Ramandeep Kaur Pandher

The respondent insurer requested a reconsideration of a decision awarding the applicant income replacement benefits, interest at 2 percent per month, and a 35 percent special award under Regulation 664.

The insurer argued the adjudicator erred in finding it had received the applicant's employment file by August 2018 via email.

Upon reconsideration, the adjudicator found that the email containing the employment file was sent to an adjuster who had not consented to electronic delivery, contrary to the requirements of the Statutory Accident Benefits Schedule and the Electronic Commerce Act, 2000.

As proper delivery was not effected, the insurer's delay in paying benefits was reasonable.

The request for reconsideration was granted, and the orders for the special award and 2 percent interest were rescinded.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to psychological treatment, physiotherapy treatment, a chronic pain assessment, and a driving reintegration assessment.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove on a balance of probabilities that the disputed treatment plans and assessments were reasonable and necessary.

The Tribunal gave little to no weight to the applicant's expert reports, noting they were completed years after the accident and were inconsistent with the clinical notes and records of the applicant's family physicians, which showed minimal complaints and primarily degenerative changes.

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

The respondent insurer limited the applicant's medical and rehabilitation benefits to the $3,500 cap under the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing that pre-existing conditions, chronic pain, and psychological impairments warranted removal from the MIG.

The Tribunal found that the applicant failed to prove her impairments fell outside the MIG, preferring the respondent's section 44 assessment reports which found no functional impairment or DSM-V diagnosis.

As the MIG limits were exhausted, the disputed treatment plans were deemed not reasonable and necessary.

Claims for an award, costs, and interest were dismissed.

The applicant sought a $10,000 death benefit following the death of her son, who was struck by a car.

The issue was whether the son, who had a developmental delay and lived independently in a subsidized apartment, was 'principally dependent' on the applicant for financial support or care under the Statutory Accident Benefits Schedule.

The Tribunal found that the son was largely independent, covering most of his expenses through social assistance and employment, and navigating the community with support from various sources.

The application for a death benefit was dismissed.

The respondent insurer requested a reconsideration of a Tribunal decision that awarded the applicant $200 for the remaining cost of a psychological assessment.

The insurer argued the Tribunal erred in law by basing its finding on whether the $200 difference between the assessor's recommended amount and the approved amount was "significant," and that the applicant failed to prove the fee was reasonable under section 25 of the Schedule.

The Vice-Chair dismissed the request, finding that the Tribunal carefully weighed the evidence, including the insurer's own assessor's opinion, and made no significant error of law that would have led to a different outcome.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that awarded the applicant a $10,000 death benefit following the death of her 48-year-old son in a motor vehicle accident.

The adjudicator had found the deceased was principally dependent on the applicant for care.

On reconsideration, the Associate Chair found the adjudicator made significant factual errors regarding the level of care and support the applicant provided, noting the deceased lived independently for 27 years and managed most of his own needs.

The reconsideration was allowed, the original decision was cancelled, and a new hearing was ordered to properly assess financial and care dependency.

The insurer filed a request for reconsideration of a Tribunal decision that awarded the insured post-104 week attendant care benefits and deemed those benefits incurred.

The adjudicator granted the request, finding that the Tribunal made two significant errors of law.

First, the Tribunal lacked jurisdiction to award attendant care benefits beyond 104 weeks because the insured had not been designated as catastrophically impaired, as required by s. 20(2)(a) of the Schedule.

Second, the Tribunal erred in deeming the expenses incurred under s. 3(8) without making any finding that the insurer unreasonably withheld or delayed payment.

The decision was amended to limit attendant care benefits to the 104-week period and to require the insured to prove the expenses were actually incurred.

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

The respondent insurer raised preliminary issues, arguing the applicant was statute-barred from proceeding before the Licence Appeal Tribunal due to failing to provide information requested under section 33 of the Schedule and failing to attend an insurer's examination under section 44.

The Tribunal found that failure to comply with section 33 does not preclude an applicant from disputing a refusal to pay benefits, and regardless, the applicant had complied with the reasonable requests.

Furthermore, the Tribunal held the applicant was not barred for failing to attend the insurer's examination because the respondent's notice was non-compliant, as it explicitly stated attendance was not required.

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

The insurer raised preliminary issues regarding the applicant's failure to attend an insurer's examination and failure to provide requested information under s. 33 of the Schedule.

The Tribunal found the applicant was barred from proceeding with claims for certain medical benefits, IRBs, and dental benefits due to non-compliance.

On the substantive issues, the Tribunal denied claims for chiropractic and psychological treatment for lack of medical evidence, but allowed a $229.10 claim for chiropractic treatment because the insurer had effectively removed the applicant from the Minor Injury Guideline by approving psychological treatment.

The applicant sought a $10,000 death benefit from the respondent insurer after their 48-year-old adult child, who had a developmental disability, died following a pedestrian-vehicle collision.

The insurer denied the benefit, arguing the deceased lived independently.

The Tribunal found that the deceased was principally dependent on the applicant for care, as the applicant coordinated support services, provided daily emotional support, and assisted with essential needs like clothing, diet, and transportation.

The Tribunal ordered the insurer to pay the death benefit plus interest.