Thulasi Kandiah

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and an attendant care assessment.

The insurer denied the benefits.

The Tribunal found that the applicant failed to prove the treatments were reasonable and necessary, noting that the injuries were primarily soft tissue and the applicant's hand injury was from a subsequent fall.

The Tribunal also found no evidence supporting the need for an attendant care assessment.

The claims for an award and interest were 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 psychological impairments and a concussion.

The Tribunal found insufficient medical evidence connecting the applicant's psychological issues or alleged concussion to the accident.

The Tribunal concluded the injuries were predominantly minor, subject to the MIG limit, and dismissed the claims for treatment plans, an award, and interest.

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

The Tribunal found that the applicant's injuries, including mild carpal tunnel syndrome and psychological symptoms, were predominantly minor and subject to the Minor Injury Guideline (MIG) limit.

As the MIG limit was exhausted and the insurer's denial notices were compliant with s. 38(8) of the Schedule, the disputed treatment and assessment plans were denied.

The Tribunal awarded pre-104 week income replacement benefits (IRBs) in varying amounts, accounting for the applicant's post-accident employment income, but denied post-104 week IRBs as the applicant failed to prove a complete inability to engage in suitable employment.

A claim for a special award under s. 10 of Regulation 664 was also dismissed.

The applicant sought $25,000 for a dental treatment plan following a motor vehicle accident.

The respondent insurer denied the claim, arguing the dental issues were caused by pre-existing periodontal disease rather than the accident.

The Tribunal applied the 'but for' test and found the accident was a necessary cause of the rapid deterioration of the applicant's dental health, relying on the opinion of the applicant's dental surgeon.

The Tribunal concluded the proposed treatment was reasonable and necessary, ordering the respondent to pay for the treatment plan plus interest.

The applicant appealed and sought judicial review of a Licence Appeal Tribunal decision upholding the insurer's denial of medical and rehabilitation benefits beyond the $3,500 Minor Injury Guideline limit.

The applicant argued the Tribunal erred in finding he did not suffer from chronic pain, misapplied the AMA Guides, misapplied the pre-existing condition exception under s. 18(2) of the SABS, and breached procedural fairness by disregarding illegible clinical notes.

The Divisional Court dismissed the appeal and application, finding the Tribunal's factual conclusions were reasonable, it was entitled to weigh the expert medical evidence, and there was no breach of procedural fairness in a written hearing where the applicant provided illegible records.

The applicant sought payment for a chronic pain assessment following a 2019 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to provide sufficient medical evidence, such as contemporaneous complaints to her family doctor, to establish grounds for the assessment.

The Tribunal dismissed the application, denying the treatment plan, interest, and a claim for a special award.

The applicant sought accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits, medical benefits for physiotherapy, and an accounting report.

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

The Tribunal found that the applicant failed to prove she suffered from chronic pain or a psychological impairment warranting removal from the MIG.

The Tribunal also dismissed the claim for income replacement benefits, finding insufficient medical evidence of an accident-related impairment causing a substantial inability to perform the essential tasks of her employment.

The claims for the accounting report and interest were also dismissed.

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

She also claimed entitlement to a non-earner benefit and a medical treatment plan.

The Tribunal found that the applicant failed to provide sufficient medical evidence to prove her injuries warranted removal from the MIG, either due to chronic pain, psychological impairments, or pre-existing conditions.

As the MIG limit was exhausted, the treatment plan was denied.

The Tribunal also dismissed the claim for a non-earner benefit, finding insufficient evidence of a complete inability to carry on a normal life.

The applicant sought payment for six treatment plans (OCF-18s) for chiropractic, massage, and physiotherapy following a 2018 motor vehicle accident.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the treatments were reasonable and necessary.

The Tribunal concluded the applicant's lower back pain was caused by age-related degenerative changes rather than the accident, and that the proposed treatments could not reasonably achieve the goal of pain reduction for his shoulder, neck, and head injuries.

Claims for interest and costs were also dismissed.

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

The respondent denied several treatment plans and expenses 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's physical injuries were soft tissue in nature and that she failed to establish removal from the MIG on the basis of chronic pain or psychological impairment.

The Tribunal preferred the respondent's section 44 psychological assessment over the applicant's section 25 assessment.

As the applicant remained within the MIG, the disputed treatment plans and expenses were not payable.

