4 total
Application for statutory accident benefits dismissed as treatment plans were not proven reasonable and necessary.
The applicant was injured in a motor vehicle accident while skateboarding and sought statutory accident benefits for chiropractic services, assistive devices, and psychological services.
The respondent denied the treatment plans on the basis that they were not reasonable and necessary.
The Licence Appeal Tribunal found that the applicant failed to provide sufficient medical evidence to support the need for the proposed treatments, noting that independent medical examinations concluded the applicant had reached maximal medical recovery.
The Tribunal also found no evidence that the assistive devices expense was incurred, and that the applicant had impliedly consented to the hourly rate paid for psychological services.
The application was dismissed.
Accident benefits claim for medications allowed due to accident aggravation, but gym membership denied.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied claims for medication expenses and a facility-based exercise program, arguing the applicant's conditions were pre-existing.
The Tribunal found that the accident caused an aggravation of the applicant's pre-existing conditions.
The Tribunal allowed the claim for medication expenses, including medical marijuana, finding them reasonable and necessary.
However, the Tribunal dismissed the claim for the facility-based exercise program, accepting the respondent's insurer's examination report that the exercises could be done at home.
Unidentified motorist claim failed for lack of reliable evidence of another vehicle's involvement.
The insurer moved for summary judgment dismissing an action under unidentified motorist coverage arising from a highway collision with a guard rail.
The court held that the written record was sufficient to determine the material issues under Rule 20 and that there was no genuine issue requiring a trial.
The plaintiff's own accounts of the accident were internally inconsistent, the passenger provided no evidence, and the investigating officer observed no damage or evidence of contact on the tractor-trailer identified at the scene.
The court found the evidence equally consistent with the plaintiff having lost control through fatigue, speed, weather, and an unsafe lane change, and concluded the plaintiff failed to prove on a balance of probabilities that an unidentified driver was involved or at fault.
Summary judgment was granted dismissing the claim under the OAPI and OPCF-44R.
Insurer's motion to add income replacement benefits as an issue in arbitration dismissed as premature.
The insurer brought a motion for an order compelling the applicant to produce medical and financial documents, and to add the applicant's entitlement to ongoing income replacement benefits (IRBs) as an issue in the arbitration.
The applicant agreed to provide consents for the release of the requested medical documentation.
The arbitrator found that it was premature to add the IRB issue to the arbitration because the parties were still awaiting a Designated Assessment Centre (DAC) report, and it was unclear if there would continue to be a dispute over the IRB payments.
The issue of expenses for the motion was left to the discretion of the hearing arbitrator.
