Amy Hanes

The applicant sought entitlement to numerous treatment plans for physical and psychological therapy, assistive devices, and assessments following a motor vehicle accident.

The Licence Appeal Tribunal denied the majority of the treatment plans, finding the applicant failed to prove they were reasonable and necessary, largely due to a lack of corroborating medical evidence and inconsistencies in the expert reports provided.

However, the Tribunal granted entitlement to translation services, a chronic pain assessment, and an attendant care assessment.

The Tribunal also ordered the respondent to pay a $250 special award under s. 10 of O. Reg. 664 for unreasonably withholding funding for the applicant's attendant care assessment while funding its own.

The applicant was injured in a motor vehicle accident and sought medical benefits for exercise equipment, assistive devices, a chronic pain assessment, and chiropractic services under the Statutory Accident Benefits Schedule.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding that the applicant relied solely on self-reporting of pain without corroborating medical documentation.

The Tribunal preferred the evidence of the respondent's insurer examination assessors, who concluded that the requested treatments and assessments were not reasonable and necessary.

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