The applicant was injured in a rear-end motor vehicle collision and sought entitlement to a chronic pain program and physiotherapy services under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide compelling evidence that the proposed treatments were reasonable and necessary.

The Tribunal relied on the respondent's section 44 assessments, which concluded the applicant had sustained soft tissue injuries, reached maximum medical improvement, and did not meet the criteria for a chronic pain disorder.

Claims for an award and interest were consequently denied.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for psychological treatment, driving rehabilitation, and an orthopaedic assessment.

The respondent insurer partially approved the psychological and driving rehabilitation treatment plans but denied the remaining balances, and fully denied the orthopaedic assessment.

The Licence Appeal Tribunal found that the applicant failed to meet her onus to prove that the denied portions of the treatment plans and the orthopaedic assessment were reasonable and necessary.

The application was dismissed.

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

In a prior Tribunal decision, it was determined that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant filed a second application disputing the MIG.

The respondent raised a preliminary issue of res judicata.

The Tribunal found that the four preconditions for res judicata were met, as the prior decision was a final judgment on the merits involving the same parties and within the Tribunal's jurisdiction.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to a chronic pain assessment, psychological treatment, and a driving rehabilitation plan.

The Licence Appeal Tribunal excluded late-filed clinical notes and records due to non-compliance with production deadlines.

The Tribunal dismissed the application, finding the applicant failed to prove the treatment plans were reasonable and necessary.

The applicant did not meet the criteria for chronic pain under the AMA Guides, and failed to provide compelling evidence for the disputed portions of the psychological and driving rehabilitation plans.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found her injuries fell within the Minor Injury Guideline (MIG) but awarded her costs for disputed treatment plans due to the insurer's defective notice.

The applicant argued the Tribunal erred in law and fact regarding the entitlement period for a physiotherapy treatment plan, the applicability of the MIG, and her claim for an award.

The adjudicator dismissed the reconsideration request, finding no errors of law or fact that would have changed the outcome, though a typographical error regarding the entitlement end date was corrected.

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

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

The Tribunal found that the applicant sustained soft tissue injuries and did not suffer from chronic pain or a psychological injury caused by the accident.

Consequently, the applicant was subject to the MIG and its funding limits, precluding entitlement to the disputed medical and attendant care benefits.

The Tribunal also dismissed the claim for non-earner benefits, finding the applicant did not suffer a complete inability to carry on a normal life.

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

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

The Tribunal found that the applicant suffered from Chronic Pain Syndrome (CPS) secondary to the accident, which removed her from the MIG.

The Tribunal ordered the respondent to pay for the disputed treatment plans for physiotherapy, a psychological assessment, and a chronic pain assessment, finding them reasonable and necessary.

Interest on overdue payments was also awarded.

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

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

The respondent also raised a preliminary issue that the applicant was barred from disputing the denials due to the expiry of the two-year limitation period under s. 56 of the Schedule.

The Tribunal found the applicant was barred from disputing the IRB denial because the respondent's notices were clear and unequivocal, and declined to extend the limitation period.

However, the notices denying the treatment plans were found invalid, so those claims were not barred.

On the substantive issue, the Tribunal concluded the applicant failed to prove her injuries fell outside the MIG.

As the MIG limits were exhausted, all claims for disputed benefits were dismissed.

The applicant requested a reconsideration of a Tribunal decision which found his injuries were predominantly minor under the Statutory Accident Benefits Schedule and denied three treatment plans.

The applicant argued the adjudicator made errors of fact and law by giving little weight to his medical expert's diagnosis of chronic pain, and that the adjudicator's interpretation of the evidence raised a reasonable apprehension of bias.

The Tribunal dismissed the request, finding that weighing evidence is a core adjudicative function and that the adjudicator's analysis did not constitute an error of law or fact.

Furthermore, the applicant failed to meet the high threshold required to establish a reasonable apprehension of bias.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including attendant care benefits and various treatment plans.

The respondent denied the benefits, arguing the applicant was bound by the Minor Injury Guideline (MIG).

The Tribunal found the applicant was not bound by the MIG due to psychological injuries, relying on an insurer's examination report.

The Tribunal granted entitlement to the physical treatment plans (physiotherapy and chiropractic) as reasonable and necessary, but denied the attendant care benefits and the unapproved balances of the psychological treatment plans for lack of evidence.