Meghan Fyall

The applicant requested reconsideration of a Licence Appeal Tribunal decision regarding statutory accident benefits.

The applicant argued the Tribunal erred by failing to award interest for the pre-application period under s. 51(3) of the Schedule and by failing to award interest on the s. 10 special award itself.

The Vice-Chair dismissed the first ground, finding no evidence that the benefits were incurred and therefore overdue.

However, the Vice-Chair granted the second ground, holding that s. 10 of O. Reg. 664 mandates the inclusion of interest on the award amount.

The original decision was varied to include interest payable under s. 10.

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

The respondent denied several treatment plans, prompting the applicant to apply to the Licence Appeal Tribunal.

The Tribunal found the applicant was statute-barred from pursuing one occupational therapy treatment plan because she failed to attend a properly scheduled insurer's examination without a reasonable explanation.

However, the Tribunal ordered the respondent to pay for a driving assessment and a dietician assessment because the respondent failed to provide proper notice of denial under s. 38(8) of the Schedule.

Another occupational therapy plan was partially approved based on medical evidence supporting the need for cognitive and psycho-emotional support.

The claim for an award for unreasonable delay was dismissed.

The applicant sought a non-earner benefit and a treatment plan for chiropractic services following a motor vehicle accident.

The Tribunal found the applicant was statute-barred from proceeding with the claim for a non-earner benefit because he failed to attend reasonably necessary insurer examinations without a reasonable explanation, and the insurer's notice of examination was compliant with s. 44 of the Schedule.

The Tribunal also dismissed the claim for the treatment plan, finding the applicant failed to prove it was reasonable and necessary, and that the insurer had provided a valid denial notice under s. 38(8).

Claims for interest and an award were dismissed.

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

The respondent insurer denied treatment plans and attendant care benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

Following a case conference, the respondent removed the applicant from the MIG due to a technical failure to respond to a treatment plan within the required time under s. 38(8) of the Schedule, and subsequently approved the disputed benefits.

The Tribunal found that the respondent unreasonably delayed removing the applicant from the MIG and approving the benefits even after discovering the technicality.

The Tribunal ordered the respondent to pay a special award of 15% of the approved benefits under s. 10 of Reg. 664, totaling $13,019.34, and to pay interest on the overdue benefits pursuant to s. 51(4) of the Schedule.

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

The Tribunal found that the issue of whether the applicant's injuries fell outside the Minor Injury Guideline (MIG) was not properly before it, as it was omitted from the Case Conference Report and Order.

The Tribunal held that the respondent's denial notices for three chiropractic treatment plans complied with s. 38(8) of the Schedule.

However, the denial notice for a chronic pain assessment and a psychological assessment was deficient under s. 38(8) because it failed to provide clear reasons or specify the treatments being denied.

Consequently, the respondent was ordered to pay for the assessments pursuant to s. 38(11).

The claim for an award was dismissed.

The applicant requested a reconsideration of a previous Tribunal decision that barred her from proceeding to a hearing on several treatment plans due to her failure to attend an insurer's examination.

The applicant argued that the Tribunal made errors of law and fact, and that new evidence—specifically her subsequent removal from the Minor Injury Guideline—should alter the outcome.

The Tribunal dismissed the reconsideration request, finding no errors of law or fact in its previous determinations regarding the validity of the notices of examination and denial letters at the time they were issued.

The Tribunal also found that the new evidence did not meet the criteria for reconsideration.

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

The respondent raised a preliminary issue arguing the applicant was barred from proceeding to a hearing because he failed to attend scheduled insurer's examinations (IEs) under s. 44 of the Schedule.

The Tribunal found the respondent's notices of examination were compliant and the requested IEs were reasonably necessary.

Consequently, the applicant was statute-barred from proceeding with four specific treatment plans.

However, the Tribunal exercised its discretion under s. 55(2) to allow the applicant to proceed with the remaining substantive issues, including attendant care benefits and occupational therapy, because the respondent failed to prove it had provided denial notices for those benefits prior to requesting the IEs.

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

The respondent denied several treatment plans and attendant care benefits.

The Tribunal found that the applicant was barred from proceeding with claims for three treatment plans because she failed to attend scheduled insurer's examinations without a reasonable explanation.

The Tribunal also dismissed the claim for a functional cognitive assessment, finding the respondent's denial notice complied with the Schedule.

The claim for attendant care benefits was dismissed for lack of evidence and failure to attend examinations.

Interest was awarded on previously resolved treatment plans, but the claim for an award for unreasonable delay was dismissed.

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

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

The Tribunal found that the applicant sustained a head injury, removing him from the MIG.

The Tribunal further held that several treatment plans were payable because the respondent failed to provide compliant denial notices under s. 38(8) of the Schedule, and others were substantively reasonable and necessary.

Claims for attendant care benefits and a special award were dismissed.

The appellant appealed a Licence Appeal Tribunal decision dismissing her claim for statutory accident benefits due to a two-year delay in notifying her insurer.

The appellant argued the Tribunal erred in law by dismissing the claim under s. 55(1)1 of the Statutory Accident Benefits Schedule, asserting that s. 32(10) provided the insurer's exclusive remedy of extra time to respond.

The Divisional Court dismissed the appeal, holding that s. 32(10) does not preclude the dismissal of a claim under s. 55(1)1 where the claimant fails to provide a reasonable explanation for the delay.

The applicant sought reconsideration of a decision finding her claim for statutory accident benefits was statute-barred due to a 27-month delay in notifying the insurer.

The applicant argued the Tribunal erred by failing to apply the rule of discoverability.

The Adjudicator dismissed the request, finding no error of law or fact, as the applicant had not raised the discoverability argument at the initial hearing and, regardless, failed to provide a reasonable explanation for the delay under section 34 of the Schedule.

The applicant applied for statutory accident benefits claiming psychological impairments resulting from her son's motor vehicle accident.

The application was submitted more than two years after the accident.

The respondent raised a preliminary issue regarding the applicant's failure to notify it of her intention to apply within the 7-day time limit prescribed by section 32(1) of the Schedule.

The Tribunal found that the applicant failed to comply with the time limit and did not provide a reasonable explanation for the delay under section 34.

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