Simran Walia

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

The respondent denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant demonstrated she suffered from a psychological condition (anxiety, PTSD, and depression) caused by the accident, warranting removal from the MIG.

The Tribunal approved a treatment plan for a psychological assessment and partially approved a treatment plan for psychological services, adjusting the hourly rate to that of a psychotherapist.

Interest was awarded on overdue benefits, but the claim for an award under s. 10 of Reg. 664 was dismissed as the respondent's conduct was not unreasonable.

The applicant, a 94-year-old pedestrian, was struck by a motor vehicle and subsequently sought statutory accident benefits.

He passed away approximately eight months after the accident, and his estate continued the application.

The Licence Appeal Tribunal held that the estate was not entitled to death benefits, as such benefits attach to dependents, nor funeral benefits, as the applicant failed to prove the accident was the direct cause of his death from C. Difficile.

The Tribunal also denied attendant care benefits incurred prior to the submission of a Form 1, and lodging expenses for lack of evidence.

The applicant was awarded partial reimbursement for a wheelchair rental and a transfer pole.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and various 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 sufficient evidence of her pre-accident activities to establish a complete inability to carry on a normal life, thereby dismissing the claim for a non-earner benefit.

Furthermore, the applicant failed to establish that she suffered from chronic pain syndrome caused by the accident that would warrant removal from the MIG, particularly given her extensive pre-existing medical conditions.

As the MIG limits were exhausted, the treatment plans were denied, along with claims for an award and interest.

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

The respondent denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that the respondent's denial notices were procedurally defective under s. 38(8) of the Schedule.

The Tribunal found that the applicant failed to provide medical evidence to establish removal from the MIG.

Furthermore, the Tribunal held that the respondent's denial notices were compliant with the Schedule, as they clearly identified the treatment plans and provided valid medical reasons for the denials.

The application was dismissed.

The respondent insurer requested reconsideration of a Tribunal decision finding that it failed to properly deny a chiropractic treatment plan under s. 38(8) of the Schedule, triggering the 'shall pay' provisions of s. 38(11).

The Tribunal dismissed the insurer's argument that its submissions were misinterpreted, but agreed that it had overlooked a second denial letter dated October 11, 2024.

The Tribunal found this second letter complied with s. 38(8) and effectively ended the 'shall pay' period.

The original decision was varied to state that the treatment plan is payable only if incurred between the first non-compliant denial on May 4, 2023, and the compliant denial on October 11, 2024.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to attendant care benefits, psychological services, and ambulance services.

The Licence Appeal Tribunal denied the claim for attendant care benefits, finding the applicant failed to prove the expenses were incurred for services qualifying as attendant care.

The Tribunal also denied the claim for pre and post-session preparation fees for psychological services, as they exceeded the Professional Services Guideline rates without justification.

However, the Tribunal granted the claim for ambulance services, finding the hospital visit was directly related to accident-caused back pain and mobility issues.

Interest was awarded on the overdue ambulance benefit.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to five physiotherapy treatment plans, a general practitioner assessment, and a social work assessment.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove on a balance of probabilities that the proposed treatments and assessments were reasonable and necessary.

The Tribunal preferred the respondent's section 44 medical assessments, which concluded the applicant had reached maximum medical improvement, over the applicant's evidence, noting that the applicant's family physician records lacked accident-related complaints.

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

The respondent denied a treatment plan for a psychological assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she suffered from post-accident psychological impairment and that the respondent failed to provide a timely denial under s. 38(8) of the Schedule.

The Tribunal found the applicant's injuries were predominantly minor and she did not establish a psychological impairment.

The Tribunal also found the respondent's denial was timely because the treatment plan was submitted after business hours, deeming it submitted the following day.

The application was dismissed.

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

The respondent denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The adjudicator found the applicant suffered from psychological conditions, including PTSD and Major Depressive Disorder, which removed her from the MIG.

The adjudicator approved a psychological services treatment plan and partially approved a physical therapy treatment plan, finding them reasonable and necessary.

Claims for a special award under s. 10 of Reg. 664 and costs were dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for occupational therapy and chiropractic treatment, which the respondent insurer denied.

The Licence Appeal Tribunal found that the proposed occupational therapy was reasonable and necessary given the applicant's ongoing post-concussive symptoms and pre-accident history of concussions, preferring the treating occupational therapist's recommendations over the insurer's assessments.

However, the Tribunal denied the claim for chiropractic treatment, noting that extensive prior sessions had yielded no improvement in the applicant's chronic pain.

