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Tribunal approves most treatment plans and assessments but denies chronic pain program and special award.
The applicant sought various medical and rehabilitation benefits, a physiatry assessment, and a disability certificate following a motor vehicle accident.
The Licence Appeal Tribunal found that the treatment plans for Botox injections, chiropractic services, massage therapy, psychological services, the physiatry assessment, and the disability certificate were reasonable and necessary.
However, the tribunal denied the treatment plan for a chronic pain program, finding that the applicant failed to establish that the costs were reasonable against the identified goals.
The tribunal awarded interest on the payable plans but declined to order a special award under s. 10 of Regulation 664.
Applicant awarded partial income replacement benefits for accident-related migraines; post-104 benefits terminated upon medical improvement.
The applicant sought income replacement benefits (IRBs) and a treatment plan following a motor vehicle accident that exacerbated her pre-existing migraines.
The Tribunal found the applicant was entitled to a pre-104 IRB, as her migraines prevented her from performing the essential tasks of her employment as a restaurant manager.
The Tribunal also awarded a post-104 IRB for a limited period, terminating when medical evidence showed her headaches had significantly improved with prophylaxis, enabling her to engage in part-time employment.
The treatment plan and a claim for a special award were denied, but interest on overdue benefits was granted.
Application for accident benefits dismissed due to unexcused failure to attend insurer's examinations and insufficient medical evidence.
The applicant sought various statutory accident benefits following a motor vehicle accident.
The respondent denied the benefits and argued the applicant was barred from proceeding with several treatment plans due to her failure to attend scheduled insurer's examinations (IEs).
The Tribunal found the applicant failed to provide a reasonable explanation for her non-attendance and was therefore statute-barred under s. 55(1)2 of the Schedule from proceeding with those claims.
For the remaining treatment plans, the Tribunal found the applicant failed to adduce sufficient objective medical evidence to prove they were reasonable and necessary, preferring the evidence of the respondent's IE assessors.
The application was dismissed.
Application for statutory accident benefits dismissed as treatment plans were not reasonable and necessary.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to psychological treatment, a driver's reintegration evaluation, and physiotherapy.
The respondent insurer denied the benefits, and the applicant applied to the Licence Appeal Tribunal.
The Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, relying on the opinions of the insurer's examiners who found no ongoing musculoskeletal or neurological impairment and that the psychological treatment proposed was excessive or premature.
Application for accident benefits dismissed due to unreliable self-reporting and lack of accident-related impairments.
The applicant sought statutory accident benefits following a 2017 motor vehicle accident, including treatment plans for catastrophic impairment assessments, an attendant care assessment, and chiropractic services.
The insurer denied the benefits.
The Tribunal found the applicant's self-reporting to be highly inconsistent and unreliable, contradicting medical records and surveillance evidence.
The Tribunal preferred the insurer's medical examinations, which found no ongoing physical or psychological impairments attributable to the accident.
The application was dismissed, and no benefits or interest were awarded.
Application for visitor's expenses dismissed due to inconsistent evidence and failure to prove accident causation.
The applicant, an international student, was injured in a motor vehicle accident and sought visitor's expenses for her mother's travel from China to Canada, claiming the visits were necessary for her recovery.
The respondent denied the benefits.
The Licence Appeal Tribunal found numerous inconsistencies in the applicant's evidence regarding her injuries, employment, and when she informed her family about the accident.
The Tribunal concluded that the applicant failed to prove on a balance of probabilities that the visitor's expenses were reasonable, necessary, or incurred as a result of the accident.