Pamela J. Quesnel

The applicant and respondent both requested a reconsideration of a previous Licence Appeal Tribunal decision that awarded the applicant a special award of $550.00 related to a denied physiatry assessment.

The respondent argued the adjudicator erred in law by considering extraneous factors and incorrectly quantifying the award.

The applicant argued the adjudicator erred in calculating the award amount by not including other denied treatment plans.

The adjudicator dismissed both requests, finding that the respondent failed to establish any error of law regarding the special award, and that the applicant's request involved issues not properly raised at the original hearing.

Both the applicant and the respondent requested a reconsideration of a previous Tribunal decision that awarded the applicant a special award of $550.00 related to a denied physiatry examination.

The respondent argued the adjudicator erred in law by considering extraneous factors and concluding a general practitioner was unqualified to assess the need for a physiatry assessment.

The applicant argued the adjudicator erred in calculating the special award amount.

The Tribunal dismissed both requests, finding no error of law or fact, as the respondent failed to explain its decision-making process and the applicant raised issues not properly before the Tribunal at the original hearing.

During an in-person hearing regarding a catastrophic impairment claim, the applicant sought to admit the full neuropsychological report of Dr. Gilman, which had not been fully disclosed prior to the hearing.

The respondent objected on the basis of late disclosure and prejudice.

The Tribunal allowed the full report to be admitted, finding that its relevance and probative value outweighed any prejudice to the respondent.

The Tribunal ordered the applicant to provide the complete report to the respondent's expert and directed a case conference to address any necessary rebuttal reports.

The applicant sought reconsideration of a Tribunal decision finding his injuries fell within the Minor Injury Guideline (MIG).

Following the initial decision, the respondent conducted a psychological insurer's examination which concluded the applicant sustained a psychological impairment.

The respondent subsequently conceded the applicant was not subject to the MIG and approved the disputed treatment plans, save for a neurological assessment.

The Tribunal granted the reconsideration request, finding the psychological report constituted new evidence that would have affected the result.

The Tribunal remitted the issues of the neurological assessment and a special award back to the hearing adjudicator, while dismissing the applicant's request for costs due to procedural non-compliance.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for an in-home assessment, prescription medication, a chronic pain assessment, and chiropractic treatment.

The respondent insurer denied the claims.

The Licence Appeal Tribunal found that the applicant was not entitled to the in-home assessment or the prescription expenses, as the evidence did not establish they were reasonable and necessary for accident-related impairments.

However, the Tribunal granted the claims for the chronic pain assessment and chiropractic treatment, finding that the applicant's pre-existing chronic pain was exacerbated by the accident and that the proposed treatments were reasonable and necessary to manage her symptoms.

Interest was awarded on the overdue payments for the approved benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic and psychological services.

The respondent insurer denied the treatment plans based on insurer examinations which found no objective physical impairments and concluded that the applicant's psychological symptoms were related to pre-existing behavioural issues rather than the accident.

The adjudicator agreed with the respondent's medical experts, finding that the applicant failed to prove the treatments were reasonable and necessary.

The application was dismissed.

The applicant, injured in a motor vehicle accident, sought statutory accident benefits from the insurer.

After the insurer terminated and denied certain benefits, the applicant applied for arbitration and sought a special award, alleging bad faith.

As a preliminary issue, the applicant brought a motion for the production of information regarding the insurer's setting of reserve amounts for his claim.

The arbitrator ordered the insurer to disclose the reserve information, finding it relevant to the applicant's claim that the file was adjusted unreasonably and to the potential quantification of a special award.

The issue of expenses was deferred to the hearing arbitrator.