Nicholas M. Wine

The applicant sought statutory accident benefits arising from a motor vehicle accident involving her mother when the applicant was seven years old.

The applicant submitted an application for benefits (OCF-1) nearly twelve years after the accident and almost two years after turning eighteen.

The insurer denied the claim due to the delay.

The Tribunal found that the applicant failed to provide a reasonable explanation for the delay in submitting the OCF-1 after reaching the age of majority.

The application was dismissed as the applicant was barred from proceeding under section 55(1) of the Schedule.

The applicant sought statutory accident benefits for psychological injuries allegedly sustained during a road rage incident where third parties struck her vehicle and yelled at her.

The respondent denied benefits on the basis that the incident was not an 'accident' under the Schedule.

The Tribunal applied the two-part purpose and causation test and found that the incident did not arise out of the ordinary use or operation of an automobile.

The Tribunal concluded that the verbal and feared assaults constituted an intervening act that broke the chain of causation.

The application was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claims for an attendant care benefit, treatment plans for meal delivery, and a visual skills assessment following a motor vehicle accident.

The Vice-Chair granted the reconsideration in part, finding that the original decision erred by focusing exclusively on the applicant's physical ability to prepare meals while ignoring her documented cognitive and psychological limitations.

The Tribunal varied the decision to award the attendant care benefit of $448.49 per month.

However, while the Tribunal found an error in the original statutory interpretation regarding meal delivery plans, it ultimately confirmed their denial, concluding they were not reasonable and necessary given the approval of the attendant care benefit.

The denial of the visual skills assessment was also confirmed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including medical benefits and income replacement benefits.

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

The applicant argued she suffered from chronic pain and a pre-existing condition that precluded recovery within the MIG.

The Tribunal found insufficient medical evidence to support a chronic pain diagnosis or a psychological impairment.

The Tribunal concluded the applicant sustained a minor injury and was subject to the $3,500 funding limit.

The claims for medical benefits outside the MIG and income replacement benefits were dismissed.

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

The applicant also claimed entitlement to non-earner benefits and several treatment plans.

The Tribunal found that the insurer's denial notices were compliant with the Schedule.

The Tribunal concluded that the applicant failed to provide sufficient medical evidence to prove their injuries warranted removal from the MIG, noting that a self-reported diagnosis of Adjustment Disorder was insufficient.

Furthermore, the applicant did not meet the test for non-earner benefits as they failed to demonstrate a complete inability to carry on a normal life.

All claims, including requests for an award and interest, were dismissed.

The applicant sought payment for two physiotherapy treatment plans totaling $3,600.96 following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to demonstrate the treatment plans were reasonable and necessary.

The Tribunal noted a lack of contemporaneous medical evidence, as the applicant's medical records predated the proposed treatment plans by over two years, and held that a treatment plan alone is insufficient to establish entitlement to a benefit.

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

The respondent denied benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued that persistent physical symptoms and psychological injuries warranted removal from the MIG.

The Tribunal found that the medical evidence, which consisted of a telephone consultation with a general practitioner and a physiotherapist's treatment plan, only supported minor physical injuries such as sprains and strains.

The Tribunal also found insufficient evidence of a psychological impairment.

As the applicant failed to meet the onus for removal from the MIG, the claims for further treatment, medication, interest, and an award were dismissed.

The applicant sought accident benefits following a motor vehicle accident.

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

The Tribunal found the applicant sustained a concussion, removing her from the MIG, based on the contemporaneous diagnoses of her treating physicians.

However, the Tribunal denied the applicant's claim for a $2,845.64 physiotherapy treatment plan, finding insufficient evidence that it was reasonable and necessary.

The Tribunal also dismissed the respondent's claim for repayment of an income replacement benefit overpayment, as the respondent failed to provide evidence to quantify the amount owed.

The applicant was injured in a motor vehicle accident and sought payment for the unapproved balances of three treatment plans for psychological services and catastrophic impairment assessments.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the proposed hourly rate of $224.42 for psychological services was reasonable and necessary, as it exceeded the maximum rate in the Professional Services Guidelines.

The Tribunal also found the applicant failed to justify the cost of clinical file review assessments, which appeared to duplicate approved in-person assessments.

Claims for interest and an award were consequently dismissed.

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

The respondent insurer denied treatment plans for physiotherapy and assistive devices/occupational therapy.

The Licence Appeal Tribunal found that the proposed physiotherapy was reasonable and necessary given the applicant's chronic pain and fibromyalgia, preferring the recommendations of the applicant's treating practitioners over the insurer's assessors.

The Tribunal also approved the assistive devices based on a thorough in-home occupational therapy assessment.

The applicant was awarded the claimed benefits with interest, but the claim for a special award under s. 10 of Regulation 664 was dismissed as the insurer's conduct did not rise to the level of being unreasonable.

