Melanie A. Sousa

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

The matter proceeded to a written hearing, but the applicant failed to file any submissions or participate after his legal counsel withdrew.

The Tribunal proceeded in the applicant's absence pursuant to section 7(2) of the Statutory Powers Procedure Act.

The application was dismissed because the applicant failed to meet his evidentiary burden to demonstrate entitlement to the claimed benefits.

Aviva General Insurance applied to the Licence Appeal Tribunal for repayment of income replacement benefits (IRBs) paid to the respondent following a motor vehicle accident.

Aviva alleged the respondent misrepresented his employment status by returning to work as a truck driver without notifying the insurer.

The adjudicator found that the respondent had indeed returned to work and misrepresented his status, disentitling him to the IRBs.

However, because Aviva's unequivocal notice of repayment only specified $8,800.00, the adjudicator limited the repayment order to that amount, rather than the $18,000.00 sought.

The respondent was also ordered to pay $250.00 in costs for unreasonable conduct during the proceeding.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision.

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

The applicant contended that pre-existing psychological conditions and insomnia warranted removal from the MIG.

The Tribunal found that the applicant's physical injuries were minor and that he failed to establish on a balance of probabilities that his pre-existing conditions prevented maximal recovery within the MIG limits.

Furthermore, the Tribunal applied the 'but for' test and concluded the accident was not a necessary cause of the applicant's psychological issues.

The application was dismissed, and claims for a psychological assessment, chiropractic services, an award, and interest were denied.

The applicant sought $12,580.00 for a multidisciplinary chronic pain program following a 2015 motor vehicle accident.

The respondent denied the treatment plan, arguing the applicant's current pain complaints were not accident-related and she had reached maximum medical recovery.

The Tribunal found the proposed program lacked specificity and the applicant failed to prove it was reasonable and necessary.

The Tribunal also noted inconsistencies in the applicant's reporting of her injuries and preferred the respondent's medical evidence, which concluded the applicant had achieved maximum medical improvement.

The application was dismissed.

The applicant sought medical benefits for two physiotherapy treatment plans following a motor vehicle accident.

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

The Tribunal found that the first treatment plan was duplicative and the proposing clinic no longer existed.

For the second treatment plan, the Tribunal found a lack of medical evidence supporting the need for treatment and that the applicant failed to establish causation, noting a more serious prior accident.

The application was dismissed and no interest was payable.

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

The respondent denied treatment plans for medical cannabis and chiropractic treatment, and requested insurer examinations under s. 44 of the Schedule.

The applicant failed to attend the examinations.

The Tribunal held that the insurer's requests were reasonably necessary and compliant with notice requirements.

Consequently, under s. 55(1), the applicant was barred from proceeding with the dispute regarding those treatment plans.

A separate claim for chiropractic treatment was dismissed as the applicant failed to prove it was reasonable and necessary.