The Tribunal also dismissed the applicant's claim for a special award under s. 10 of Regulation 664, finding no evidence that the insurer acted unreasonably in its handling of the claims.

The applicant was awarded the cost of the occupational therapy treatment plus interest.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing for removal from the Minor Injury Guideline (MIG) on the basis of chronic pain.

The Licence Appeal Tribunal found that the applicant failed to provide objective medical evidence of a functional impairment accompanying the chronic pain.

Relying on the respondent's section 44 multidisciplinary assessments, which concluded the applicant had reached maximum medical recovery, the Tribunal held the applicant to the MIG.

Consequently, the disputed treatment plans were not assessed for reasonableness and necessity, and claims for interest and a section 10 award were dismissed.

The applicant sought accident benefits following a motor vehicle accident, disputing the insurer's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on chronic pain and psychological impairment, relying on an orthopedic assessment.

The Tribunal found the applicant did not meet the burden of proof, assigning more weight to the insurer's examinations which found normal physical limits and no functional impairment.

The Tribunal also dismissed the claim for a non-earner benefit, finding the applicant returned to school and managed job responsibilities, failing to demonstrate a complete inability to carry on a normal life.

The application was dismissed.

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

The respondent denied a treatment plan for chiropractic services and argued the applicant was subject to the Minor Injury Guideline (MIG).

The Tribunal found the applicant was no longer subject to the MIG.

The Tribunal also held that the respondent's denial notice for the chiropractic treatment plan was defective because it lacked specific medical reasons, triggering the 'shall pay' provision under s. 38(11) of the Schedule.

The applicant was awarded the treatment plan costs once incurred, plus interest, but the claim for a special award was dismissed.

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 for removal from the MIG based on chronic pain and a psychological condition.

The Tribunal found insufficient contemporaneous medical evidence to support a diagnosis of chronic pain with functional impairment or a psychological condition beyond normal psycho-social sequelae.

The Tribunal concluded the applicant's injuries were subject to the MIG limit, making it unnecessary to assess the disputed treatment plans, and denied the claim for interest.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her physical and psychological impairments warranted removal from the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's physical injuries were soft-tissue in nature and not corroborated by legible medical records to be outside the MIG.

Furthermore, the Tribunal assigned little weight to a psychological report that failed to consider non-accident-related stressors.

The Tribunal concluded the injuries were minor, and since the $3,500 MIG limit was exhausted, the disputed treatment plans and claim for a section 10 award were dismissed.

The applicant sought payment for unapproved portions of three treatment plans for psychological services and attendant care assessments, arguing a social worker should be paid at a psychologist's hourly rate.

The Tribunal found the applicant failed to prove the unapproved amounts, including additional administrative fees and the higher hourly rate, were reasonable and necessary.

The Tribunal also found the insurer's denial letters complied with s. 38(8) of the Schedule.

The application for benefits, interest, and an award under s. 10 of Reg. 664 was dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, claiming chronic pain and psychological impairments warranted removal from the MIG.

The Tribunal found the applicant failed to meet his burden of proof, noting a lack of medical evidence supporting chronic pain with functional impairment or a psychological condition.

As the applicant remained within the MIG, the disputed psychological assessment was not payable.

The application was dismissed.

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.

The matter proceeded to a written hearing.

The applicant failed to file any submissions or evidence despite receiving notice.

Consequently, the Tribunal proceeded without her participation under section 7(2) of the Statutory Powers Procedure Act.

As the applicant bore the onus of proof and provided no evidence, the Tribunal found she failed to demonstrate entitlement to removal from the Minor Injury Guideline or to the disputed treatment plans.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain.

The Licence Appeal Tribunal found the applicant failed to establish he met at least three criteria under the AMA Guides for chronic pain, noting insufficient corroborating evidence for his expert's assessment.

The Tribunal also found the applicant unreasonably refused to attend a section 44 insurer's examination.

As the applicant remained within the MIG and the funding limits were exhausted, the claims for additional treatment plans, interest, and a section 10 award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to two physiotherapy treatment plans, three psychological services treatment plans, interest, and an award for unreasonable delay.

The adjudicator found that the applicant failed to prove the physiotherapy plans were reasonable and necessary, placing significant weight on the respondent's physiatry report which was corroborated by the applicant's own family doctors' clinical notes.

The adjudicator also found the respondent complied with the notice requirements under s. 38(8) of the Schedule.

The psychological services plans were no longer in dispute as they had already been paid in full.

As no benefits were overdue or unreasonably withheld, the claims for interest and an award were dismissed.