2 total
Application for statutory accident benefits dismissed as proposed treatment and assessment plans were not reasonable and necessary.
The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including treatment plans for occupational therapy, a chronic pain program, and assessments for neuropsychological, chronic pain, functional cognitive, and catastrophic impairment, as well as a SPECT scan.
The insurer denied the claims.
The Licence Appeal Tribunal dismissed the application in its entirety, finding that the applicant failed to demonstrate on a balance of probabilities that the proposed plans were reasonable and necessary.
The Tribunal relied on insurer examination reports and surveillance evidence showing the applicant engaging in normal activities, which contradicted the applicant's self-reported functional limitations and the opinions of his assessors.
Applicant found catastrophically impaired due to accident exacerbating pre-existing psychological condition; partial benefits awarded.
The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including a determination of catastrophic impairment due to a mental or behavioural disorder.
The respondent denied the benefits, arguing the applicant's psychological impairments pre-dated the accident.
The Tribunal found that the accident exacerbated the applicant's pre-existing condition, resulting in a marked class 4 impairment in her adaption to the workplace.
The Tribunal concluded the applicant was catastrophically impaired and awarded attendant care benefits of $931.57 per month, along with partial entitlement to claimed medical, rehabilitation, and examination expenses.
No co-appearing lawyers found.
No judges found.