Michael Jeffrey Silver

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident.

At the time of the accident, the applicant was on an unpaid leave of absence due to a prior slip and fall and was not receiving any employment income.

The Tribunal found that the applicant did not meet the definition of "employed" under section 5 of the Statutory Accident Benefits Schedule because she was not receiving remuneration, and therefore was not entitled to IRBs.

The respondent insurer sought repayment of $17,563.50 in IRBs that were paid in error.

The Tribunal dismissed the repayment claim, finding that the insurer failed to provide proper notice under section 64(2)(e) of the Schedule because the notice was sent electronically without the applicant's consent.

The application was dismissed.

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

The respondent denied certain treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been exhausted.

The applicant argued that psychological impairments, insomnia, and chronic pain removed him from the MIG.

The Tribunal found that the applicant's physical injuries were soft tissue injuries falling within the MIG definition.

The Tribunal concluded the applicant failed to provide sufficient evidence that his insomnia or chronic pain were caused by the accident.

As the injuries were predominantly minor, the disputed treatment plans and examination costs were not payable.

The application was dismissed.

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

The insurer deemed the applicant's physical injuries to be predominantly minor and subject to the $3,500 limit under the Minor Injury Guideline (MIG).

The applicant argued he sustained psychological injuries that removed him from the MIG.

The Tribunal found the applicant's self-reporting of psychological distress to be unreliable and contradictory to his family doctor's records.

The Tribunal concluded the applicant's injuries were minor, and because the MIG limits were exhausted, the disputed treatment plans and assessment costs were not reasonable and necessary.

Claims for an award, interest, and costs were dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for occupational therapy, an optometry assessment, and a gym membership.

The respondent insurer denied the benefits.

The Tribunal found that the applicant had proven on a balance of probabilities that the claimed treatment plans and assessments were reasonable and necessary to treat her concussion and psychological symptoms.

The Tribunal placed less weight on the insurer's examination reports.

The applicant was awarded the claimed benefits and interest, but her claim for an award was dismissed.

The respondent's request for costs was also dismissed.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits, which the respondent insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal for dispute resolution.

The Tribunal found that while the initial physical injuries were predominantly minor, the applicant subsequently developed chronic pain with accompanying psychological impairment, removing him from the MIG.

The Tribunal concluded that the disputed treatment plans for chiropractic and psychological services were reasonable and necessary, and ordered the respondent to pay the benefits with interest.

The applicant was injured in a motor vehicle accident and sought medical benefits, which the respondent insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

Prior to the hearing, the respondent approved the disputed treatment plans.

The remaining issues were whether the applicant was entitled to an award for unreasonably delayed payments and whether either party was entitled to costs.

The Tribunal found that the respondent unreasonably withheld payments by maintaining its MIG denial despite having an independent medical examination report diagnosing a psychological impairment outside the MIG.

The Tribunal awarded the applicant 25% of the delayed benefits, totaling $2,316.38, plus interest.

Both parties' requests for costs were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically a treatment plan for physiotherapy.

The respondent denied the plan based on an insurer's examination report.

The Tribunal found the treatment plan reasonable and necessary to support the applicant's maximal recovery from cervical spine and shoulder impairments.

The Tribunal approved the treatment plan but denied the applicant's claims for interest and a special award, finding the respondent's reliance on its medical expert was appropriate.

The applicant sought ongoing income replacement benefits (IRBs) beyond the 104-week mark following a motor vehicle accident.

The Licence Appeal Tribunal found that while the accident caused the applicant's impairments, she failed to prove a complete inability to engage in any employment for which she was reasonably suited by education, training, or experience.

The Tribunal preferred the respondent's independent medical examinations and functional evaluations over the applicant's subjective complaints and expert evidence, noting credibility issues and the employer's willingness to accommodate her.

The application for IRBs, interest, and a special award was dismissed, and no costs were awarded.

The applicant brought a motion to exclude two medical reports obtained by the respondent insurer without providing the required notice under s. 44(5)(a) of the Statutory Accident Benefits Schedule.

The respondent admitted the failure to provide notice was a clerical error.

The adjudicator granted the motion, finding that the notice requirement is mandatory and the appropriate remedy for non-compliance is the exclusion of the reports.

The applicant also brought a motion for the adjudicator to recuse himself on the basis of a reasonable apprehension of bias, arguing that having read the excluded reports, the adjudicator could not decide the substantive issues fairly.

The adjudicator dismissed the recusal motion, holding that the applicant failed to meet the high threshold to establish bias, as adjudicators routinely rule on the admissibility of evidence without being disqualified from hearing the merits.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, as well as the costs of several assessments, which the respondent insurer denied.

The Licence Appeal Tribunal found that the proposed chiropractic and psychological treatment plans, along with a chronic pain assessment, were reasonable and necessary given the applicant's ongoing pain and psychological symptoms.

However, the Tribunal concluded that a cognitive assessment and a driver's reintegration assessment were not reasonable and necessary, as the applicant did not exhibit cognitive impairment and the driving phobia could be addressed through the approved psychological treatment.

The applicant was awarded interest on overdue payments, and no costs were awarded to either party.

The defendant brought a motion to compel the plaintiff to answer outstanding refusals from discovery.

The refusals related to a prior motor vehicle accident in 2007, which was similar in nature to the subject accident, and pre-existing complaints of neck, back, and shoulder pain.

The court found that information regarding the 2007 accident and related injuries was potentially relevant to the assessment of damages, the degree to which alleged damages were attributable to the subject accident, and whether injuries predated it.

The motion was granted, requiring the plaintiff to answer the refusals and provide relevant records, with costs awarded to the defendant.