4 total
Applicant removed from MIG for psychological conditions but denied benefits due to section 33 non-compliance.
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) and that the applicant failed to comply with section 33 of the Schedule by not providing requested documents.
The Tribunal found that the applicant's pre-existing and accident-related psychological conditions removed him from the MIG.
However, because the applicant failed to comply with the respondent's section 33 requests for nearly three years without a reasonable explanation, he was barred from receiving the disputed medical and rehabilitation benefits.
The claims for an award and interest were also dismissed.
Applicant removed from Minor Injury Guideline due to chronic pain syndrome; physiotherapy treatment plans approved.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits.
The respondent insurer denied several physiotherapy treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant suffered from accident-related chronic pain syndrome with functional impairment, justifying removal from the MIG.
The Tribunal ordered the respondent to pay for the disputed physiotherapy treatment plans with interest, but denied the applicant's request for a special award under s. 10 of Regulation 664.
Application for income replacement benefits dismissed as applicant failed to prove quantum of loss.
The applicant sought income replacement benefits (IRBs) following a motor vehicle accident.
The parties disputed the quantum of the IRB for the periods pre- and post-104 weeks.
Both parties submitted accounting reports, but the adjudicator found both reports flawed as neither correctly attributed the loss of self-employment income to the accident versus a separate fire at the applicant's rental property.
As the applicant bore the burden of proof and failed to provide accurate evidence of the quantum owed, the application for IRBs, interest, and a special award was dismissed.
Application for income replacement benefits dismissed as statute-barred; extension of limitation period denied.
The applicant sought income replacement benefits following a motor vehicle accident, which the respondent insurer denied.
The applicant filed an appeal with the Licence Appeal Tribunal 20 days after the expiry of the two-year limitation period under section 56 of the Statutory Accident Benefits Schedule.
The applicant sought an extension of time under section 7 of the Licence Appeal Tribunal Act, 1999.
The Tribunal applied the four-factor test from Manuel and found that the applicant failed to demonstrate a bona fide intention to appeal within the limitation period, did not adequately explain the delay, and lacked strong merits for the appeal.
The Tribunal concluded that the justice of the case did not warrant an extension of time, and the applicant was statute-barred from proceeding with her claim.
