Brett Todd

The applicant sought statutory accident benefits for two chiropractic treatment plans totaling over $17,000 following a motor vehicle accident.

The respondent insurer denied the plans on the basis that the physical injuries were soft tissue in nature and resolved, noting a prior workplace injury to the same areas.

The Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, citing inconsistencies in the medical records, a two-year gap in treatment, and the significant role of the prior workplace injury.

The application was dismissed.

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

The respondent insurer determined the injuries fell within the Minor Injury Guideline (MIG) and denied several treatment plans.

The Tribunal found that the applicant suffered from chronic pain with functional impairment as a result of the accident, removing him from the MIG and its $3,500 funding limit.

The Tribunal approved five treatment plans for chiropractic and physical therapy services as reasonable and necessary, but denied two assessment plans for lack of supporting medical evidence.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming losses from her self-employment business.

The Tribunal found that the applicant failed to prove her business losses were caused by the accident, preferring the respondent's accounting report.

The Tribunal awarded $152,478.03 in past IRBs.

Additionally, while the respondent failed to provide the required notice to claim an overpayment under section 52 of the Schedule, the Tribunal held that the applicant was not entitled to interest on the overpaid amounts, as doing so would create an absurd result.

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

The respondent insurer denied portions of treatment plans for chiropractic and physiotherapy, as well as a chronic pain assessment.

The Tribunal found that the respondent failed to provide a proper denial with medical and other reasons for the first treatment plan, triggering the consequences of s. 38(11) of the Schedule.

For the remaining treatment plan and assessment, the Tribunal preferred the applicant's medical evidence, finding the respondent's independent medical examination contained internal contradictions.

The Tribunal concluded the treatment and assessment were reasonable and necessary, ordering the respondent to pay the disputed amounts plus interest.