Michelle L. Velvet

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to treatment plans for physiotherapy, chiropractic services, and psychological and chronic pain assessments outside the Minor Injury Guideline (MIG).

The Tribunal found the applicant failed to prove his injuries warranted removal from the MIG, noting his functional abilities and return to work were inconsistent with chronic pain or psychological impairment.

As the MIG limits were exhausted, the treatment plans were not payable.

The Tribunal also found the respondent's denial notices complied with s. 38(8) of the Schedule and dismissed claims for interest and a punitive award.

The appellant appealed a Licence Appeal Tribunal (LAT) decision denying her entitlement to post-104-week income replacement benefits under the Statutory Accident Benefits Schedule.

The Divisional Court dismissed the appeal, finding no errors of law.

The court affirmed that new binding case law does not constitute new evidence for a reconsideration request, and held that the insurer's denial letter adequately complied with the statutory notice requirements under s. 37(4) of the SABS.

The applicant sought reconsideration of a decision finding she was not catastrophically impaired and denying various benefits.

The applicant argued the adjudicator breached procedural fairness by inserting causation as an issue in dispute when it was not listed in the Case Conference Report and Order.

The Tribunal agreed, finding that deciding the issue of causation without notice denied the applicant the right to fairly present evidence and argument.

The reconsideration request was granted, the original decision was cancelled, and a new hearing was ordered.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed entitlement to an income replacement benefit, outstanding physiotherapy costs, interest, and an award for unreasonable delay.

The Licence Appeal Tribunal found that the applicant failed to provide compelling medical evidence to prove his injuries, including alleged chronic pain and psychological impairments, warranted removal from the MIG.

The Tribunal also found the applicant did not establish a substantial inability to perform the essential tasks of his employment as an Uber driver.

All claims were dismissed.

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) limit of $3,500.

The applicant argued his injuries fell outside the MIG due to psychological impairments, chronic pain, and pre-existing conditions.

The Tribunal found that the applicant sustained predominantly minor injuries (back and shoulder sprains) and failed to prove on a balance of probabilities that he suffered from an accident-related psychological impairment or chronic pain syndrome that would warrant removal from the MIG.

The Tribunal also found no compelling evidence of a pre-existing condition that would prevent maximal recovery within the MIG limit.

As the MIG limits were exhausted, the disputed treatment plans were denied, and no award for unreasonable delay was granted.

The applicant sought a determination that his injuries fell outside the Minor Injury Guideline (MIG) and claimed entitlement to a non-earner benefit following a motor vehicle accident.

The Tribunal held it lacked jurisdiction to determine the MIG issue on a stand-alone basis without an underlying dispute over a specific medical benefit.

On the substantive claim, the Tribunal found the applicant did not suffer a complete inability to carry on a normal life, as he continued to work as an independent contractor and maintained most of his pre-accident daily activities.

The Tribunal also found the insurer's denial letters were compliant with the Schedule and dismissed the claims for an award and interest.

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

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

The applicant applied to the Licence Appeal Tribunal, claiming removal from the MIG due to psychological impairment, chronic pain, and pre-existing conditions.

The Tribunal found insufficient medical evidence to support a psychological injury, chronic pain with functional limitations, or a pre-existing condition that would preclude recovery within the MIG.

The Tribunal held that the applicant remains subject to the $3,500 MIG limit.

The disputed treatment plans were deemed reasonable and necessary up to the remaining MIG limit, provided they are incurred.

The claim for an award for unreasonable delay was dismissed.

The applicant requested a reconsideration of a decision finding he was not involved in an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The applicant argued the adjudicator breached procedural fairness and made errors of law and fact by failing to properly consider his evidence regarding a slip and fall at a Collision Reporting Centre following a guardrail collision.

The adjudicator dismissed the request, finding no breach of procedural fairness and that the applicant was improperly attempting to reweigh the evidence.

The original finding that the slip and fall was an intervening act, and not an accident, was upheld.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident.

The applicant did not attend the hearing.

The core issue was whether the applicant properly responded to a request for further information under s. 36(4)(c) of the Statutory Accident Benefits Schedule.

The Tribunal found that the respondent validly requested further information via fax to the applicant's representative, despite the lack of a cover letter.

Because the applicant failed to comply with the request for information, s. 33(6) was triggered, and the IRB was not payable.

The application was dismissed.

The applicant requested reconsideration of a preliminary issue decision that barred him from proceeding with his claim for accident benefits due to his failure to notify the insurer of his intention to apply within seven days.

The applicant argued the Tribunal breached procedural fairness by deciding an issue without notice and erred in its interpretation of section 32(1) of the Schedule.

The Vice-Chair dismissed the request, finding that the parties had explicitly agreed to the wording of the preliminary issue and that the applicant was attempting to re-litigate the Tribunal's interpretation of the Schedule without establishing an error of law.

