Mobina Khan

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

The respondent insurer denied benefits, arguing the application was delayed without a reasonable explanation.

The Tribunal found that the applicant, being seven years old at the time of the accident and reliant on her parents, had a reasonable explanation for the delay.

The Tribunal noted the applicant's minority status, her parents' language barriers, and the lack of significant prejudice to the insurer.

The applicant was permitted to proceed with her claim.

The applicant sought statutory accident benefits for optometric services, a functional abilities evaluation, and physiotherapy following a 2018 motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to meet his onus to prove the treatments were reasonable and necessary.

The Tribunal drew an adverse inference from the applicant's failure to produce agreed-upon medical and employment records.

The Tribunal preferred the respondent's expert evidence, which indicated the applicant had reached maximum medical recovery and that the proposed vision therapy was not a recognized treatment.

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

The respondent denied several treatment plans for chiropractic services, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant did not meet her burden to prove chronic pain with functional impairment or a psychological injury warranting removal from the MIG.

However, because the respondent failed to provide compliant denial notices within the required 10-day period under section 38(8) of the Schedule, the Tribunal ordered the respondent to pay for the incurred treatment plans from the 11th day after submission until the date the defective notices were cured.

The applicant's claim for an award for unreasonable delay was dismissed.

The applicant requested a reconsideration of a previous Licence Appeal Tribunal decision that found his injuries fell within the Minor Injury Guideline (MIG) and denied certain treatment plans.

The applicant argued the Tribunal failed to properly assess medical evidence, including diagnostic imaging showing a partial tear, and his psychological symptoms.

The Vice-Chair dismissed the request, finding that the applicant was attempting to re-weigh the evidence rather than identifying a material error of law or fact.

The Vice-Chair noted that a partial tear is considered a minor injury under the Schedule and that the Tribunal had adequately considered the evidence in its original decision.

The applicant, a minor, 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 on a balance of probabilities that he suffered from a pre-existing condition, a physical impairment (concussion), or a psychological impairment that would warrant removal from the MIG.

As the applicant remained subject to the MIG limit, the disputed treatment plans were not considered.

Claims for an award and interest were also dismissed.

The applicant was injured in a motor vehicle accident and sought $7,738.72 for a chiropractic treatment plan.

The respondent insurer denied the plan based on insurer's examinations which concluded the applicant had reached maximum medical recovery.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to provide contemporaneous medical evidence or address the goals of the treatment to prove it was reasonable and necessary.

The Tribunal also found the insurer's denial was compliant with the Schedule and denied claims for interest and an award.

The applicant sought accident benefits for psychological injuries allegedly sustained as a result of her spouse's involvement in a motor vehicle accident four years prior.

The respondent denied the claim, arguing the applicant was not an 'insured person' under section 3(1) of the Statutory Accident Benefits Schedule and had failed to apply within the prescribed timelines.

The Tribunal found that the applicant failed to provide evidence linking her psychological impairments to the accident, as her medical records did not mention the accident and instead noted unrelated anxiety.

Consequently, the Tribunal concluded the applicant was not an 'insured person' and dismissed the claim, finding it unnecessary to address the limitation period issue.

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

The respondent denied several treatment plans and an IRB report, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found the applicant's injuries were predominantly minor, as the medical evidence only supported conditions like sprains, strains, and whiplash-associated disorders.

The applicant failed to provide compelling medical evidence of a concussion or psychological condition warranting removal from the MIG.

Consequently, the treatment plans were not payable.

The Tribunal also denied the cost of an IRB report, finding it was not reasonable and necessary.

The applicant sought accident 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 applicant failed to prove on a balance of probabilities that she sustained physical or psychological injuries warranting removal from the MIG.

The Tribunal also found that the respondent's denial letters complied with the notice requirements under s. 38(8) of the Schedule, and therefore the treatment plans were not payable under s. 38(11).

The application was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied his appeal for removal from the Minor Injury Guideline (MIG), treatment plans, and a Non-Earner Benefit (NEB).

The applicant argued the Tribunal made errors of fact and law, and breached procedural fairness by failing to consider medical evidence in his document brief.

The Vice Chair dismissed the request, finding that the applicant failed to point to contemporaneous medical evidence in his initial submissions and that it is not the adjudicator's role to search through unreferenced documents to make a party's case.

