Lisa Bishop

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming a substantial inability to perform the essential tasks of her employment as a personal support worker.

The respondent denied the IRBs and sought repayment for an alleged overpayment.

The Tribunal found that the applicant failed to prove a substantial inability to work, as the medical evidence indicated she was engaging in modified work duties and failed to delineate her essential tasks.

The Tribunal also dismissed the respondent's claim for repayment, finding insufficient evidence to prove the overpayment was actually advanced and received.

Both the applicant's claim and the respondent's claim for repayment were dismissed.

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

The central issue was whether the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant's medical experts opined that he suffered from chronic pain and psychological impairments outside the MIG.

However, the adjudicator preferred the insurer's medical examination and the applicant's own statements, which confirmed he was working full-time, attending school, and maintaining his social life.

The adjudicator concluded the injuries were predominantly minor and dismissed the application for benefits beyond the MIG cap, as well as claims for interest and a special award.

The applicant insurer sought judicial review of a FSCO Director's Delegate decision that allowed an insured's appeal in part regarding statutory accident benefits.

The insurer had denied claims for an in-home assessment and form preparation, alleging the clinics were engaged in a fraudulent scheme.

The Divisional Court held that the Director's Delegate exceeded his jurisdiction by interfering with the Arbitrator's findings of fact regarding the in-home assessment, as appeals are limited to questions of law.

However, the court upheld the decision requiring the insurer to pay for form preparation because the insurer failed to object to the application within the statutory timeframe.

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

The respondent insurer brought a preliminary motion to bar the application because the applicant failed to attend independent medical examinations (IEs) under s. 44 of the Schedule and failed to provide requested information under s. 33.

The Tribunal found the applicant was barred from proceeding with his appeal for medical benefits and examination costs due to his unexcused failure to attend the IEs.

However, the insurer was liable to pay non-earner benefits for a specific period due to its failure to provide proper notice of election of benefits, though it could withhold payments for the subsequent period of the applicant's non-compliance with s. 33.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit and various medical and rehabilitation benefits.

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

The Tribunal found that the applicant's physical injuries were predominantly minor and that he failed to establish a psychological impairment or chronic pain condition that would remove him from the MIG.

The Tribunal preferred the respondent's psychological assessment over the applicant's, noting the latter omitted a significant life event.

The Tribunal also found the applicant failed to prove he missed work as a result of the accident, dismissing the claim for an income replacement benefit.

The application was dismissed in its entirety.

The applicant was involved in a motor vehicle accident and sought medical benefits for physiotherapy, massage therapy, and a psychological assessment.

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

The Tribunal found that the applicant's injuries were predominantly minor and that she failed to establish a pre-existing medical condition that would prevent maximal recovery under the Guideline.

The application for benefits and an award for unreasonable delay was dismissed.

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

The respondent denied funding for attendant care benefits and various treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's injuries, particularly chronic pain, removed him from the MIG.

The Tribunal partially approved the treatment plans for physical therapy and assistive devices, and approved the cost of a chronic pain assessment.

However, claims for attendant care benefits, psychological treatment, psychological assessment, and a special award were dismissed.

Interest was awarded on overdue payments.

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 and requested the applicant attend two insurer's examinations under section 44 of the Schedule to assess further treatment plans.

The applicant failed to attend the examinations, arguing the notices were improper and not scheduled at convenient times.

The Licence Appeal Tribunal found the notices complied with the Schedule and the insurer was not required to provide multiple dates for the applicant to choose from.

Consequently, the applicant was barred from proceeding with the application under section 55.

Both parties' requests for costs were denied.

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

The respondent insurer argued the applicant was precluded from proceeding before the Licence Appeal Tribunal under section 55 of the Statutory Accident Benefits Schedule for allegedly failing to attend insurer examinations under section 44.

The adjudicator found insufficient evidence that the respondent made reasonable efforts to schedule convenient appointments or that the applicant refused to attend relevant examinations.

