Sue Yingxue Li

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

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

The Licence Appeal Tribunal found that the applicant failed to establish a psychological impairment warranting removal from the MIG, as the evidence lacked independent medical assessments or clinical notes.

However, the Tribunal found that the insurer failed to provide a timely denial for one psychological assessment under section 38(8) of the Schedule.

Consequently, the applicant was entitled to the incurred costs for that assessment for the period of non-compliance, plus interest.

The remaining claims for treatment plans were dismissed.

The Applicant sought entitlement to statutory accident benefits for chiropractic services and a psychological assessment following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the Applicant failed to meet the onus of establishing that the proposed treatment plans were reasonable and necessary.

The Tribunal noted that the Applicant relied solely on the OCF-18 forms and self-reporting without providing sufficient medical evidence or explaining how the treatment goals would be met.

Claims for an award and interest were also dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The respondent denied certain treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and requested the applicant attend insurer's examinations (IEs) under section 44 of the Schedule.

The applicant failed to attend the scheduled IEs and did not provide a reasonable explanation for his non-attendance.

On a preliminary issue, the Tribunal found that the notices of examination were valid and that the applicant was statute-barred under section 55(1)2 from proceeding with the issue of whether his injuries were predominantly minor and one treatment plan dependent on the MIG.

However, because the respondent failed to provide evidence linking three other treatment plans to the MIG, the applicant was permitted to proceed to a hearing on those remaining issues.