5 total
Application for accident benefits dismissed as treatment plans were not proven reasonable and necessary.
The applicant sought entitlement to statutory accident benefits for physiotherapy and psychological services following a motor vehicle accident.
The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the treatment plans were reasonable and necessary.
The Tribunal preferred the evidence of the respondent's section 44 assessors, who concluded the applicant sustained self-resolving soft tissue injuries and had already received adequate psychological treatment.
Claims for interest and an award for unreasonable delay were also dismissed.
Application for accident benefits dismissed; medical marijuana contraindicated and PRP therapy deemed experimental.
The applicant sought various medical and rehabilitation benefits following a motor vehicle accident, including natural supplements, medical marijuana, Platelet Rich Plasma (PRP) therapy, physiotherapy, psychological services, and a visual assessment.
The Licence Appeal Tribunal dismissed the application in its entirety.
The Tribunal found that medical marijuana was contraindicated due to the applicant's pre-existing conditions, and that PRP therapy was experimental and thus excluded under s. 15(2)(a) of the Schedule.
Relying on independent medical examinations, the Tribunal concluded that the remaining physical and psychological treatment plans were not reasonable and necessary.
Application for accident benefits dismissed as applicant failed to prove injuries warranted removal from the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied various treatment plans and assessments on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.
The Tribunal found that while the accident was a necessary cause of the applicant's neck, right forearm, and left shoulder impairments (excluding a partial thickness tear), the applicant failed to prove that her injuries warranted removal from the MIG.
The Tribunal rejected the applicant's claims of chronic pain syndrome and psychological impairment, finding that she did not meet the AMA Guides criteria for chronic pain and that her self-reported limitations were inconsistent with her return to work and medical records.
As the MIG limits were exhausted, the disputed benefits, interest, and award were denied.
Insurer's defective notices under s. 38(8) entitle applicant to incurred costs; several treatment plans approved.
The Licence Appeal Tribunal found that the insurer failed to provide adequate medical reasons in its notices denying certain treatment plans under s. 38(8) of the Schedule, entitling the applicant to incurred costs until proper notice is given.
The Tribunal also found three chiropractic treatment plans and one psychological treatment plan to be reasonable and necessary.
However, a second psychological treatment plan, a chronic pain assessment, and a cognitive assessment were deemed not reasonable and necessary.
The applicant's claim for an award under Regulation 664 was dismissed.
Accident benefits claim dismissed as applicant failed to prove causation and reasonableness of proposed treatments.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a psychological assessment, chiropractic services, and an occupational therapy in-home assessment.
The insurer denied the benefits, arguing the physical injuries were pre-existing and the psychological assessment costs were unreasonable.
The Licence Appeal Tribunal dismissed the appeal, finding the applicant failed to prove the claimed psychological assessment costs were reasonable compared to the insurer's examination.
The Tribunal also found the applicant failed to establish causation for the physical injuries, noting extensive pre-existing conditions and a lack of evidence connecting the requested chiropractic and occupational therapy treatments to the accident.
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