56 total
Application for income replacement benefits dismissed due to inconsistent presentation and lack of full effort during medical assessments.
The applicant sought an income replacement benefit (IRB) following a motor vehicle accident, claiming physical and psychological impairments prevented her from working.
The Tribunal reviewed conflicting medical assessments and found the applicant's presentation of pain and limitation to be inconsistent and lacking full effort.
Preferring the respondent's medical evidence, the Tribunal concluded the applicant did not suffer a substantial inability to perform the essential tasks of her employment.
The application for IRBs, interest, and a special award was dismissed.
Application for unapproved balances of social rehabilitation treatment plans dismissed for lack of evidence.
The applicant sought entitlement to the unapproved balances of four treatment plans for social rehabilitation counselling following a motor vehicle accident.
The dispute centered on the hourly rate of a social worker, the cost of completing the treatment plan forms, and transportation expenses.
The Tribunal found that the applicant failed to prove the higher hourly rate was reasonable and necessary, as there was insufficient evidence of specialized training or psychotherapy services.
The Tribunal also denied the transportation expenses and provider travel time, noting the applicant did not meet the catastrophic impairment exception for the 50 km deductible.
The application was dismissed, and requests for interest and costs were denied.
Application for accident benefits dismissed; applicant failed to prove injuries warranted removal from the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant failed to prove on a balance of probabilities that she suffered from chronic pain with a functional impairment or a psychological condition warranting removal from the MIG.
The Tribunal also found the applicant was not entitled to a non-earner benefit as she did not demonstrate a complete inability to carry on a normal life.
The application was dismissed.
Accident benefits denied as applicant's injuries fell within the Minor Injury Guideline and limit was exhausted.
The respondent denied various treatment plans for physiotherapy and psychological services on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.
The applicant argued her injuries fell outside the MIG due to a psychological impairment and pre-existing conditions.
The Tribunal found the applicant's physical injuries were soft tissue in nature and her psychological testing did not support a formal diagnosis.
The Tribunal accepted the respondent's section 44 assessors' conclusions that the injuries were minor.
As the MIG limit was exhausted, the disputed treatment plans and interest were denied.
Insured not barred from proceeding with application where insurer's notice of examination lacked sufficient medical reasons.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits.
The respondent insurer denied benefits and raised a preliminary issue that the applicant was barred from proceeding with his application for failing to attend an insurer's examination under section 44 of the Schedule.
The Tribunal found that the insurer's notices of examination did not comply with section 44(5) because they failed to provide sufficient medical or other reasons for the examination.
As the notices were deficient, the applicant was not barred from proceeding with his application.
The applicant's request for costs was denied.
Tribunal awards accident benefits for chiropractic and psychological treatment but denies award for unreasonable delay.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic and psychological treatment, which the respondent insurer denied.
The Licence Appeal Tribunal found that the proposed chiropractic treatment and the substantive psychological treatment sessions were reasonable and necessary to achieve maximum recovery, given the applicant's chronic pain and psychological impairments.
However, claims for document preparation and transportation expenses were denied.
The Tribunal also dismissed the applicant's claim for an award for unreasonable delay, finding the insurer acted in good faith, but awarded interest on the overdue benefit payments.
Applicant remains in MIG, but treatment plans payable due to insurer's defective denial letters.
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.
Applicant barred from pursuing certain accident benefits after failing to attend insurer examinations without reasonable explanation.
The respondent raised a preliminary issue, arguing the applicant was barred from proceeding with his claims because he failed to attend insurer examinations under section 44 of the Schedule.
The Tribunal found the applicant failed to attend examinations for catastrophic impairment and income replacement benefits without a reasonable explanation, barring those claims under section 55.
However, the respondent did not establish that examinations were requested for the chronic pain assessment or attendant care benefits, allowing those claims to proceed.
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline limit.
The insurer denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered physical or psychological injuries warranting removal from the MIG.
The Tribunal preferred the evidence of the insurer's assessors, noting the lack of objective medical evidence supporting non-minor physical injuries and the absence of the applicant's psychological reports in the submissions.
Application for accident benefits dismissed as injuries fell within the exhausted Minor Injury Guideline limits.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming her injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain and psychological impairments.
The respondent denied the benefits, arguing the injuries were minor and the $3,500 MIG limit was exhausted.
The Tribunal found the applicant failed to prove her injuries warranted removal from the MIG, noting her treating physicians primarily diagnosed minor sprains and strains, and her psychological complaints arose over a year post-accident.
As the MIG limit was exhausted, the claims for further physiotherapy and psychological assessments were dismissed.
The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.
The applicant argued for removal from the MIG due to chronic pain and psychological impairments.
The Tribunal found the applicant failed to provide compelling medical evidence to support removal from the MIG, noting illegible clinical notes and a lack of corroborating evidence beyond self-reports.
The application was dismissed as the MIG limit was exhausted.
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline.
The Tribunal found that the applicant's physical injuries, including a nose injury and sprains/strains, met the definition of a minor injury.
The applicant failed to prove a pre-existing condition or that his psychological symptoms were accident-related to justify removal from the MIG.
Consequently, the claims for various treatment plans and interest were dismissed.
Reconsideration request dismissed as applicant failed to establish errors of law or fact.
The applicant requested a reconsideration of a preliminary issue decision which found she was not involved in an accident under the Statutory Accident Benefits Schedule.
The applicant argued the Tribunal made errors of fact regarding the cause of her injuries and errors of law in applying the test for an accident.
The adjudicator dismissed the request, finding that the applicant was attempting to re-argue her case and failed to meet the high threshold for reconsideration under Rule 18.2.
Applicant held to Minor Injury Guideline limit as evidence failed to establish injuries warranting removal.
The respondent determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied several treatment plans as the $3,500 limit was exhausted.
The applicant argued that psychological sequelae and physical injuries warranted removal from the MIG.
The Tribunal found the applicant's psychological evidence lacked objective support and failed to disclose pre-existing conditions, preferring the respondent's psychological and physical assessments.
The Tribunal concluded the applicant's injuries were predominantly minor, and because the MIG limit was exhausted, the disputed treatment plans and interest were not payable.
Application for accident benefits dismissed after self-represented applicant failed to attend the hearing.
The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that her injuries fell within the Minor Injury Guideline.
A videoconference hearing was scheduled, but the self-represented applicant failed to attend.
The Tribunal proceeded in her absence under the Statutory Powers Procedure Act.
Because the applicant provided no submissions or evidence, she failed to meet her burden of proof.
The application for non-earner benefits, medical benefits, and interest was dismissed.
Slip and fall on ice while entering a vehicle is not an accident under the Schedule.
The applicant sought statutory accident benefits after slipping on ice while attempting to enter her vehicle in a parking lot.
The respondent denied benefits on the basis that the incident was not an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.
The Tribunal applied the purpose and causation test, finding that while the purpose test was met, the causation test was not.
The Tribunal concluded that the ice on the ground was an intervening cause and the dominant feature of the incident, breaking the chain of causation.