Shikha Sharma

The applicant sought payment for two chiropractic treatment plans following a motor vehicle accident.

The respondent denied the benefits on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment was reasonable and necessary, noting the lack of recommendation from his family physician and his own reports that his soft tissue injuries had resolved.

The Tribunal also dismissed the applicant's claims for a section 10 award and costs, finding that the applicant's failure to provide timely medical documentation impeded the respondent's ability to adjust the claim.

The applicant sought income replacement benefits following a motor vehicle accident.

The respondent insurer brought a motion for repayment of benefits already paid, alleging wilful misrepresentation.

The Tribunal found that the applicant deliberately misrepresented his employment status, claiming to be an employee rather than self-employed, and submitted falsified pay slips to support his claim.

Surveillance evidence further undermined the applicant's credibility.

The Tribunal dismissed the application for ongoing benefits and ordered the applicant to repay $59,817.21 in benefits previously paid due to his wilful misrepresentation.

The respondent was also found entitled to an off-set for CPP disability benefits.

The applicant, an 85-year-old pedestrian injured in a 2012 motor vehicle accident, sought attendant care benefits and funding for assessments.

The Tribunal dismissed the application, finding the applicant failed to prove her niece sustained an economic loss to qualify for attendant care benefits under the incurred expense requirement.

The Tribunal also denied funding for an occupational therapy assessment and a clinic file review, finding them not reasonable and necessary.

As no benefits were payable, the claim for an award for unreasonable delay was also dismissed.

The insurer requested reconsideration of a Licence Appeal Tribunal decision that awarded the claimant a special award under s. 10 of the Automobile Insurance Regulation for unreasonable delay in paying benefits.

The Associate Chair granted the reconsideration, finding that the Tribunal made an error of law by ordering the award solely because the insurer agreed to pay the treatment plan shortly before the hearing, without evidence of unreasonable delay.

The Tribunal also breached procedural fairness by not allowing the insurer an opportunity to respond to the claimant's late request for the special award.

The order granting the s. 10 award was cancelled.

The applicant, a 79-year-old passenger injured in a bus accident, sought a non-earner benefit and medical benefits.

The insurer initially denied medical benefits beyond the Minor Injury Guideline (MIG) cap but later conceded the injuries were not minor and approved a disputed treatment plan.

The Tribunal dismissed the claim for a non-earner benefit, finding the applicant failed to prove a complete inability to carry on a normal life, as his limitations were largely due to pre-existing conditions.

However, the Tribunal awarded interest and a 50% special award on the delayed treatment plan, finding the insurer's belated decision to remove the applicant from the MIG unreasonably delayed his access to treatment.

The applicant filed applications alleging that the respondents contravened Minutes of Settlement by failing to use best efforts to provide home care services in accordance with her preferences, specifically for a non-smoking Filipina personal support worker available on Sunday mornings.

Following the withdrawal of the applicant's long-time worker, the respondents faced difficulties finding a suitable replacement due to the applicant's extensive 'do not send' list and her refusal to consider alternative agencies.

The Tribunal found that the respondents had made best efforts and did not contravene the settlement, dismissing the applications.

The applicant sought reconsideration of a Licence Appeal Tribunal decision denying her claim for an income replacement benefit following a motor vehicle accident.

The applicant argued that the Tribunal misapplied the test for eligibility, failed to state the standard of proof, and improperly considered certain evidence.

The Executive Chair dismissed the request for reconsideration, finding that the Tribunal correctly concluded the applicant was not working due to a temporary layoff rather than a substantial inability to perform her pre-accident employment.

The Chair also found no error in the Tribunal's application of the standard of proof or its treatment of the evidence.

The applicant sought income replacement benefits following a motor vehicle accident.

The respondent denied the benefits based on independent medical examinations.

The Tribunal found that the applicant failed to prove she suffered a substantial inability to perform the essential tasks of her pre-accident employment.

The evidence indicated that the applicant's periods of unemployment were due to temporary layoffs rather than accident-related impairments, and she had actively sought and obtained other employment.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits after the respondent terminated them.

The Tribunal found that while the accident caused the applicant's sprains and strains, he failed to prove a substantial inability to perform the essential tasks of his pre-accident employment as a cleaner.

The Tribunal rejected the applicant's medical evidence for failing to link test results to diagnoses, preferring the respondent's medical examiners who found no specific neuromusculoskeletal abnormality.

The application for benefits and costs was dismissed.

In a dispute over income replacement benefits, the respondent raised a preliminary issue seeking to exclude four sets of documents submitted by the applicant, arguing they breached a prior Tribunal order and disclosure rules.

The adjudicator found no breach of the prior order.

Three documents were served within the filing deadline and were admitted.

The fourth document, an expert report, was served late under Rule 10.

Applying Rule 3.1 to liberally interpret the rules, the adjudicator admitted the expert report as relevant and necessary, curing any prejudice by granting the respondent 30 days to review and respond to it.