Nadia Peles

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).

The applicant argued for removal from the MIG based on chronic pain, a pre-existing condition, and the respondent's accidental overpayment of the MIG limit.

The Tribunal found insufficient evidence to establish chronic pain under the AMA Guides or a documented pre-existing condition that would delay recovery.

The Tribunal also held that an administrative overpayment of $63.78 did not estop the respondent from relying on the MIG limits.

The disputed treatment plan was found not payable as the respondent provided adequate notice of denial under s. 38(8) of the Schedule.

Claims for an award and interest were dismissed.

The applicant requested a reconsideration of a decision finding he did not sustain a catastrophic impairment.

He argued the Tribunal committed a material breach of procedural fairness by providing inadequate reasons and raising issues on its own, and that it erred in fact and law in assessing the medical evidence.

The Vice-Chair dismissed the request, finding the reasons were adequate, the evidence relied upon was properly before the Tribunal, and the applicant was improperly attempting to re-weigh the evidence rather than identifying actual errors.

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

The respondent denied the benefits, and the matter proceeded to a written hearing before the Licence Appeal Tribunal.

The applicant failed to file any written submissions or evidence by the deadline and did not request an extension.

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

The Tribunal found that the applicant failed to meet the burden of demonstrating removal from the Minor Injury Guideline or entitlement to the disputed medical benefit, award, and interest.

The application was dismissed.

The applicant sought a determination that he was catastrophically impaired under Criterion 8 of the Statutory Accident Benefits Schedule due to mental and behavioral disorders resulting from a motor vehicle accident.

While the Tribunal accepted that the applicant sustained post-traumatic stress disorder, a major depressive episode, and substance use disorder as a result of the accident, it found that these impairments did not reach the threshold of a marked (Class 4) impairment in any of the four functional domains.

The Tribunal concluded that the applicant retained some useful functioning in activities of daily living and social functioning, and therefore dismissed the application.

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

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

The applicant argued that psychological and neurological impairments, as well as pre-existing conditions, removed him from the MIG.

The Tribunal found that the applicant's injuries were predominantly minor and that he failed to provide compelling medical evidence of pre-existing conditions that would prevent maximal recovery within the MIG limits.

However, because the respondent's initial notice of denial for one treatment plan was non-compliant with section 38(8) of the Schedule, the applicant was entitled to incurred costs for that plan up until a compliant notice was issued.

The remaining treatment plans and a claim for a special award were dismissed.