Tal Eshel

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

The insurer denied treatment plans for neurological and chronic pain assessments, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant filed her appeal beyond the two-year limitation period, but the Tribunal granted an extension under s. 7 of the LAT Act.

While the Tribunal found the applicant's injuries did not warrant removal from the MIG, it held that the insurer's denial notices failed to provide sufficient medical reasons as required by s. 38(8) of the Schedule.

Consequently, under s. 38(11), the insurer was ordered to pay for the disputed assessments with interest.

The appellant appealed a License Appeal Tribunal (LAT) decision denying his claims for a catastrophic impairment designation, attendant care benefits, and various treatment plans following a motor vehicle accident.

The Divisional Court found no errors of law in the LAT Vice-Chair's application of the 'but for' causation test or her factual findings that the appellant's ongoing impairments were not accident-related.

The court also held that the LAT correctly dismissed the claims for treatment plans and attendant care benefits, as the appellant had no accident-related impairments during the relevant periods.

The appeal was dismissed.

The applicant sought statutory accident benefits following a 2019 motor vehicle accident.

The insurer denied treatment plans for psychological and chiropractic services in 2019.

The applicant filed an application with the Tribunal in December 2023, beyond the two-year limitation period under section 56 of the Schedule, even accounting for the 183-day extension under Regulation 73/20.

The Tribunal found the insurer's denial notices were valid and, in the absence of submissions from the applicant, declined to exercise its discretion to extend the limitation period.

The application was dismissed as statute-barred.

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

The respondent insurer denied a treatment plan for psychological services on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that while the applicant's physical injuries initially met the definition of a minor injury, she subsequently developed chronic pain and psychological impairments, including adjustment disorder and somatic symptom disorder, which warranted removal from the MIG.

The Tribunal concluded that the proposed psychological services were reasonable and necessary to address her chronic pain and emotional issues, approving the treatment plan at a reduced rate.

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

The insurer denied five treatment plans, and the applicant applied to the Tribunal more than two years after the denials.

The insurer argued the claims were statute-barred under s. 56 of the Schedule.

The Tribunal found that the denial notices for three of the treatment plans were defective as they relied on vague, boilerplate language and failed to identify the applicant's medical conditions, meaning the limitation period was not triggered for those claims.

However, the denial notices for the remaining two plans were valid and clear, and the Tribunal declined to extend the limitation period for them.

The applicant was permitted to proceed to a hearing on the three plans with defective denials.

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

The respondent denied several treatment plans, and the applicant applied to the Tribunal to dispute the denials.

The respondent argued the application was barred by the two-year limitation period under s. 56 of the Schedule.

The applicant contended the limitation period was not triggered because the denial notices lacked valid medical reasons.

The Tribunal found the respondent's denial notices were valid and clear, triggering the limitation period.

The Tribunal also declined to extend the limitation period under s. 7 of the LAT Act, as the applicant failed to establish a bona fide intention to appeal within the time limit or address the other Manuel factors.

The application was dismissed as statute-barred.

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

The respondent denied various treatment plans in 2018 and 2019.

The applicant submitted her application to the Tribunal in 2023, beyond the two-year limitation period under s. 56 of the Schedule.

The applicant argued the denials were invalid for failing to provide medical reasons.

The Tribunal found the respondent's Explanation of Benefits provided clear and unequivocal denials with sufficient reasons, triggering the limitation period.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act, finding the applicant failed to demonstrate a bona fide intention to appeal, and the delay was significant.

The application was dismissed as statute-barred.

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

The respondent denied various treatment plans, and the applicant applied to the Licence Appeal Tribunal.

The Tribunal found that the applicant's claim for a psychological assessment was statute-barred because he failed to dispute the respondent's clear and unequivocal partial denial within the two-year limitation period under s. 56 of the Schedule.

Regarding the substantive issues, the Tribunal held that the applicant failed to meet his burden of proving that the disputed treatment plans for physiotherapy, botox injections, occupational therapy, and psychological services were reasonable and necessary.

The application was dismissed in its entirety.

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 should be removed from the MIG due to physical and psychological impairments, chronic pain, and a pre-existing condition.

The Tribunal found that the applicant failed to prove on a balance of probabilities that her injuries warranted removal from the MIG.

The medical evidence supported that she suffered predominantly soft tissue injuries.

Consequently, the disputed treatment plans and claim for interest were dismissed.

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

The respondent denied several treatment plans, and the applicant applied to the Tribunal outside the two-year limitation period.

The preliminary issue was whether the applicant was barred from proceeding.

