Rand Meshki

The applicant sought $1,887.95 for physiotherapy and massage therapy expenses incurred while awaiting a catastrophic impairment determination.

The respondent denied the claim because the expenses were incurred before a treatment plan was submitted, contrary to s. 38(2) of the Statutory Accident Benefits Schedule.

The Tribunal agreed with the respondent, finding that s. 38(2) is mandatory and relieves the insurer from liability for expenses incurred prior to the submission of a treatment plan.

The application was dismissed.

The applicant was involved in a motor vehicle accident and sought a determination of catastrophic impairment based on a mental and behavioural disorder.

The respondent denied the claim, arguing the applicant's impairments were pre-existing and did not meet the threshold.

The Tribunal found that the accident was a necessary cause of the applicant's psychological impairment, applying the 'but for' test.

Preferring the evidence of the applicant's psychological expert over the respondent's assessors, the Tribunal concluded the applicant sustained a marked impairment in all four spheres of functioning.

The application for a catastrophic impairment determination was granted, but the claim for an award for unreasonable delay was dismissed.

The applicant sought medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent insurer denied treatment plans for psychological services, physiotherapy, and vision therapy based on the opinions of its assessors.

The Licence Appeal Tribunal found that the applicant met her burden of proving the treatments were reasonable and necessary, preferring the evidence of her treating practitioners over the respondent's assessors.

The Tribunal ordered the respondent to pay $16,870.79 for the disputed treatment plans plus interest, but declined to make a special award under Regulation 664.