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

The insurer partially approved treatment plans for psychological services but reduced the hourly rate for a psychotherapist from the psychologist rate to a lower rate.

The applicant also sought approval for a naturopath examination.

The Tribunal found that the insurer correctly applied the Professional Services Guideline in determining the hourly rate for the psychotherapist, as psychotherapists are not listed in the Guideline and the insurer's approved rate was reasonable.

The Tribunal also found the naturopath examination was not reasonable and necessary, preferring the insurer's examination report.

The application was dismissed.

The applicant was involved in a single-vehicle collision with a guardrail.

His vehicle was towed to a Collision Reporting Centre, where he slipped and fell on a snow-covered hill, fracturing his ankle.

He sought statutory accident benefits, claiming his injuries were caused by the collision.

The Tribunal found that the applicant was not involved in an 'accident' as defined by s. 3(1) of the Schedule, as the slip and fall was an intervening act that directly caused his injuries, breaking the causal link to the use or operation of the automobile.

The application for benefits was dismissed.

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 sought statutory accident benefits following a 2017 motor vehicle accident, claiming catastrophic impairment and entitlement to income replacement benefits, treatment plans, and a special award.

The respondent denied the benefits, arguing the applicant's impairments were caused by a prior 2015 accident, pre-existing conditions, and subsequent unrelated incidents.

The Tribunal found that the applicant failed to prove on a balance of probabilities that her injuries were caused by the 2017 accident, noting her failure to follow medical advice regarding the prolonged use of a knee brace.

Consequently, the Tribunal dismissed the claims for catastrophic impairment, income replacement benefits, treatment plans, and the special award.

The applicant sought statutory accident benefits following a 2014 motor vehicle accident involving his children.

In 2021, he submitted treatment plans for psychological injuries, which the insurer denied because he had not submitted an Application for Accident Benefits (OCF-1) or provided a reasonable excuse for the delay.

The Tribunal found that the applicant failed to notify the insurer of his intention to apply for benefits within seven days or as soon as practicable, as required by section 32(1) of the Schedule.

The applicant provided no reasonable explanation for the multi-year delay.

Consequently, the application was dismissed.

The applicant sought reconsideration of a Licence Appeal Tribunal decision denying entitlement to five treatment and assessment plans, including chiropractic treatment, attendant care, chronic pain, social work, and neurological assessments.

The applicant argued the adjudicator violated procedural fairness and erred in law, particularly regarding the sufficiency of the insurer's denial notices under section 38 of the Statutory Accident Benefits Schedule.

The adjudicator dismissed the request, finding the applicant was attempting to relitigate the weighing of evidence and correctly applied the law that an insured must incur the expenses to trigger the mandatory payment provisions under section 38(11).

The applicant sought statutory accident benefits following a 2016 motor vehicle accident, claiming catastrophic impairment due to mental/behavioural disorders and physical impairments.

The Licence Appeal Tribunal found the applicant was not catastrophically impaired, as her psychological symptoms and knee osteoarthritis were pre-existing and not caused by the accident.

Claims for a non-earner benefit and various assessments were dismissed.

However, the Tribunal granted a treatment plan for chiropractic services, finding the applicant sustained permanent back injuries in the accident.

A claim for an award under Regulation 664 was dismissed, but interest was awarded on the overdue chiropractic benefits.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for various treatment and assessment plans, including chiropractic treatment, attendant care, chronic pain, social work, and neurological assessments.

The respondent insurer denied the plans.

The Licence Appeal Tribunal found that the applicant failed to prove the plans were reasonable and necessary, noting that the applicant had already received adequate facility-based treatment, exhibited functional independence, and lacked medical evidence supporting the need for the proposed assessments.

The application was dismissed in its entirety.

The applicant requested a reconsideration of a Tribunal decision that denied her entitlement to post-104 week income replacement benefits (IRBs).

The applicant argued the Tribunal made errors of law and fact, including misapprehending the medical reasons for the IRB stoppage, failing to consider both physical and psychological impairments, and failing to quantify her entitlement.

The Tribunal dismissed the request, finding no errors of law, fact, or procedural fairness that would have changed the outcome.

The Tribunal also rejected the applicant's attempt to introduce a recent Court of Appeal decision as new evidence, noting that case law does not constitute evidence under the reconsideration rules.

The applicant was catastrophically injured in a motor vehicle accident and sought statutory accident benefits, including custom orthotics and attendant care benefits (ACBs).

The respondent denied the orthotics and partially denied the ACBs.

The Tribunal found the orthotics were reasonable and necessary, noting the respondent's notice was proper but the medical evidence supported the claim.

Regarding ACBs, the Tribunal weighed competing Form 1 assessments, finding the applicant's assessor recommended excessive hours while the respondent's assessor failed to account for the applicant's psychological impairments and lack of motivation.

The Tribunal awarded ACBs at $3,121.57 per month.

Claims for a Regulation 664 award were dismissed, but interest was awarded on overdue payments.