Matthew Owen

The applicant sought a death benefit of $16,250.00 following the death of his brother in a motor vehicle accident.

The applicant argued that due to his disability, he was principally dependent on his brother for financial support and care.

The Tribunal found that the applicant failed to provide sufficient evidence to establish dependency under s. 3(7)(b) of the Schedule.

The application for death benefits, interest, and an award was dismissed.

The applicant sought a death benefit of $16,250 following the death of her brother in a motor vehicle accident.

The insurer denied the claim on the basis that the applicant was not principally dependent on the deceased.

The Tribunal found that the applicant failed to provide sufficient evidence to establish financial or care dependency under s. 3(7)(b) of the Statutory Accident Benefits Schedule.

The application for death benefits, interest, and an award was dismissed.

The applicant sought a death benefit and reimbursement for interpretation services under the Statutory Accident Benefits Schedule following the death of his son in a motor vehicle accident.

The central issue was whether the applicant was 'principally dependent' on his son for financial support or care pursuant to s. 3(7)(b) of the Schedule.

The Tribunal found that the applicant failed to establish financial dependency, as the evidence indicated only 7% of the funds deposited into his account came from his son, and there was insufficient evidence regarding his financial needs or inability to support himself.

The Tribunal also found no evidence of dependency for care.

Consequently, the claims for death benefits, interpretation services, interest, and an award were dismissed.

The applicant sought a death benefit of $16,250.00 following the death of her son in a motor vehicle accident.

The respondent denied the benefit on the basis that the applicant was not principally dependent on the deceased for financial support or care.

The Tribunal found that the applicant failed to provide sufficient evidence, such as banking records or specific details of care, to establish dependency under the Statutory Accident Benefits Schedule.

The application for death benefits and an award for unreasonable delay was dismissed.

The applicant sought a non-earner benefit, medical benefits for chiropractic and psychological services, and an award under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Tribunal dismissed the application in its entirety.

Surveillance evidence and employment records demonstrated that the applicant had returned to full-time, physically demanding work as a personal support worker during the period he claimed a complete inability to carry on a normal life.

The requested treatment plans were found not to be reasonable and necessary, and no benefits were unreasonably withheld or delayed.

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

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

The Tribunal found that the applicant failed to prove chronic pain with functional impairment or a psychological impairment that would warrant removal from the MIG.

Because the applicant was subject to the MIG limit, the disputed treatment plans were not considered.

Claims for interest and an award under section 10 of Regulation 664 were also dismissed.

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

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

The Tribunal found that the medical evidence, including hospital records, family doctor notes, and an insurer's examination report, indicated the applicant sustained uncomplicated soft tissue injuries.

The Tribunal concluded the applicant's impairments were predominantly minor and subject to the $3,500 MIG limit.

As the MIG limit applied, the disputed treatment plans were not payable.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and funding for physiotherapy and a physiatry assessment.

The insurer had suspended IRBs due to the applicant's failure to attend section 44 examinations.

The Tribunal found that the applicant did not suffer a substantial inability to perform the essential tasks of her pre-accident employment, relying on functional abilities evaluations and the applicant's return to work as a cashier.

The Tribunal also dismissed the claim for physiotherapy as not reasonable and necessary, and declined to order a special award, finding the insurer did not unreasonably withhold benefits.

The insurer agreed to fund the physiatry assessment, and the Tribunal ordered interest on that overdue payment.

The applicant was injured in a motor vehicle accident and sought $4,520.00 for catastrophic impairment assessments, representing the denied portion of a treatment plan.

The respondent had approved $10,230.81 for the assessments but denied the $2,000.00 fee for each medical professional to conduct a clinical file review assessment, arguing it exceeded the $2,000.00 cap per assessment under section 25(5)(a) of the Schedule.

The Tribunal agreed with the respondent, finding that a file review is part of the assessment expense and is included within the $2,000.00 limit.

The application was dismissed, and no interest was awarded.

The applicant sought various medical and rehabilitation benefits following a motor vehicle accident.

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

The Tribunal found that the issue of the applicant's MIG status had already been decided in a previous hearing, and therefore the doctrine of issue estoppel applied.

The Tribunal rejected the applicant's argument that new medical reports constituted fresh evidence or that fairness required waiving issue estoppel, as the reports did not establish that her pre-existing osteoarthritis would prevent maximal recovery under the MIG.

The application was dismissed.

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

The Licence Appeal Tribunal found the applicant failed to provide compelling medical evidence to support removal from the MIG, noting her injuries were predominantly soft tissue in nature.

