OLAT 2017

The applicant, a pedestrian struck by a vehicle, applied to the Licence Appeal Tribunal for non-earner benefits and funding for various treatment plans.

The insurer denied the claims, arguing the applicant did not meet the test for non-earner benefits and that his injuries fell within the Minor Injury Guideline (MIG), for which the $3,500 limit had been exhausted.

The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered a complete inability to carry on a normal life, noting surveillance evidence and his ability to engage in many daily activities and work casually.

Furthermore, the Tribunal held that the applicant failed to provide medical evidence establishing a causal link between his back and shoulder issues and the accident to rebut the insurer's medical examination, thereby failing to prove his injuries fell outside the MIG.

The application was dismissed.

The applicant, a pedestrian struck by a vehicle, sought Income Replacement Benefits (IRBs) and funding for psychological and chronic pain assessments.

The insurer terminated IRBs after six months and denied the assessments, arguing the applicant's injuries fell within the Minor Injury Guidelines (MIG).

The Tribunal found the applicant did not suffer a substantial inability to perform his essential tasks for the first 104 weeks, nor a complete inability to engage in employment thereafter, relying on surveillance evidence showing him working and medical reports indicating symptom magnification.

The Tribunal also concluded the applicant's injuries were minor, dismissing the claims for the assessments.

The applicant sought an income replacement benefit following a motor vehicle accident, claiming he was substantially unable to perform the essential tasks of his pre-accident employment as an automobile garage owner.

The respondent insurer terminated the benefit and relied on surveillance evidence that contradicted the applicant's self-reported limitations.

The adjudicator found the applicant's medical evidence relied heavily on his self-reports, which were undermined by surveillance showing him walking without a cane, driving, and bending without visible difficulty.

The application was dismissed as the applicant failed to prove on a balance of probabilities that he suffered a substantial inability to perform his essential tasks.

The applicant sought a non-earner benefit and a rehabilitation benefit following a motor vehicle accident.

The adjudicator excluded late-filed medical reports submitted by the applicant in reply, finding their admission would prejudice the respondent.

Applying the Heath test, the adjudicator found the applicant failed to prove a complete inability to carry on a normal life, as evidence showed she continued to perform most of her pre-accident caregiving and household activities.

The claim for the rehabilitation benefit was dismissed for lack of evidence that it was reasonable and necessary.

Claims for interest, costs, and a special award were also dismissed.

The applicant was injured in a motor vehicle accident and claimed attendant care benefits for services provided by his wife, a professionally qualified personal attendant.

The insurer denied the claim.

The Licence Appeal Tribunal found that the applicant's wife did not provide the services in the course of her ordinary employment, nor did she sustain an economic loss as a result of providing the care.

Consequently, the applicant failed to prove that the attendant care expenses were 'incurred' under section 3(7)(e)(iii) of the Statutory Accident Benefits Schedule.

The appeal for benefits, interest, and costs was dismissed.

The applicant sought payment for a neurocognitive assessment, a psychological assessment, and various other expenses following a motor vehicle accident.

The Licence Appeal Tribunal found that the neurocognitive assessment was reasonable as it was intended to help the applicant decide whether to bring a claim for catastrophic impairment, but capped the payable amount at $2,000 plus tax.

The claims for the psychological assessment and other expenses were dismissed, as the applicant failed to prove they were reasonable and necessary, and the medical evidence provided by the applicant was found to be inconsistent and lacking credibility.

The applicant sought income replacement benefits (IRBs) and the cost of an orthopaedic assessment following a motor vehicle accident.

The insurer denied the benefits based on insurer examinations and surveillance video, arguing the applicant did not suffer a substantial inability to perform his pre-accident employment as a truck driver assistant and that his injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's physical and psychological impairments, combined with the heavy physical demands of his pre-accident employment, entitled him to IRBs.

The Tribunal also found the orthopaedic assessment was reasonable and necessary as the applicant's injuries fell outside the MIG.

Both parties' requests for costs were denied.

The applicant sought statutory accident benefits for medical and rehabilitation treatments following a motor vehicle accident.

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

The Tribunal found that the applicant's injuries were predominantly minor and that she failed to provide compelling evidence of a pre-existing medical condition that would entitle her to treatment beyond the MIG cap.

The application for benefits and interest was dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits after the respondent terminated them.

The applicant, a personal support worker, returned to work on modified duties and reduced hours.

The Tribunal found that the applicant suffered soft tissue injuries to her cervical and lumbar spine, rendering her substantially unable to perform the physically demanding essential tasks of her pre-accident employment.

The Tribunal ordered the respondent to pay the income replacement benefits with interest, but declined to award costs as the applicant failed to provide evidence of unreasonable conduct by the respondent.

The applicant was injured in a motor vehicle accident and sought funding for physiotherapy and a chronic pain treatment program under the Statutory Accident Benefits Schedule.

The insurer denied the treatment plans on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal reviewed the medical evidence, including reports from psychologists and orthopaedic surgeons, and found that the applicant had made significant progress in his recovery.

The Tribunal concluded that the proposed treatment plans were not reasonable or medically necessary and dismissed the application.

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

After failing to participate in a case conference and losing contact with his legal representative, the respondent moved to dismiss the application as abandoned.

The applicant failed to attend the motion hearing despite receiving notice.

The adjudicator found that the applicant had abandoned the proceeding and dismissed the application.

The applicant sought an income replacement benefit and funding for medical marijuana following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the claims.

The applicant's post-accident income in 2015 exceeded his pre-accident income, eliminating any entitlement for that year.

For 2016, the applicant failed to provide required financial disclosure despite a Tribunal order.

The claim for medical marijuana was dismissed because the applicant failed to produce a valid medical document authorizing its use under the applicable federal regulations.

The applicant was injured in a motor vehicle accident and submitted a treatment plan to the respondent insurer.

The respondent denied the plan, arguing it was unsigned and that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant submitted a valid treatment plan for $369.47.

Furthermore, the respondent failed to respond within the required 10 business days under section 38 of the Schedule.

As a result, the respondent was prohibited from taking the position that the applicant's impairment fell within the MIG and was ordered to pay the treatment plan costs along with accrued interest.

The applicant's claim for costs was dismissed.

The Applicant sought payment for three chiropractic treatment plans and non-earner benefits following a 2015 motor vehicle accident.

The insurer denied the claims on the basis that the Applicant's injuries fell within the Minor Injury Guideline (MIG) and were not reasonable and necessary.

The Tribunal found the Applicant lacked credibility due to inconsistent statements about his employment and failure to disclose a prior 2013 accident with similar injuries.

The Tribunal accepted the insurer's independent medical examinations, concluding the Applicant failed to prove his impairments were directly caused by the 2015 accident or that he met the test for non-earner benefits.

The appeal was dismissed entirely.