Sam Davies

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 applicant argued she suffered from chronic pain with functional limitations, removing her from the MIG.

The Tribunal found the applicant failed to prove on a balance of probabilities that she suffered from chronic pain caused by the accident, preferring the respondent's physiatrist's evidence over the applicant's.

As the MIG limits were exhausted, the disputed treatment plans were not payable.

The Tribunal also found the respondent properly denied the treatment plans within the prescribed timelines, and dismissed the claims for interest and an award.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, specifically claiming entitlement to a chronic pain assessment.

The insurer denied the benefit, arguing the applicant's pain was related to a more severe 2018 accident and that he did not meet the AMA Guides criteria for chronic pain.

The Tribunal found the applicant failed to establish that the assessment was reasonable and necessary, noting the lack of objective evidence linking his pain to the 2017 accident and his failure to meet three of the six AMA Guides criteria.

The claims for the assessment, interest, and a section 10 award were dismissed.

The applicant sought reconsideration of a Licence Appeal Tribunal decision denying entitlement to medical benefits and interest.

The applicant argued the Tribunal violated procedural fairness by ruling on settled issues, limiting written submissions, and failing to award interest on overdue payments.

The applicant also alleged errors of law and fact regarding the causation of a shoulder injury and the necessity of various treatment plans.

The adjudicator dismissed the majority of the request, finding no procedural unfairness or errors of law, and noting that a reconsideration is not an opportunity to re-argue facts.

However, the adjudicator granted the request in part, ordering the respondent to pay interest on two treatment plans it had previously agreed to fund.

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

The insurer denied treatment plans for physiotherapy, psychological services, a neuropsychological assessment, and an attendant care assessment.

The Tribunal found that the applicant's left shoulder injury was a pre-existing condition that was not caused or exacerbated by the accident, failing the "but for" causation test.

The Tribunal preferred the insurer's psychological assessment over the applicant's experts, finding insufficient objective evidence to support a psychological diagnosis.

The application was dismissed, and no benefits or interest were awarded.