M. Aftab Alam

The appellant insurer appealed a Licence Appeal Tribunal reconsideration decision that upheld a finding that the respondent was catastrophically impaired and entitled to non-earner benefits following a motor vehicle accident.

The Divisional Court dismissed the appeal, finding that the appellant failed to identify any extricable error of law in the adjudicator's assessment of the medical evidence and whole person impairment ratings.

The Court also rejected the appellant's argument that the adjudicator lacked jurisdiction to hear the reconsideration request as a single member of the original two-member panel, noting that the Tribunal's rules permit such a procedure.

The respondent insurer requested a reconsideration of a Tribunal decision which found that the applicant sustained a catastrophic impairment and was entitled to a Non-Earner Benefit (NEB).

The respondent argued the Tribunal made significant errors of fact and law regarding the Whole Person Impairment (WPI) percentages assigned for medication use, sleep disorder, occipital neuralgia, and mental and behavioural disorders, as well as in applying the legal test for the NEB.

The Adjudicator found that while the Tribunal erred in assigning a 3% WPI for medication use, deducting this amount still left the applicant meeting the catastrophic impairment threshold.

The Adjudicator dismissed the remaining arguments, finding no significant errors of law or fact in the Tribunal's assessment of the medical evidence or its application of the Heath test for the NEB.

The request for reconsideration was dismissed.

The respondent insurer requested a reconsideration of a Tribunal decision that found the applicant's injuries fell outside the Minor Injury Guideline (MIG) and awarded various medical benefits and assessments.

The insurer argued the Tribunal failed to provide adequate reasons, ignored its independent medical examiners, and erred in law by relying on a chiropractor for a chronic pain diagnosis.

The adjudicator denied the request, finding the Tribunal provided adequate reasons, properly weighed the competing medical evidence, and did not require a formal chronic pain diagnosis to determine the injuries were not predominantly minor.

The respondent insurer requested a reconsideration of a Tribunal decision awarding the applicant the costs of a chronic pain assessment and a chiropractic functional impairment assessment following a motor vehicle accident.

The insurer argued the Tribunal erred in its causation analysis, its determination of what constitutes a valid medical reason for denying a treatment plan, and its finding that an assessment was for accident benefits rather than a tort claim.

The Adjudicator found that while the Tribunal erred in determining that 'insufficient documentation' was not a valid medical reason for denial, this error would not have changed the ultimate outcome.

The Adjudicator found no other significant errors of law or fact and dismissed the request for reconsideration.

The applicant, who was deemed catastrophically impaired following a motor vehicle accident, sought payment for four physiotherapy treatment plans.

The insurer denied the claims on the basis that the applicant had reached maximal medical recovery for his musculoskeletal injuries.

The adjudicator preferred the evidence of the insurer's medical examiners, finding that the applicant's pain complaints had a strong non-organic component and that further physiotherapy would not be beneficial.

The adjudicator also found that the insurer's notices of denial were sufficient.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought payment for five medical assessments under the Statutory Accident Benefits Schedule.

The insurer denied the assessments.

The Licence Appeal Tribunal found that the psychological, orthopaedic, and physiatry assessments were not reasonable and necessary.

However, the Tribunal ordered the insurer to pay for the chronic pain assessment, finding it reasonable and necessary to explore treatment options, and the functional impairment assessment, as the insurer failed to provide a proper medical reason for denial within the required timeframe.

The applicant was awarded interest on overdue payments but denied a special award under section 10 of Regulation 664.

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

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

The Licence Appeal Tribunal found that the applicant suffered from chronic pain, which removed him from the MIG.

The Tribunal approved the requested physiotherapy services and an impairment assessment as reasonable and necessary.

However, requests for an in-home assessment and a psychological assessment were denied due to insufficient evidence.

Claims for an award and costs were also dismissed.