The Tribunal also dismissed the claim for Income Replacement Benefits (IRB), finding insufficient evidence that the applicant suffered a substantial inability to perform the essential tasks of her pre-accident employment.

As the applicant remained within the MIG, the disputed treatment plans were denied, along with claims for interest and an award.

The applicant sought statutory accident benefits for psychological injuries sustained after her husband suffered a medical incident (stroke and cardiac arrest) while driving, which resulted in a collision.

The respondent denied benefits on the basis that the applicant was not an 'insured person' under section 3(1) of the Schedule.

The Tribunal found that there was no medical evidence proving the applicant's husband sustained a physical injury as a result of the accident, as opposed to the medical incident itself.

Consequently, the applicant did not meet the definition of an insured person under section 3(1)(a)(ii) and the application was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claims for income replacement benefits and various medical and rehabilitation benefits following a motor vehicle accident.

The applicant argued the Tribunal made errors of fact and law in assessing her pre-104 week disability test.

The adjudicator dismissed the request, finding that the applicant was merely attempting to relitigate the original hearing by asking the Tribunal to re-evaluate the same evidence.

The adjudicator confirmed that the original decision properly weighed the evidence, including functional capacity assessments and medical reports, and found no significant legal or evidentiary mistake.

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

The respondent insurer argued the applicant was statute-barred under s. 55 of the Statutory Accident Benefits Schedule from disputing her catastrophic impairment designation because she failed to attend scheduled s. 44 insurer's examinations.

The Tribunal found that the respondent's notices of examination did not comply with the strict requirements of s. 44(5), as they lacked clear medical reasons and failed to specify the assessors' designations.

Consequently, the applicant was not prohibited from proceeding with her application.

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

The respondent insurer raised a preliminary issue that the applicant was barred from proceeding because she failed to cooperate during an insurer's examination.

The Tribunal found insufficient evidence of a deliberate failure to cooperate and allowed the application to proceed.

On the substantive issue, the Tribunal applied the Heath test and found a total lack of cogent evidence to support a finding that the applicant suffered a complete inability to carry on a normal life.

The application was dismissed.

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

The respondent denied a treatment plan for physiotherapy, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG due to pre-existing conditions, including osteoporosis and Cauda Equina syndrome, and because the respondent failed to provide proper medical reasons for its denial under section 38(8) of the Schedule.

The Tribunal found that the applicant failed to meet her evidentiary burden to prove her injuries or pre-existing conditions warranted removal from the MIG, noting her failure to properly reference evidence in her submissions.

The Tribunal also found the respondent's denial notice was valid.

The application was dismissed, and the applicant was not entitled to the claimed treatment, interest, or an award.

The applicant was injured in a motor vehicle accident and sought non-earner benefits.

The respondent denied the claim, leading to a preliminary issue hearing to determine whether the insurance policy was entered into or renewed before June 1, 2016, which would dictate the applicable version of the Statutory Accident Benefits Schedule.

The Tribunal found that the insurance contract was a new contract entered into on April 28, 2016, before the June 1, 2016 amendments.

Consequently, the pre-June 1, 2016 Schedule applied to the applicant's claim for non-earner benefits.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident.

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

The Licence Appeal Tribunal found that the applicant failed to provide compelling evidence that his injuries were outside the MIG, that his pre-existing osteoarthritis prevented maximal recovery, or that he suffered from chronic pain.

The disputed treatment plan for physiotherapy was deemed not reasonable and necessary.

The application was dismissed.

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

The respondent denied the benefits and requested insurer's examinations.

The Tribunal found that the applicant failed to establish the reasonableness and necessity of the disputed treatment plans, noting a lack of objective medical evidence and significant credibility issues with a pre-screen psychological assessment report that appeared to be copied from another patient.

The application was dismissed.

The Tribunal awarded $100 in costs to the respondent, finding that the applicant engaged in vexatious and bad faith conduct by misrepresenting evidence and submitting a questionable medical report.

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

The insurer denied certain benefits and requested the applicant attend insurer's examinations to determine ongoing entitlement to income replacement benefits.

The applicant refused to attend, arguing the insurer's reasons were boilerplate and insufficient.

The Tribunal found the insurer's reasons satisfied the notice requirements under section 44 of the Schedule, as they provided a principled rationale based fairly on the applicant's file.

Consequently, the applicant was statute-barred from proceeding with her application under section 55(1)2 of the Schedule, and the application was dismissed.