Maggie Morgan

The applicant sought payment for four chiropractic treatment plans following a motor vehicle accident.

The respondent denied the plans on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant failed to meet his burden of proof, noting that the treatment goals were identical across all plans, there was limited evidence of progress, and the treatment was not tailored to his predominantly minor physical injuries.

The Tribunal preferred the respondent's section 44 medical assessment and dismissed the application.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that awarded the applicant a non-earner benefit.

The insurer argued the Tribunal erred in law by awarding the benefit beyond the 104-week statutory maximum, misapplied the Heath test by not requiring quantitative evidence of the applicant's activities, and erred in fact by relying on the applicant's self-reports.

The Tribunal granted the reconsideration in part, amending the order to limit the non-earner benefit to 104 weeks after the accident.

The Tribunal dismissed the remaining grounds, finding no error in its qualitative application of the Heath test or its weighing of the evidentiary record.

The applicant sought statutory accident benefits for physiotherapy, acupuncture, and assistive devices following a 2015 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant was not entitled to reimbursement for physiotherapy expenses incurred before submitting a treatment plan.

For two subsequent treatment plans, the Tribunal approved shockwave therapy at a reduced rate but dismissed claims for acupuncture, orthotics, and other assistive devices, finding them not reasonable and necessary given the applicant's ongoing participation in a chronic pain program and lack of evidence supporting their efficacy.

The applicant's claim for costs was dismissed.

The applicant was injured in a rear-end motor vehicle collision and sought medical benefits for chiropractic and psychological treatment under the Statutory Accident Benefits Schedule.

The respondent insurer denied the treatment plans, arguing the applicant had reached maximum medical improvement and that his ongoing symptoms were related to extensive pre-existing degenerative conditions.

The Tribunal applied a two-step causation test and found the applicant failed to prove his current impairments were caused by the accident, preferring the insurer's medical examination evidence over the applicant's chiropractor.

The application for further benefits was dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including non-earner benefits (NEBs) and medical benefits for physiotherapy and a chronic pain assessment.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal found that the applicant suffered a complete inability to carry on a normal life due to severe psychological impairment resulting from the accident, which continuously prevented her from engaging in her pre-accident activities of caring for her children and pursuing her vocational goals.

The Tribunal awarded NEBs of $185.00 per week and interest.

However, the Tribunal dismissed the claims for physiotherapy and a chronic pain assessment, finding insufficient evidence that they were reasonable and necessary, as the applicant's impairment was fundamentally psychological rather than physical.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for chiropractic treatment.

The respondent insurer 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 compelling contemporaneous medical evidence, such as clinical notes and records, to support the need for the disputed chiropractic treatment.

The Tribunal preferred the evidence of the respondent's independent medical examiner, who concluded the applicant suffered uncomplicated soft-tissue injuries that had resolved.

The application was dismissed, and no interest was awarded.

The applicant sought entitlement to an income replacement benefit following a motor vehicle accident.

Prior to the accident, the applicant was unable to work due to severe bilateral knee osteoarthritis and was awaiting knee replacement surgery.

The applicant argued that the accident aggravated his condition and caused chronic pain syndrome, satisfying the 'but for' test for causation.

The Tribunal found that the applicant was already substantially unable to perform the essential tasks of his pre-accident employment prior to the accident due to his unresolved knee issues.

The application was dismissed, as the applicant failed to establish that his inability to work was caused by the accident.

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

The adjudicator found that the applicant's injuries fell outside the Minor Injury Guideline (MIG) due to pre-existing physical conditions and an exacerbation of psychological injuries, relying on the respondent's own Insurer's Examination reports.

However, the adjudicator dismissed the claims for various treatment plans, finding them not reasonable and necessary because they proposed block fees without specifying the provider or duration of modalities, contrary to the Professional Services Guideline.

Claims for the costs of disability certificates, interest, and costs of the proceeding were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits (IRBs) and treatment beyond the Minor Injury Guideline (MIG) limit due to chronic pain and psychological impairments.

The Licence Appeal Tribunal found that the applicant's physical injuries were predominantly soft tissue sprains and strains falling within the MIG.

The Tribunal gave little weight to the applicant's medical reports regarding chronic pain and psychological issues, preferring the respondent's independent medical examinations which found no objective evidence of ongoing impairment.

