17 total
Application for accident benefits dismissed; injuries deemed minor and subject to the Minor Injury Guideline.
The applicant sought accident benefits following a motor vehicle accident, arguing his injuries fell outside the Minor Injury Guideline (MIG) due to pre-existing chronic pain and a diagnosis of spinal stenosis.
The Licence Appeal Tribunal found that the applicant failed to provide compelling medical evidence that his pre-existing condition would prevent recovery within the MIG, noting that post-accident clinical records showed no exacerbation of his condition.
The Tribunal accepted the respondent's insurer examination reports, which concluded the applicant sustained soft tissue injuries treatable within the MIG.
As the MIG limits were exhausted, the claims for chiropractic services, a chronic pain assessment, interest, and an award were dismissed.
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming his physical and psychological injuries warranted removal from the Minor Injury Guideline (MIG).
The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor, noting that his self-reported symptoms were inconsistent and did not demonstrate functional impairment.
The Tribunal preferred the respondent's s. 44 assessors over the applicant's pre-screening report.
The application for treatment plans, an award for unreasonable delay, and interest was dismissed.
The Court of Appeal upheld the summary dismissal of a negligence claim against a driver who reasonably reacted to a sudden emergency.
The appellants appealed a summary judgment dismissing their negligence action against one defendant (Franchetto) following a motor vehicle accident.
The motion judge found Franchetto not negligent, applying the "sudden emergency" doctrine.
The Court of Appeal upheld this decision, finding no palpable and overriding error in the motion judge's conclusion that Franchetto's actions were reasonable given the sudden emergency created by the other driver.
The appeal was dismissed.
Application for chronic pain treatment plan dismissed due to applicant's failure to properly pinpoint supporting medical evidence.
The applicant sought entitlement to a $9,024.34 treatment plan for a chronic pain program following a motor vehicle accident, along with interest and an award for unreasonable delay.
The Licence Appeal Tribunal dismissed the application, finding the applicant failed to meet her evidentiary burden to prove the treatment was reasonable and necessary.
The adjudicator noted the applicant's case was hampered by a lack of contemporaneous evidence and a failure to properly pinpoint evidence within the submitted medical reports as required by the case conference report and order.
Consequently, the claims for interest and an award were also dismissed.
Claim for chronic pain treatment plan dismissed due to lack of medical evidence and three-year treatment gap.
The applicant sought $9,024.34 for a chronic pain treatment plan following a 2017 motor vehicle accident.
The respondent denied the benefits, arguing the applicant had recovered and returned to work full-time.
The Tribunal found the treatment plan was not reasonable or necessary, noting a three-year gap between the chronic pain assessment and the treatment plan, a lack of corroborating medical evidence, and the applicant's successful return to a physically demanding job.
The claims for an award under s. 10 of Reg. 664 and interest were also dismissed.
Applicant's injuries found to be predominantly minor; removal from Minor Injury Guideline denied.
The applicant sought accident benefits following a motor vehicle accident, arguing her left sternoclavicular joint injury and chronic pain warranted removal from the Minor Injury Guideline (MIG).
The Tribunal found that while the accident caused the subluxation of the joint, the applicant failed to demonstrate that the injury caused functional impairment or met the criteria for chronic pain.
The Tribunal concluded the injuries were predominantly minor and subject to the $3,500 MIG limit.
Consequently, the applicant's claims for a chronic pain assessment, interest, and an award for unreasonable delay were dismissed.
Applicant remains in MIG, but treatment plans payable due to insurer's defective denial letters.
The applicant sought statutory accident benefits following a motor vehicle accident.
The Tribunal found that the applicant failed to prove her injuries warranted removal from the Minor Injury Guideline (MIG), as the medical evidence did not establish chronic pain with functional impairment or a psychological condition.
However, the Tribunal ordered the respondent to pay for three disputed treatment plans because the respondent failed to prove it delivered valid denial letters within the required 10 business days under s. 38(8) of the Schedule.
The applicant's claim for an award under s. 10 of Reg. 664 was dismissed.
Application for statutory accident benefits dismissed as treatment plans were not proven reasonable and necessary.
The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's denial of six treatment plans for physiotherapy, assistive devices, and a chronic pain assessment.
The Tribunal excluded the applicant's late-disclosed clinical notes and records due to prejudice to the respondent.
On the merits, the Tribunal found the applicant failed to demonstrate that the treatment plans were reasonable and necessary, noting a lack of supporting objective medical evidence and physician recommendations.
The application was dismissed, and claims for interest and a special award were denied.
Reconsideration of catastrophic impairment decision dismissed as adjudicator made no errors regarding expert evidence admissibility.
The applicant requested a reconsideration of a decision that dismissed his claims for catastrophic impairment, attendant care benefits, and medical and rehabilitation benefits following a motor vehicle accident.
