was exhausted, the claims for benefits, interest, a special award, and costs were dismissed.

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

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

The applicant argued that pre-existing migraines and wrist pain, as well as psychological impairments, removed him from the MIG.

The Tribunal found that the applicant failed to provide compelling evidence that his pre-existing conditions would prevent maximal recovery under the MIG limits.

Furthermore, the applicant was precluded from relying on his psychological assessment to escape the MIG because he failed to attend the scheduled section 44 insurer's examinations.

The application for medical benefits, interest, and a special award was dismissed.