Maggie Morgan

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

The respondent insurer denied funding for a psychological assessment and psychological services, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and its $3,500 limit.

The Licence Appeal Tribunal found that the applicant suffered a psychological impairment (including adjustment disorder and specific phobia) as a result of the accident, removing her from the MIG.

The Tribunal ordered the respondent to pay for the psychological services and a portion of the psychological assessment, noting the respondent failed to provide timely notice of its denial under s. 38(8) of the Schedule.

Interest on overdue payments was also awarded.

The applicant requested a reconsideration of a previous Tribunal decision which found his injuries fell within the Minor Injury Guideline (MIG) and denied his claim for an Income Replacement Benefit (IRB).

The applicant argued the Tribunal made significant errors of fact and law regarding his pre-existing conditions, psychological injuries, and inability to work, and sought to introduce new medical evidence.

The adjudicator dismissed the request, finding no significant errors in the original decision and concluding that the new evidence could have been obtained earlier and would not have changed the outcome.

The applicant was injured in a motor vehicle accident and sought medical benefits and income replacement benefits (IRB) from the respondent insurer.

The adjudicator found that the applicant's physical and psychological injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 funding limit, as the applicant failed to prove pre-existing conditions or psychological injuries that would exempt him.

Consequently, the disputed treatment plans were denied.

The adjudicator also dismissed the claim for IRB, finding the applicant did not provide sufficient medical evidence to prove a substantial inability to perform the essential tasks of his employment as a taxi driver.

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), limiting medical and rehabilitation benefits to $3,500.

The Tribunal found that the medical evidence, including clinical notes from the applicant's treating family physician and a disability certificate, supported that the injuries were minor in nature.

The applicant failed to provide objective medical evidence of chronic pain or other injuries outside the MIG.

As the $3,500 limit had been exhausted, the application for further medical benefits was dismissed.

The applicant sought statutory accident benefits for chiropractic and physiotherapy services following a motor vehicle accident.

The insurer denied the treatment plans based on its examination reports.

The Tribunal found that the applicant's contemporaneous medical records, including psychological assessments and family physician notes, demonstrated that the physical therapies were reasonable and necessary to address her accident-related impairments.

The Tribunal ordered the insurer to pay for the disputed treatment plans and interest on overdue payments, but denied the applicant's request for a special award under O. Reg. 664, finding no evidence of unreasonable conduct by the insurer.

The applicant sought statutory accident benefits for chiropractic services following a motor vehicle accident.

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

The applicant argued that a pre-existing left knee injury and a lip laceration took her out of the MIG, and that the respondent failed to provide sufficient reasons for denial within the required timelines under section 38 of the Schedule.

The Tribunal found that the respondent complied with section 38, the injuries were predominantly minor, and the applicant failed to establish that her pre-existing condition would prevent maximal recovery.

The treatment plan was deemed not reasonable and necessary, and the application was dismissed.

The insurer was entirely successful at the arbitration hearing regarding the applicant's claim for accident benefits.

The insurer subsequently sought its expenses for the arbitration.

The arbitrator considered the criteria under the Expense Regulation, noting the insurer's 100% success and an unaccepted Rule 76 offer to settle.

The arbitrator rejected the applicant's argument that his limited financial means due to incarceration should preclude an expense award, as ability to pay is not a listed criterion.

The arbitrator reduced the insurer's claimed legal fees and disbursements, awarding a total of $4,851.23 in expenses payable by the applicant.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision awarding the applicant income replacement benefits (IRBs).

The insurer argued the Tribunal made a significant error of fact regarding the start date of the applicant's post-accident employment, which precluded the insurer from deducting 70% of gross employment income under s. 7(3)(a) of the Statutory Accident Benefits Schedule.

The applicant argued the request should be summarily dismissed for failing to comply with Rule 18.1(b) notification requirements.

The Executive Chair declined to dismiss the request on procedural grounds, finding no prejudice to the applicant.

On the merits, the Executive Chair found the Tribunal made a significant error of fact by concluding the applicant started work in July 2015, despite irreconcilable medical evidence indicating she was working by June 2015.

The reconsideration was granted and a written rehearing was ordered to determine the employment start date and any resulting IRB deductions.

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

After his legal counsel was removed from the record, the applicant failed to attend the scheduled arbitration hearing or file any documentation.

The insurer brought an oral motion to dismiss the application.

The arbitrator dismissed the application for arbitration due to the applicant's failure to appear and awarded $2,000 in expenses to the insurer.

The applicant was injured in a motor vehicle accident and sought accident benefits, including non-earner benefits and medical benefits for physiotherapy and a psychological assessment.

The insurer denied the claims.

At arbitration, the arbitrator dismissed the claim for non-earner benefits because the applicant failed to submit a completed disability certificate within 104 weeks of the accident, statutorily barring the claim, and otherwise failed to provide sufficient evidence of entitlement.

The claims for medical benefits were also dismissed as the treatment plans were unsigned, not proven to be reasonable and necessary, and could not be causally linked to the subject accident due to an intervening second accident.