The applicant argued the adjudicator erred by allowing the respondent's psychiatric expert to testify outside the scope of her report, by limiting the evidence of the applicant's chiropractor regarding psychological impairments, and by failing to properly consider the meaning of 'useful function'.
The adjudicator dismissed the reconsideration request, finding no errors of law or fact.
The adjudicator held that the respondent's expert evidence was latent in her report, the chiropractor was not qualified to opine on psychological impairments, and the applicant was improperly attempting to relitigate findings of fact.
Application for catastrophic impairment benefits dismissed; applicant failed to prove accident caused marked or extreme psychological impairment.
The applicant sought statutory accident benefits after witnessing a fatal bus accident, claiming it caused a catastrophic impairment (schizophrenia).
The respondent denied the benefits, arguing the applicant's condition was pre-existing or prodromal.
The Tribunal found that while the accident may have triggered an acute psychotic episode, the applicant was likely prodromal for years prior and failed to prove he sustained a Class 4 marked or Class 5 extreme impairment in the required spheres of function.
The Tribunal also dismissed claims for attendant care, rehabilitation support worker services, and other expenses, as the applicant's non-catastrophic policy limits were exhausted and the expenses were either not incurred or not reasonable and necessary.
Reconsideration denied; applicant failed to produce new evidence or demonstrate error of law regarding minor injury finding.
The applicant sought reconsideration of a decision finding his injuries fell within the Minor Injury Guideline (MIG) and denying his claims for chiropractic treatment.
The applicant argued there was new evidence (his psychiatrist's clinical notes) and that the adjudicator erred in law by failing to request these records.
The adjudicator dismissed the request, finding that the records were not new evidence as they had not yet been produced, there was no evidence they could not have been reasonably obtained earlier, and the applicant failed to show they would have affected the result.
The adjudicator also found no error of law, noting the applicant bears the onus to adduce evidence.
Application for accident benefits dismissed due to lack of evidence linking injuries to the subject accident.
The applicant sought statutory accident benefits for physiotherapy and a psychological assessment following a May 2016 motor vehicle accident.
The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the treatments were reasonable and necessary as a result of the subject accident.
The Tribunal noted significant gaps in the medical records and unrefuted evidence of subsequent intervening accidents, including another motor vehicle accident and a cycling accident, which likely caused the current injuries.
Application for accident benefits dismissed; applicant failed to prove injuries fell outside Minor Injury Guideline.
The respondent insurer denied a treatment plan for a chronic pain assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant argued she should be removed from the MIG due to pre-existing conditions and chronic pain.
The Tribunal found that the applicant's pre-existing conditions did not preclude her from achieving maximal medical recovery within the MIG limit.
Applying the AMA Guides criteria for chronic pain, the Tribunal concluded the applicant failed to establish that she suffered from chronic pain caused by the accident.
The application was dismissed, and the applicant was not entitled to the treatment plan or interest.
Applicant removed from Minor Injury Guideline due to chronic pain; chronic pain assessment funded.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits.
The respondent denied a treatment plan for a chronic pain assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) limit of $3,500.
The Tribunal found that the applicant suffered from chronic pain, removing her from the MIG.
The Tribunal ordered the respondent to pay $2,000 for the chronic pain assessment and interest on overdue payments, but denied the applicant's claim for an award under Regulation 664 as there was no evidence of unreasonable delay.
Application for accident benefits dismissed; injuries fell within the Minor Injury Guideline.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic treatment.
The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant argued that a pre-existing psychological condition and a psychological injury sustained in the accident removed him from the MIG.
The Tribunal found that the applicant's physical injuries were predominantly minor and that he failed to provide compelling evidence of a pre-existing condition that would prevent maximal recovery under the MIG.
The Tribunal also found no evidence of a psychological impairment beyond psychosocial sequelae.
The application was dismissed.
Insurer ordered to pay chiropractic treatment plans and interest after section 44 assessments rejected.
The applicant was injured in a motor vehicle accident and sought medical benefits for three chiropractic treatment plans under the Statutory Accident Benefits Schedule.
The respondent insurer denied the plans based on section 44 assessments.
The Licence Appeal Tribunal found the treatment plans reasonable and necessary, noting the applicant's pre-existing osteoarthritis and ongoing pain.
The Tribunal rejected the insurer's medical assessments because they failed to account for key medical evidence, including a diagnostic imaging report.
The applicant was awarded the disputed benefits and interest.
Accident benefits claims dismissed as applicant's injuries fell within the Minor Injury Guideline limit.
The applicant, a pedestrian struck by a vehicle, sought statutory accident benefits for medical and rehabilitation treatments.
The respondent denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit was exhausted.
The Tribunal found that the applicant's physical injuries were minor and that she failed to prove a pre-existing condition or a psychological impairment that would warrant removal from the MIG.
The Tribunal preferred the respondent's comprehensive psychological assessment over the applicant's pre-screen.
As the injuries fell within the MIG and the limit was exhausted, the claims for further treatment and interest were dismissed.