6 total
Applicant removed from Minor Injury Guideline due to psychological impairment; psychological assessment approved but others denied.
The applicant sought statutory accident benefits following a motor vehicle accident.
The insurer denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found the applicant suffered from an accident-related psychological impairment, specifically Somatic Symptom Disorder and Adjustment Disorder, warranting removal from the MIG.
The Tribunal approved a treatment plan for a psychological assessment but denied other treatment plans for chronic pain, physiotherapy, guided exercise, and a social work assessment due to lack of supporting evidence.
Insurer awarded partial repayment of income replacement benefits; higher claim barred by 12-month notice period.
The applicant insurer sought repayment of $4,336.81 in income replacement benefits (IRBs) paid to the respondent, alleging he returned to work without notifying them.
The respondent argued the repayment notices were deficient under s. 52 of the Schedule.
The Tribunal found the applicant's initial notices for $1,697.09 were valid and timely, but a subsequent notice for the higher amount was issued beyond the 12-month limitation period without proof of wilful misrepresentation or fraud.
The Tribunal ordered the respondent to repay $1,697.09 plus interest, and denied the respondent's request for costs.
Application for medical benefits dismissed as applicant failed to prove treatment plans were reasonable and necessary.
The applicant sought medical benefits for occupational therapy (a SPECT scan) and optometric services following a motor vehicle accident, along with interest and a special award.
The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the treatment plans were reasonable and necessary.
The medical evidence, including normal MRI results and a lack of referrals, did not support the need for a SPECT scan or functional assessment.
The claims for interest and a special award were consequently dismissed.
Insurer granted repayment of $1,428.58 in overpaid Income Replacement Benefits due to post-accident employment income.
The insurer applied to the Licence Appeal Tribunal for repayment of Income Replacement Benefits (IRB) paid to the respondent.
The insurer argued that the respondent received post-accident employment income that was deductible from the IRB, resulting in an overpayment of $1,428.58.
The respondent did not provide written submissions.
The Tribunal proceeded in the respondent's absence and found that the insurer was entitled to the repayment of $1,428.58, plus interest, as the respondent's gross employment income was deductible under the Schedule.
SABS application dismissed and costs awarded after applicant failed to file timely hearing submissions.
The applicant sought statutory accident benefits for chiropractic services following a motor vehicle accident.
The matter proceeded to a written hearing, but the applicant failed to file her submissions by the deadline set in the Case Conference Report and Order.
The Tribunal excluded the applicant's late submissions and evidence, resulting in the dismissal of her claims for the treatment plans.
The Tribunal awarded $300 in costs to the respondent due to the applicant's unreasonable conduct in failing to comply with the Tribunal's orders and providing no explanation for the delay.
Applicant awarded post-104 IRBs due to accident-related psychological impairments preventing return to suitable employment.
The applicant was involved in a motor vehicle accident and sought post-104 income replacement benefits (IRBs) due to psychological impairments.
The respondent terminated IRBs based on insurer examinations suggesting the applicant could work in alternative roles or teach yoga.
The Tribunal found that the applicant suffered from severe depression and anxiety that prevented her from maintaining regular attendance or performing duties in a competitive, real-world setting comparable to her pre-accident career as a mental health consultant.
The Tribunal ordered the respondent to pay the post-104 IRBs with interest, but dismissed the applicant's claim for a special award under s. 10 of O. Reg. 664, finding insufficient evidence of unreasonable conduct by the insurer.