The applicant sought $2,028.20 for osteopathy, kinesiology, and physiotherapy services incurred without first submitting a treatment plan, arguing the exception under s. 38(2)(d) of the Statutory Accident Benefits Schedule applied.

The Licence Appeal Tribunal found that the insurer did not explicitly or implicitly agree that the previously-incurred expenses were essential for the applicant's treatment or rehabilitation.

The application was dismissed, and the applicant was denied the expenses, interest, an award, and costs.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits and medical/rehabilitation benefits beyond the Minor Injury Guideline (MIG) limit.

The Licence Appeal Tribunal found that the applicant failed to prove a complete inability to carry on a normal life, noting inconsistencies between his reported impairments and his actual function, such as continuing to work in excavation and playing hockey.

The Tribunal also held that the applicant did not provide compelling evidence to justify removal from the MIG.

As the MIG limits were exhausted, the disputed treatment plans were not payable, and claims for an award and interest were dismissed.

The applicant sought non-earner benefits and a treatment plan for psychological and neuropsychological assessments following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's limitations were due to pre-existing conditions, including multiple sclerosis, and that he did not suffer a complete inability to carry on a normal life.

The Tribunal found the applicant failed to provide sufficient evidence of his pre-accident activities or objective medical evidence to refute the respondent's insurer's examinations.

The Tribunal dismissed the application, finding the applicant was not entitled to the non-earner benefits, the treatment plan, interest, or an award for unreasonable delay.

The applicant sought statutory accident benefits after slipping and falling on ice while walking towards her parked vehicle.

She was approximately 10 to 15 feet away from the vehicle with her keys in hand when the fall occurred.

The Licence Appeal Tribunal applied the two-part test for an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

While the purpose test was met, the causation test failed because the ice on the ground was an intervening cause and the dominant feature of the incident, breaking the chain of causation.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic, occupational therapy, and speech therapy treatment plans, as well as an award for unreasonably withheld payments.

The Licence Appeal Tribunal found that the applicant failed to prove the chiropractic and speech therapy plans were reasonable and necessary, noting a lack of objective medical evidence and the duplicative nature of the speech therapy assessment.

The Tribunal partially approved the occupational therapy plan, awarding $150 for a heating pad, but denied the remainder.

The claim for an award under Regulation 664 was dismissed, as the insurer's conduct was not unreasonable.

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

The applicant claimed entitlement to expenses for vision therapy and eyeglasses, physiotherapy services, and the unapproved balance of a psychological assessment.

The Tribunal dismissed the application in its entirety.

The Tribunal found that the applicant failed to establish on a balance of probabilities that the visual impairments were caused by the accident, relying on the respondent's optometry assessment.

The Tribunal also preferred the respondent's physiatry assessments, which concluded that maximum therapeutic benefit had been reached, over the applicant's lack of responding reports regarding physical injuries.

Finally, the Tribunal found the applicant failed to justify the additional cost claimed for the psychological assessment beyond what the respondent had already approved.

The applicant sought income replacement benefits and approval for three physiotherapy treatment plans following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove a substantial inability to perform the essential tasks of her sedentary employment as an insurance agent.

The Tribunal preferred the respondent's medical evidence, which found no organic pathology preventing her return to work and concluded that further passive facility-based treatment was not reasonable and necessary.

The defendant and statutory third party brought a motion to compel the plaintiffs to attend in-person defence medical examinations, including physiatry assessments for both plaintiffs and a psychiatric assessment for one plaintiff, after the action had been set down for trial.

The court granted leave under Rule 48.04(1), finding that the plaintiffs' late delivery of numerous expert reports and medical records demonstrating a significant and unexpected deterioration in their conditions constituted a substantial change in circumstances.

The court ordered the plaintiffs to attend the requested examinations to ensure trial fairness and allow the defendants an adequate opportunity to meet the plaintiffs' case.

The applicant sought statutory accident benefits for psychological treatment to address post-traumatic stress disorder following a motor vehicle accident.

The respondent partially denied two treatment plans, arguing that the proposed length and number of sessions were excessive and that a local treatment provider should be used to reduce travel expenses.

The Tribunal found that the applicant's treating psychologist was the preferred option due to his extensive experience and established patient-psychologist relationship, and that surveillance evidence did not undermine the applicant's psychological impairments.

The Tribunal concluded that the treatment plans were partially reasonable and necessary, awarding portions of the claimed amounts along with interest on overdue payments.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her physical and psychological impairments warranted removal from the Minor Injury Guideline (MIG).

The adjudicator found that the applicant's physical injuries were soft-tissue in nature and that she failed to demonstrate functionally disabling pain or a diagnosable psychological condition requiring treatment beyond the MIG.

The adjudicator preferred the respondent's expert reports, noting the applicant continued to work full-time and lacked corroborating medical evidence for her claims.

As the injuries fell within the MIG and the limits were exhausted, the claims for attendant care, medical benefits, and an award for unreasonable delay were dismissed.