The applicant was permitted to proceed with the application.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits, attendant care benefits, and various medical benefits.

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 establish entitlement to income replacement benefits, as he returned to work full-time and his business suffered no economic loss.

Furthermore, the Tribunal concluded that the applicant's physical injuries were predominantly minor and that he failed to prove on a balance of probabilities that he suffered from psychological impairments, chronic pain syndrome, or post-concussion syndrome that would remove him from the MIG.

Consequently, the application for benefits was denied.

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 found that the applicant, who was self-employed in a physically demanding construction job, suffered a substantial inability to perform the essential tasks of his employment, relying on the respondent's own physiotherapist's assessment.

The Tribunal awarded IRBs at $400.00 per week and attendant care benefits based on the Form 1 hourly rate, along with interest on overdue payments.

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

After failing to attend a pre-hearing and numerous assessments, the arbitrator ordered the applicant to attend an in-home assessment.

The applicant failed to do so and ignored subsequent production requests and notices of resumption of the pre-hearing.

The arbitrator issued a notice of intention to dismiss the proceeding.

The applicant's counsel confirmed they had no response.

The arbitrator dismissed the proceeding without a hearing under Rule 68.1 of the Dispute Resolution Practice Code, finding it frivolous, vexatious, or commenced in bad faith due to the applicant's failure to pursue the claim.

The Applicant applied for statutory accident benefits following a motor vehicle accident.

After failing to attend a pre-hearing and numerous assessments, the insurer requested the case be dismissed.

The Arbitrator issued a notice of intention to dismiss the proceeding under Rule 68.1 of the Dispute Resolution Practice Code.

The Applicant failed to respond or engage meaningfully in the arbitration.

Consequently, the Arbitrator dismissed the proceeding without a hearing, finding it to be frivolous, vexatious, or commenced in bad faith.

The applicant sought payment for a $2,000 chronic pain assessment following a motor vehicle accident.

The respondent denied the claim, arguing the applicant's injuries fell within the Minor Injury Guideline.

The applicant challenged the sufficiency of the respondent's denial notices under s. 38 of the Statutory Accident Benefits Schedule.

The Tribunal found that the respondent's explanations of benefits complied with s. 38.

On the merits, the Tribunal held that the applicant failed to prove the chronic pain assessment was reasonable and necessary, noting evidence of steady improvement, return to pre-accident activities, and failure to pursue approved treatments.

The application was dismissed, with no interest or costs awarded.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, which were denied by the respondent.

The applicant filed an application with the Licence Appeal Tribunal but withdrew it at a Case Conference after the respondent raised her failure to attend an Insurer's Examination.

Hours later, the applicant filed a second application for the same issue.

She subsequently failed to attend a rescheduled Insurer's Examination and withdrew the second application at another Case Conference.

The respondent sought costs.

The Tribunal found the applicant's conduct in filing the second application to be frivolous, vexatious, and unreasonable, constituting an abuse of process.

The respondent was awarded $500 in costs.

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

The respondent insurer denied the treatment plans on the basis that the injuries fell within the Minor Injury Guideline and required the applicant to attend insurer's examinations (IEs).

The applicant failed to attend multiple scheduled IEs over a nine-month period, later claiming the notices were non-compliant with the Schedule.

The Tribunal found that the respondent's notices were sufficient and compliant, as they clearly stated the medical and other reasons for the IEs.

Consequently, the applicant was found to be in non-compliance with section 44 of the Schedule.

Pursuant to section 55, the application was dismissed and the Tribunal file closed.

The respondent's request for costs was denied.

The applicant sought payment for various medical and assessment benefits following a motor vehicle accident.

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

The Tribunal found that the applicant's injuries were soft tissue in nature and fell within the MIG.

The Tribunal preferred the evidence of the insurer's examiners over the applicant's assessors, noting the former reviewed comprehensive medical records.

Furthermore, the applicant failed to provide compelling evidence of a pre-existing medical condition that would warrant an exception to the MIG cap.

The application was dismissed.