Yalda Aziz

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for occupational therapy and a driver re-integration assessment.

The respondent denied the benefits, relying on independent medical examinations.

The Tribunal found the occupational therapy assessment and a portion of the occupational therapy services were reasonable and necessary, given the applicant's ongoing functional limitations.

However, the in-vehicle driver assessment was denied because the applicant's passenger anxiety had already been diagnosed and could be addressed through previously approved cognitive behavioural therapy.

Claims for a special award and costs were dismissed, but interest on overdue payments was granted.

The applicant sought accident benefits following a motor vehicle accident, claiming her injuries warranted removal from the Minor Injury Guideline (MIG) due to a pre-existing condition and chronic pain.

The Licence Appeal Tribunal found insufficient objective medical evidence to support a pre-existing condition or chronic pain with functional impairment.

The Tribunal concluded the applicant's injuries were predominantly minor, subject to the MIG and its $3,500 funding limit.

Consequently, the claims for chiropractic treatment plans, interest, and an award for unreasonable delay were dismissed.

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

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

The Licence Appeal Tribunal found that the applicant sustained a concussion, removing him from the MIG.

The Tribunal approved treatment plans for early physiotherapy and a neurological assessment, finding them reasonable and necessary.

However, later physiotherapy plans, an attendant care assessment, and a psychological assessment were denied for lack of supporting evidence.

Interest was awarded on overdue benefits.

The applicant sought entitlement to statutory accident benefits for an occupational therapy assessment and treatment plan following a 2018 motor vehicle accident.

The adjudicator found that the applicant failed to prove the treatment plans were reasonable and necessary, noting that medical evidence and the applicant's own self-reports indicated she was independent in her activities of daily living, had resumed driving, and was working.

As no benefits were payable, the claims for interest and a special award were also dismissed.

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

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

The applicant argued that the respondent failed to comply with the notice requirements under s. 38(8) of the Schedule.

The Tribunal found that the respondent provided timely and compliant notices with medical reasons for the denials.

The Tribunal further held that the applicant failed to provide compelling medical evidence to demonstrate that her injuries warranted removal from the MIG.

The application was dismissed.

The applicant sought various medical and rehabilitation benefits following a motor vehicle accident.

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 sustained predominantly minor injuries and failed to establish that her pre-existing conditions, chronic pain, or psychological impairments warranted removal from the MIG.

The application was dismissed, though the applicant remained entitled to benefits already incurred up to the $3,500 MIG limit.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits for a chronic pain treatment plan in the amount of $7,839.88.

The respondent partially approved the plan but denied the remaining services.

The Tribunal found that the applicant failed to meet her burden of proving the remaining services were reasonable and necessary, noting a lack of compelling medical evidence and failure to address treatment goals.

The application was dismissed, and no interest was payable.

The applicant sought accident benefits following a motor vehicle accident, claiming her injuries warranted removal from the Minor Injury Guideline (MIG) due to physical and psychological impairments, pre-existing conditions, and chronic pain.

The Tribunal found that the applicant's injuries were predominantly minor soft tissue injuries and that she failed to provide compelling medical evidence of a psychological impairment, pre-existing condition, or chronic pain with functional impairment that would justify removal from the MIG.

The Tribunal also dismissed the applicant's claim for a non-earner benefit, finding she had not demonstrated a complete inability to carry on a normal life.

All disputed treatment plans and claims for interest were denied.

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

The respondent insurer held that the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied four treatment plans for chiropractic and psychological services because the $3,500 limit had been exhausted.

The Tribunal found that the applicant failed to demonstrate chronic pain or psychological impairments warranting removal from the MIG, preferring the insurer's medical examinations over the applicant's evidence.

The application was dismissed, and no benefits or interest were awarded.

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

The matter proceeded to a written hearing, but the applicant failed to file any submissions or evidence despite receiving proper notice and multiple reminders from the Tribunal.

The Tribunal proceeded in the applicant's absence pursuant to section 7(2) of the Statutory Powers Procedure Act.

The application was dismissed as the applicant failed to meet her evidentiary burden to prove entitlement to the claimed benefits.

Aviva applied to the Licence Appeal Tribunal for the repayment of $18,935.40 in income replacement benefits paid to the respondent, alleging wilful misrepresentation of her pre-accident employment status.

The Tribunal found that the respondent provided inconsistent and unauthentic documents regarding her employment and income, establishing wilful misrepresentation.

Consequently, Aviva was not bound by the 12-month notice period for seeking repayment.

The Tribunal ordered the respondent to repay the full amount of the benefits, plus interest.

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

The respondent initially subjected the applicant to the Minor Injury Guideline (MIG) but later conceded the injuries were not predominantly minor.

Several treatment plans were resolved or withdrawn prior to the hearing.

The Tribunal found the applicant was entitled to the incurred costs of a physiatry assessment and a psychiatric assessment because the respondent failed to provide valid medical and other reasons for its denials under section 38(8) of the Schedule.

However, the Tribunal denied a chronic pain assessment, finding it was not reasonable and necessary, and declined to order an award under Regulation 664, as the respondent's defective notices did not amount to an unreasonable withholding of benefits.