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

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

The applicant applied to the Licence Appeal Tribunal, arguing for removal from the MIG due to pre-existing conditions, physical injuries including a concussion, and psychological impairments.

The adjudicator found insufficient medical evidence to support the applicant's claims, noting that complaints of concussion and psychological symptoms arose more than a year after the accident and following a separate assault.

The application was dismissed, and the applicant was found to remain subject to the MIG limit.

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 also claimed entitlement to a non-earner benefit, four chiropractic treatment plans, interest, and an award for unreasonable delay.

The Tribunal found that the applicant failed to prove his physical or psychological injuries warranted removal from the MIG, noting a lack of medical evidence connecting his claimed conditions to the accident.

The Tribunal also found the insurer's denial notices complied with s. 38(8) of the Schedule.

The claim for a non-earner benefit was dismissed as the applicant provided insufficient evidence of his pre-accident activities to establish a complete inability to carry on a normal life.

The application was dismissed in its entirety.

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

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

The applicant argued for removal from the MIG based on a concussion and psychological impairments.

The Tribunal found that the applicant failed to prove on a balance of probabilities that she sustained injuries warranting removal from the MIG, noting that the concussion and psychological diagnoses were made by a chiropractor outside his scope of practice, and medical records did not corroborate accident-related psychological impairments.

The application was dismissed.

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

The respondent denied benefits because the applicant failed to submit a completed OCF-1 application within 30 days of receiving the forms, ultimately submitting it nearly three years later.

The applicant argued that personal circumstances and medical conditions caused the delay, but provided no specific evidence to support this claim.

The Tribunal found the applicant's explanation was not credible or worthy of belief, and therefore did not meet the threshold for a "reasonable explanation" under section 34 of the Schedule.

The application was dismissed pursuant to section 55(1) of the Schedule.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied his claims for income replacement benefits and a treatment plan for an electrophysiological assessment.

The applicant argued that the Tribunal made errors of law and fact and committed a material breach of procedural fairness by improperly weighing the evidence, including OCF-3 disability certificates and medical records.

The adjudicator dismissed the request, finding that the applicant was attempting to re-litigate the original decision and disagreeing with the weight assigned to the evidence, which does not meet the high threshold for reconsideration under Rule 18.2.

The applicant requested reconsideration of a Tribunal decision that dismissed his application for failing to file submissions.

The applicant provided evidence that he had, in fact, filed and served his submissions by the deadline set in the Case Conference Report and Order.

The Tribunal found that it had erred in fact by determining the applicant had not made submissions, and that this error likely affected the outcome.

The request for reconsideration was granted, the original decision was cancelled, and a rehearing before a new adjudicator was ordered.

The applicant, a minor struck by a car while riding a bicycle, sought statutory accident benefits including a non-earner benefit and funding for chiropractic treatment plans.

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

The Tribunal found the applicant failed to prove his injuries warranted removal from the MIG, as medical evidence indicated only soft tissue injuries.

The Tribunal also dismissed the claims for a non-earner benefit, finding insufficient evidence of a complete inability to carry on a normal life, and found the treatment plans were not payable.

The application was dismissed.

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 also claimed entitlement to non-earner benefits, various treatment plans, and a special award for unreasonable delay.

The Licence Appeal Tribunal dismissed the application in its entirety, finding that the applicant failed to provide sufficient medical evidence to establish that his injuries warranted removal from the MIG or that he suffered a complete inability to carry on a normal life.

Consequently, the disputed treatment plans were not payable, and the claims for interest and a special award were denied.

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

The applicant argued he suffered from chronic pain and a psychological condition warranting removal from the MIG, and that the insurer's denial of a physiotherapy treatment plan was non-compliant with s. 38(8) of the Schedule.

The adjudicator found the applicant failed to meet the AMA Guides criteria for chronic pain and lacked evidence of a psychological condition.

The adjudicator also found the insurer's denial letter compliant.

The insurer's claim for repayment of an alleged Income Replacement Benefit overpayment was dismissed due to lack of evidence.

All claims were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB) and funding for an electrophysiological assessment.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove entitlement to either a pre-104 or post-104 week IRB due to a lack of evidence regarding employment or educational history.

The Tribunal also denied the treatment plan, noting the lack of detail, uncorroborated diagnosis, and hospital records indicating neurological results were within normal limits.

Claims for interest and an award were consequently dismissed.