Lyrica Roche

The applicant sought statutory accident benefits following a motor vehicle accident, arguing that his injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain and psychological impairment.

The Tribunal found that the applicant failed to prove a psychological impairment, giving little weight to his psychological assessment as it was unsupported by contemporaneous clinical history or psychometric testing.

The Tribunal also found that the applicant did not meet the criteria for chronic pain syndrome under the AMA Guides.

Consequently, the applicant remained subject to the MIG, and his claims for treatment plans outside the MIG limit, as well as for interest and an award, were dismissed.

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

The respondent insurer denied portions of two physiotherapy treatment plans and a psychological treatment plan, and the applicant sought resolution at the Licence Appeal Tribunal.

The Tribunal admitted late-disclosed medical records, finding no actual prejudice to the respondent, and declined to draw an adverse inference from the applicant's refusal to undergo an MRI.

The Tribunal found the physiotherapy plans reasonable and necessary, noting the applicant had been removed from the Minor Injury Guideline and the treatments were supported by medical evidence.

However, the Tribunal denied the disputed psychological services, finding insufficient evidence that the preparation and planning items were not administrative costs already captured by the hourly rate.

The applicant's request for a special award was dismissed.

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

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

The Tribunal found that the applicant failed to provide medical evidence to establish that his injuries fell outside the MIG.

The Tribunal also rejected the applicant's procedural argument that the respondent's denial letter violated section 38(8) of the Schedule, finding the letter provided a sufficient medical reason by referencing the MIG.

The application was dismissed.

The applicant sought a non-earner benefit following a motor vehicle accident.

The insurer denied the benefit on the non-medical ground that the applicant may qualify for an income replacement benefit, as he had indicated he was working at the time of the accident.

The Tribunal, applying Varriano, held that the insurer was not required to provide medical reasons for denying the benefit when a valid non-medical reason existed.

The application for the non-earner benefit, along with claims for interest and an award under s. 10 of Reg. 664, was dismissed.

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

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

The applicant applied to the Licence Appeal Tribunal, arguing for removal from the MIG due to psychological impairments and chronic pain.

The Tribunal found that the applicant failed to provide sufficient medical evidence, such as a diagnosis from a treating physician or evidence satisfying the AMA Guides criteria for chronic pain, to warrant removal from the MIG.

Consequently, the disputed treatment plans, interest, and a claim for an award were dismissed.