The claimant sought entitlement to various accident benefits. The parties reached a settlement during the hearing of the case. Adjudicator Bickley therefore closed the claim.
Menu
Category: LAT Rules
The insurer brought a motion to compel the claimant to produce tax returns. Adjudicator Robert Watt ordered the claimant to produce the requested productions as the parties appeared to agree that the order was necessary.
A catastrophically injured minor sought entitlement to the insurer’s log notes as part of the preliminary issues, arguing that the insurer’s denials were insufficient to explain why claimed benefits were denied. The insurer argued that the log notes were not relevant and that the claimant was engaged in a “fishing expedition.” Adjudicator White ordered the insurer to produce the log notes. She reasoned that disclosure obligations had to be proportional to the claim being made, and that the serious nature of the claimant’s injuries and status as a minor made the request for log notes proportionally fair.
The claimant sought reconsideration of the Tribunal’s decision to deny medical benefits above MIG limits and IRBs. The Tribunal had denied the claimant’s entitlement to these benefits based on its review of the available medical evidence. The claimant made multiple arguments: first, that the Tribunal did not consider evidence indicating she suffered from a pre-existing condition; second, that the Tribunal considered improper surveillance footage; and, lastly, that the Tribunal erred in refusing her requests for an oral hearing and for the hearing to be recorded. Executive Chair Lamoureux denied the reconsideration request. She held that the Tribunal had properly reviewed the entire medical record when it determined that the claimant fell within the MIG. She noted that claimant’s counsel had provided the Tribunal with little guidance regarding the evidentiary record, and had failed in its duty to best present the claimant’s position. She further held that the Tribunal had properly addressed the claimant’s objections to the surveillance footage, and any new concerns raised in the reconsideration request were not permissible. Moreover, Executive Chair Lamoureux held that the claimant’s rights to procedural fairness were not affected by the Tribunal’s decisions to deny her requests for an oral hearing and for the hearing to be recorded.
The claimant sought reconsideration of the Tribunal’s decision to deny medical benefits above MIG limits and IRBs. The Tribunal had denied the claimant’s entitlement to these benefits based on its review of the available medical evidence. The claimant made multiple arguments: first, that the Tribunal did not consider evidence indicating she suffered from a pre-existing condition; second, that the Tribunal considered improper surveillance footage; and, lastly, that the Tribunal erred in refusing her requests for an oral hearing and for the hearing to be recorded. Executive Chair Lamoureux denied the reconsideration request. She held that the Tribunal had properly reviewed the entire medical record when it determined that the claimant fell within the MIG. She noted that claimant’s counsel had provided the Tribunal with little guidance regarding the evidentiary record, and had failed in its duty to best present the claimant’s position. She further held that the Tribunal had properly addressed the claimant’s objections to the surveillance footage, and any new concerns raised in the reconsideration request were not permissible. Moreover, Executive Chair Lamoureux held that the claimant’s rights to procedural fairness were not affected by the Tribunal’s decisions to deny her requests for an oral hearing and for the hearing to be recorded.
The claimant sought entitlement to attendant care benefits and multiple treatment plans. A preliminary issue was whether late submitted medical records should be excluded from the hearing. Regarding the late records, Adjudicator Treksler admitted the records reasoning that third parties had control over the records and that the claimant could not control the date of disclosure. She also reasoned that the insurer had not suffered any prejudice. In terms of the attendant care benefits, Adjudicator Treksler awarded four months of attendant care benefits and held that the use of a professional service provider met the incurred requirements in the SABS. No attendant care benefits were awarded beyond the date the claimant was observed to be fully functional on surveillance. Five of the 12 claimed treatment plans were awarded.
The insurer sought an order for costs given the claimant twice failed to meet the filing deadlines prescribed by the case conference adjudicator. The representative of the claimant indicated that the deadlines were missed due to workload and illness. A doctor’s note was produced but did not provide an explanation as to why the claimant’s representative was unable to meet the deadlines. Adjudicator Rebecca Hines reviewed Rule 19 and accepted the medical note as proof the claimant’s representative was suffering from an illness. Making an order for costs would not be in line with procedural fairness and natural justice. Costs were not awarded and the request dismissed.
The insurer sought an order for costs given the claimant twice failed to meet the filing deadlines prescribed by the case conference adjudicator. The representative of the claimant indicated that the deadlines were missed due to workload and illness. A doctor’s note was produced but did not provide an explanation as to why the claimant’s representative was unable to meet the deadlines. Adjudicator Rebecca Hines reviewed Rule 19 and accepted the medical note as proof the claimant’s representative was suffering from an illness. Making an order for costs would not be in line with procedural fairness and natural justice. Costs were not awarded and the request dismissed.
The insurer sought an order for costs given the claimant twice failed to meet the filing deadlines prescribed by the case conference adjudicator. The representative of the claimant indicated that the deadlines were missed due to workload and illness. A doctor’s note was produced but did not provide an explanation as to why the claimant’s representative was unable to meet the deadlines. Adjudicator Rebecca Hines reviewed Rule 19 and accepted the medical note as proof the claimant’s representative was suffering from an illness. Making an order for costs would not be in line with procedural fairness and natural justice. Costs were not awarded and the request dismissed.
The claimant brought a motion to combine the insurer’s appeal for repayment of income replacement benefits with the claimant’s case for IRBs, attendant care, and medical benefits. The insurer resisted the motion as a hearing date and preparation for said date had already been established – to allow the combination would result in a delay. Vice Chair Terry Hunter denied the claimant’s motion and concluded there was no advantage in terms of efficiency of proceedings to combine the files.