Terio Francis

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claims for post-104 week income replacement benefits, a chronic pain assessment, and various medical and rehabilitation benefits.

The applicant argued that the Tribunal breached procedural fairness by admitting late-served surveillance evidence and erred in law and fact in its evaluation of the medical evidence and the legal test for benefits.

The Vice-Chair dismissed the request, finding that the Tribunal properly weighed the prejudice of the late evidence, applied the correct legal tests, and reasonably preferred the respondent's independent medical examinations over the applicant's evidence.

The reconsideration request was deemed an improper attempt to re-litigate the initial hearing.

The applicant sought $2,460 for a Chronic Pain Assessment following a motor vehicle accident, which the respondent insurer denied based on a s. 44 insurer's examination.

The Tribunal found the assessment reasonable and necessary, noting that the applicant's treating practitioners consistently documented chronic pain and even the respondent's assessor acknowledged the applicant's considerable discomfort.

The Tribunal also granted an award of 25% under s. 10 of Regulation 664, finding the respondent's denial stubborn and inflexible given the overwhelming medical evidence of chronic pain.

The respondent insurer requested a reconsideration of a Tribunal decision that awarded the applicant $25,280.00 for a catastrophic assessment treatment plan.

The respondent argued the Tribunal failed to apply the $2,000.00 statutory limit per assessment under s. 25(5) of the Schedule and improperly awarded separate fees for duplicative assessments and a file review.

The Tribunal found it had erred by not addressing these key arguments in the original decision.

The reconsideration was granted in part, and the applicant's entitlement to the treatment plan was reduced to $17,176.00.

The applicant sought various statutory accident benefits following a 2020 motor vehicle accident.

The respondent denied the claims and argued the applicant was statute-barred from proceeding due to an expired limitation period and failure to attend insurer examinations.

The Tribunal extended the limitation period under section 7 of the LAT Act, finding the delay was minor and caused no prejudice.

On the merits, the Tribunal denied the claim for non-earner benefits, finding the applicant did not suffer a complete inability to carry on a normal life.

However, the Tribunal approved several treatment plans for chiropractic, massage, and chronic pain services, as well as attendant care and catastrophic impairment assessments, finding them reasonable and necessary.

A claim for a special award was dismissed.

The applicant sought post-104-week income replacement benefits (IRBs) and various medical and rehabilitation benefits following a motor vehicle accident.

The Tribunal found the applicant did not meet the 'complete inability' test for post-104-week IRBs, relying on insurer's examinations and surveillance evidence showing her performing work activities.

The Tribunal denied claims for chiropractic services, massage therapy, and a chronic pain assessment, finding them not reasonable and necessary.

However, the Tribunal granted the applicant's claims for a psychological assessment and a driving reintegration assessment to address her vehicular anxiety, along with interest on those overdue amounts.

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

The respondent denied the claim for attendant care benefits and chiropractic services.

The applicant applied to the Licence Appeal Tribunal.

The Tribunal found that the claim for attendant care benefits was statute-barred as it was filed outside the two-year limitation period, and the applicant failed to establish reasonable grounds for an extension under s. 7 of the LAT Act.

The Tribunal also dismissed the claim for chiropractic services, finding that the applicant failed to prove the expenses were reasonable and necessary.

The application was dismissed.

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

The Tribunal found that the applicant was not entitled to $2,200.00 for minor injury guideline (MIG) treatment and supplementary goods because the MIG limit had already been exhausted prior to changing clinics.

However, the Tribunal found that a treatment plan for physical therapy in the amount of $3,622.73 was reasonable and necessary based on the medical evidence.

The applicant's claim for a special award was dismissed as there was no evidence the insurer unreasonably withheld benefits.

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 for removal from the MIG due to pre-existing osteoarthritis, chronic pain, and psychological impairments.

The Tribunal found that the applicant failed to prove her pre-existing condition prevented maximal recovery within the MIG.

Furthermore, the Tribunal gave little weight to the applicant's medical evidence regarding chronic pain, noting she had failed to disclose five prior and subsequent workplace injuries to her assessors.

The Tribunal concluded the injuries were predominantly minor, dismissed the claims for the treatment plans, and found the respondent's denial notices compliant with the Schedule.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming she was substantially unable to perform her pre-accident employment tasks.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to provide contemporaneous medical evidence of disability during the claim period.

The Tribunal relied on insurer's examinations and the applicant's successful enrollment in a computerized accounting program to conclude she was not disabled from her sedentary administrative duties.

Claims for an award and interest were consequently dismissed.

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

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

The Tribunal found the applicant suffered from a psychological impairment and chronic pain that warranted removal from the MIG.

The Tribunal ordered the respondent to pay for the disputed psychological and chronic pain assessments and treatment plans, with interest.

However, the Tribunal declined to order an award under s. 10 of O. Reg. 664, finding the respondent's denials were not unreasonable as they relied on available medical evidence.

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

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

The Tribunal found that the applicant's injuries were predominantly minor and that she failed to establish a pre-existing condition, chronic pain, or psychological impairment that would warrant removal from the MIG.

As the MIG limits were exhausted, the disputed treatment plans were not payable.

Furthermore, the Tribunal ordered the applicant to repay income replacement benefits received between October 2018 and January 2019, finding she wilfully misrepresented her work status by failing to report her return to work.

The applicant sought medical benefits and income replacement benefits following a motor vehicle accident.

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

The Tribunal found that the applicant sustained predominantly soft tissue injuries and did not suffer from chronic pain or an accident-related psychological injury.

Consequently, the applicant was subject to the MIG and not entitled to the disputed treatment plans.

The claim for income replacement benefits was also dismissed because the applicant failed to submit a disability certificate prior to the claimed period.

The applicant requested a reconsideration of a previous Tribunal decision that denied his entitlement to a non-earner benefit and an award.

The applicant argued that the adjudicator made an error of law or fact by misapprehending evidence regarding his post-accident physical and academic limitations.

The adjudicator dismissed the reconsideration request, finding no error of law or fact that would have led to a different result, and noted that the applicant was attempting to relitigate issues that had already failed at the hearing.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a non-earner benefit, treatment plans for physiotherapy and assistive devices, interest, and a special award.

The Licence Appeal Tribunal found that the applicant was not entitled to the non-earner benefit because he did not suffer a complete inability to carry on a normal life, noting he returned to school and engaged in more activities post-accident than pre-accident.

However, the Tribunal approved the three treatment plans for physiotherapy and the balance of the plan for assistive devices, finding them reasonable and necessary to treat his ongoing left elbow impairment.

Interest was awarded on the approved plans.

The claim for a special award was dismissed as the insurer's reliance on its medical assessors was not unreasonable.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for psychological services and a speech language pathology assessment.

The respondent insurer partially denied the psychological treatment plan, arguing that 1-hour sessions were sufficient rather than the 1.5-hour sessions recommended by the treating psychologist.

The respondent also denied the speech language pathology assessment.

The Licence Appeal Tribunal found that the 1.5-hour psychological sessions were reasonable and necessary, preferring the treating psychologist's recommendation.

However, the Tribunal denied the speech language pathology assessment, finding insufficient evidence of a speech impairment, as the pathologist had not examined the applicant before recommending the assessment.

The applicant was awarded the balance for the psychological services with interest.