The Tribunal found that four of the respondent's denial notices were invalid because they lacked specific medical reasons, thus failing to trigger the limitation period.

However, two denial notices were valid, and the applicant failed to establish reasonable grounds for an extension under section 7 of the LAT Act.

The applicant was barred from proceeding with two treatment plans but allowed to proceed with the remaining ones.

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

The respondent insurer denied the benefits and argued the applicant was statute-barred from proceeding because he failed to commence his application within the two-year limitation period under section 56 of the Schedule.

The Tribunal found that the respondent's denial letters for psychological, chiropractic, and chronic pain assessments were defective because they relied on vague, boilerplate language that failed to provide clear medical reasons as required by section 38(8) of the Schedule and the principles in Smith v. Co-operators.

Consequently, the defective notices did not trigger the limitation period, and the applicant was permitted to proceed with his claims.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits and treatment plans for psychological and occupational assessments.

The respondent denied the claims.

The Tribunal found that the applicant was not entitled to attendant care benefits because he failed to submit evidence that the expenses were incurred.

The Tribunal also denied the psychological treatment plan because the applicant failed to address the specific portions of the plan that were denied, and denied the occupational assessment plan because it was not proven reasonable and necessary and was incurred before the treatment plan was submitted.

The application was dismissed.

The applicant requested a reconsideration of a Tribunal decision that found he was not entitled to benefits or a catastrophic impairment designation.

The applicant argued that the Tribunal made an error of law or fact regarding the applicable version of the Statutory Accident Benefits Schedule and the rules of discoverability for future claims.

The Tribunal dismissed the request, finding that the applicant failed to identify any specific error of law or fact in the original decision that would alter the result.

The Tribunal noted that the original decision does not prevent the applicant from applying for future benefits or arguing discoverability in the future.

The applicant sought a catastrophic impairment designation and entitlement to attendant care benefits and various treatment plans following a 2015 motor vehicle accident.

The central issue was causation, as the applicant experienced subsequent accidents, medical conditions including seizures and a Hills-Sachs lesion, and significant life stressors post-accident.

The Tribunal found that while the accident initially exacerbated pre-existing physical impairments and triggered some psychological symptoms, the applicant's current severe psychological impairments were caused by intervening life events and medical issues unrelated to the accident.

The Tribunal concluded the applicant did not meet the 'but for' test for causation, dismissing the application for catastrophic designation and all claimed benefits.

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

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

The applicant argued the injuries fell outside the MIG and that the respondent failed to provide proper notice of denial.

The Tribunal found that while the respondent provided late notice for two treatment plans, it cured the non-compliance before expenses were incurred.

The Tribunal concluded the applicant did not meet the burden of proving his injuries fell outside the MIG and that the disputed treatment plans were not reasonable and necessary.

The application was dismissed.

The applicant sought accident benefits following a motor vehicle collision.

The respondent denied a chiropractic treatment plan and a chronic pain assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been exhausted.

The applicant argued that pre-existing low back pain, psychological impairments, and chronic pain removed him from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence of a pre-existing condition that would prevent maximal recovery within the MIG limits.

Furthermore, the Tribunal gave little weight to the orthopaedic surgeon's recording of self-reported psychological symptoms and found insufficient evidence to establish chronic pain.

As the injuries were predominantly minor and the funding limit was exhausted, the application was dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits and the cost of a chronic pain assessment from the respondent insurer.

The insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The Tribunal found that the applicant failed to provide compelling evidence of chronic pain or a psychological impairment that would remove him from the MIG.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming chronic pain, post-traumatic fibromyalgia, and sleep disorder to escape the Minor Injury Guideline (MIG).

The adjudicator found the applicant's evidence of functional limitations and pain severity to be vague, inconsistent, and contradicted by his family doctor's records.

The adjudicator rejected the applicant's expert opinion and concluded the injuries were predominantly minor soft tissue injuries subject to the MIG.

As the $3,500 MIG limit was exhausted, the claimed medical and assessment benefits were denied.

The respondent's request for costs was also dismissed.

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

The insurer suspended and subsequently denied income replacement, attendant care, and medical/rehabilitation benefits due to the insured's failure to provide requested information under section 33 of the Schedule.

The insurer brought a preliminary issue motion to dismiss the arbitration application, arguing it was statute-barred.

The Arbitrator found that the insured failed to apply for mediation within the two-year limitation period following the clear denials of benefits.

The Arbitrator held that a suspension of benefits under section 33 triggers the limitation period once a denial is properly communicated.

The application for arbitration was dismissed in its entirety.