Shirline Apiou

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including an income replacement benefit and funding for treatment plans.

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 provide compelling medical evidence to warrant removal from the MIG.

Furthermore, the applicant was not entitled to an income replacement benefit because the disability certificate was submitted after the disputed period.

The application was dismissed.

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

The insurer partially approved treatment plans for psychological services but reduced the hourly rate for a psychotherapist from the psychologist rate to a lower rate.

The applicant also sought approval for a naturopath examination.

The Tribunal found that the insurer correctly applied the Professional Services Guideline in determining the hourly rate for the psychotherapist, as psychotherapists are not listed in the Guideline and the insurer's approved rate was reasonable.

The Tribunal also found the naturopath examination was not reasonable and necessary, preferring the insurer's examination report.

The application was dismissed.

The applicant sought judicial review of a Licence Appeal Tribunal decision barring him from proceeding with an appeal for catastrophic injury benefits due to his failure to attend an insurer's medical examination and provide documents.

The Divisional Court dismissed the application, finding that the applicant had an adequate alternative remedy through a statutory right of appeal under the Licence Appeal Tribunal Act.

The court held that no exceptional circumstances existed to justify bypassing the statutory appeal process in favour of judicial review.

The insurer brought a preliminary motion to bar the insured's appeal for statutory accident benefits on the basis that the insured failed to attend scheduled independent medical examinations (IEs) and failed to provide requested medical information.

The insured argued that the insurer failed to properly arrange the IEs and that the assessment facility was not independent.

The Tribunal rejected the insured's arguments, finding that the insurer properly scheduled the IEs and that the insured's refusal to attend was without merit.

The Tribunal held that the appeal was statute-barred under section 55 of the Schedule due to the insured's non-compliance with section 44.

The insurer's request for an order restraining the insured from contacting its IE providers was dismissed for lack of jurisdiction, and both parties' requests for costs were denied.

The applicant sought reconsideration of a Tribunal decision that found his appeal for statutory accident benefits was statute-barred due to his failure to attend independent medical examinations (IEs).

The applicant also requested the adjudicator's recusal, alleging a reasonable apprehension of bias based on the adjudicator's professional background and alleged errors in the original decision.

The adjudicator dismissed the recusal request, finding no cogent evidence to overcome the presumption of impartiality.

The adjudicator also dismissed the requests for reconsideration, concluding that while some minor factual errors were made in the original decision, they did not amount to significant errors of law or fact that would have altered the outcome regarding the applicant's non-compliance with section 44 of the Schedule.

Both parties' requests for costs were denied.

The applicant, who sustained a catastrophic impairment, sought payment for mileage expenses incurred by his service providers travelling to his home for treatment.

The insurer denied the mileage claims, arguing the Statutory Accident Benefits Schedule (SABS) and related Guidelines do not require payment for provider travel costs.

The Licence Appeal Tribunal agreed with the insurer, finding that while the SABS explicitly covers transportation expenses for insured persons and their aides, it does not mandate payment for service provider mileage.

The application for mileage expenses was dismissed.

The Applicant was catastrophically injured when he lost control of an uninsured motorcycle.

The Insurer denied certain statutory accident benefits under s. 31(1)(a)(i) of the Schedule, arguing the Applicant had purchased the motorcycle that day and knew or ought reasonably to have known it was uninsured.

The Arbitrator found the Insurer failed to prove on a balance of probabilities that the Applicant had purchased the motorcycle or that an ordinary rational person in his circumstances ought reasonably to have known it was uninsured.

The Arbitrator also admitted the testimony of the Applicant's cousin despite late disclosure, and admitted a discovery transcript from a related priority arbitration.

The preliminary issue was resolved in the Applicant's favour.

The applicant applied for statutory accident benefits following a motor vehicle accident.

After failing to attend multiple pre-hearing resumptions and her counsel withdrawing due to an inability to contact her, the insurer brought a motion to dismiss the arbitration.

The arbitrator attempted to reach the applicant by telephone at the hearing but was unsuccessful.

Finding that the applicant had abandoned her application, the arbitrator granted the motion and dismissed the application for arbitration.

The applicant's representative brought a motion to be removed as solicitor of record in a statutory accident benefits dispute.

The representative provided evidence of a complete breakdown in the solicitor-client relationship, noting that the applicant had failed to respond to numerous letters and telephone calls and had failed to attend scheduled pre-hearings.

The arbitrator found that the representative had complied with the requirements of the Dispute Resolution Practice Code and granted the motion to withdraw.

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

The insurer terminated benefits after conducting section 42 assessments but failed to request a new disability certificate prior to the assessments, relying instead on an eight-week-old certificate.

The applicant moved for interim benefits based solely on this procedural breach.

The arbitrator found that while the insurer breached section 37(1)(a) of the Schedule by failing to request a new disability certificate, this breach did not automatically entitle the applicant to interim benefits.

The applicant was still required to show a prima facie case, urgency, or compelling need, which she failed to do.

The motion for interim benefits was dismissed.

The insurer brought a motion to determine whether insurer's examinations under section 42 of the Statutory Accident Benefits Schedule were reasonably required to assess whether the applicant met the post-104 week test for entitlement to income replacement benefits.

The arbitrator found that the change in the test for entitlement at 104 weeks was sufficient to entitle the insurer to an examination addressing the new test.

The assessments were found to be reasonably required and the arbitration hearing was adjourned on consent.

The insurer brought a motion to dismiss the applicant's arbitration for statutory accident benefits without a hearing.

The parties had previously negotiated a settlement, but the applicant drafted his own release, which the insurer rejected, and the applicant subsequently ceased communicating with the Commission and the insurer.

The arbitrator found that the applicant's conduct did not meet the high threshold for dismissal under Rule 68 as frivolous, vexatious, or in bad faith.

However, the arbitrator concluded that the applicant had abandoned his claim and deemed the arbitration withdrawn pursuant to Rule 70.

The applicant was ordered to pay $1,000 in expenses to the insurer.