Consequently, the Tribunal held that the applicant did not suffer a substantial inability to perform the essential tasks of his pre-accident employment as a delivery truck driver.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought a medical benefit of $2,851.28 for chiropractic treatment.

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

The Tribunal found that the applicant's physical injuries were predominantly minor and that she failed to prove on a balance of probabilities that she suffered from a psychological impairment or chronic pain that would remove her from the MIG.

As the applicant was subject to the MIG limit, the claim for the treatment plan and interest was dismissed.

The applicant was involved in a motor vehicle accident and sought medical benefits from the respondent insurer.

The respondent argued that the applicant's injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 limit.

The applicant contended that pre-existing conditions and psychological impairments removed her from the MIG.

The adjudicator found that the applicant failed to provide compelling medical evidence that her pre-existing back pain would prevent maximal recovery under the MIG.

Furthermore, there was insufficient evidence of psychological impairments outside the MIG.

The application was dismissed as the injuries were predominantly minor.

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

The Licence Appeal Tribunal found that the applicant sustained predominantly minor injuries, as there was insufficient evidence to establish that his chronic pain was more than a sequelae of his soft tissue injuries.

The Tribunal dismissed the claims for income replacement benefits due to lack of evidence, and denied the claimed medical and rehabilitation benefits for chiropractic treatment, an orthopaedic assessment, and a chronic pain assessment, finding them not reasonable and necessary.

The application was dismissed in its entirety.

The defendants moved for summary judgment to dismiss the plaintiff's motor vehicle accident claim, arguing it was statute-barred by the Limitations Act, 2002.

The court dismissed the motion, finding that the defendants failed to meet their evidentiary burden to establish there was no serious issue requiring a trial regarding the discoverability of the claim, specifically whether the plaintiff's injuries met the "threshold" for non-pecuniary damages within the limitation period.

The court also found that the matter was not suitable for resolution using expanded summary judgment powers due to overlapping evidence with the merits of the claim.

The applicant sought a non-earner benefit following a motor vehicle accident, claiming a complete inability to carry on a normal life due to physical and psychological injuries.

The Licence Appeal Tribunal dismissed the application, finding the applicant's evidence lacked specificity and was contradicted by inconsistent self-reporting and surveillance evidence showing him jet skiing and lifting weights.

The Tribunal preferred the respondent's assessments, concluding the applicant failed to meet the stringent threshold for the benefit.

The applicant sought reconsideration of a Tribunal decision that found her injuries fell within the Minor Injury Guideline (MIG) and denied two treatment plans.

The applicant argued the adjudicator erred in fact and law by misweighing evidence regarding her psychological condition and failing to address the respondent's allegedly inadequate denial letter.

The Vice-Chair found no error in the adjudicator's weighing of the medical evidence.

While acknowledging a minor factual error regarding when the applicant first complained of psychological symptoms, the Vice-Chair concluded this did not affect the outcome as a diagnosis is required to remove an applicant from the MIG.

The reconsideration request was dismissed as an attempt to re-litigate the case.

The applicant sought statutory accident benefits for physiotherapy treatment and a functional abilities evaluation following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant had reached maximum medical recovery, as her self-reported pain had not improved with previous treatments.

The Tribunal also found that the applicant had returned to her pre-accident employment and was functional, rendering the functional abilities evaluation unnecessary.

The claims for medical benefits, cost of examination, an award, and interest were dismissed.

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

The respondent denied the claim because the disability certificate submitted by the applicant indicated she did not suffer a complete inability to carry on a normal life.

In a preliminary issue hearing, the Tribunal held that the applicant failed to submit a 'completed' disability certificate as required by section 36(2) of the Statutory Accident Benefits Schedule, because the certificate did not certify that she met the criterion for the benefit.

The application for non-earner benefits was dismissed.

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

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

The Tribunal found that the applicant's physical injuries were predominantly minor and that he did not suffer from chronic pain syndrome that would remove him from the MIG.

The application for benefits was dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The adjudicator found that the applicant failed to prove she suffered a substantial inability to perform the essential tasks of her employment, noting she returned to work post-accident and was terminated for performance issues.

The adjudicator preferred the respondent's insurer's examination reports, which concluded the applicant had no functional impairments preventing her from working.

The claims for IRBs, treatment plans, and assessments were dismissed.

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.