10 total
Applicant removed from Minor Injury Guideline due to chronic pain and awarded disputed treatment plans.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied several treatment and assessment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant suffered from chronic pain with functional impairments, removing her from the MIG.
The Tribunal ordered the respondent to pay for the disputed physiotherapy, psychological, and chronic pain treatment plans, finding them reasonable and necessary.
The applicant's claim for a special award for unreasonable delay was dismissed, but interest on overdue benefits was granted.
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline.
The respondent denied various treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant argued she should be removed from the MIG due to pre-existing conditions, a concussion, chronic pain, and psychological impairments.
The Tribunal found insufficient evidence to support removal from the MIG, preferring the respondent's insurer examinations over the applicant's medical reports.
As the $3,500 MIG limit was exhausted, the disputed treatment plans were not payable, and claims for interest and an award were dismissed.
Applicant removed from Minor Injury Guideline due to chronic pain; treatment plan approved but special award denied.
The applicant was injured in a motor vehicle accident and sought accident benefits.
The respondent insurer denied a treatment plan for an occupational therapy assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found the applicant demonstrated she suffered from chronic pain with functional impairment, warranting removal from the MIG, based on a chronic pain assessment and consistent reporting of ongoing pain and withdrawal from activities.
The Tribunal ordered the respondent to pay the $2,195.01 treatment plan plus interest, finding it reasonable and necessary.
However, the Tribunal denied the applicant's request for a special award, concluding the insurer's reliance on its medical examination report, while ultimately unpersuasive, was not unreasonable.
Application for accident benefits dismissed as applicant failed to prove chronic pain syndrome or need for treatment.
The applicant sought statutory accident benefits for a multidisciplinary chronic pain treatment program and chiropractic services following a motor vehicle accident.
The insurer denied the benefits.
The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain syndrome or that the proposed treatment plans were reasonable and necessary.
The Tribunal noted a lack of objective medical evidence and found that the applicant did not meet the criteria for chronic pain under the AMA Guides.
The application was dismissed.
Application for accident benefits beyond the Minor Injury Guideline limit dismissed.
The Tribunal found that the respondent's notices for insurer's examinations were insufficient, so the applicant was not barred from proceeding.
However, the Tribunal concluded that the applicant failed to prove he suffered from chronic pain with functional impairment or a psychological impairment.
Therefore, the applicant's injuries remained subject to the $3,500 MIG limit, and the application for treatment plans beyond that limit was dismissed.
Application for accident benefits dismissed as applicant failed to prove injuries warranted removal from MIG.
The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant sought removal from the MIG on the basis of psychological impairment and chronic pain.
The Tribunal found insufficient objective medical evidence to support a psychological impairment or chronic pain with functional impairment caused by the accident.
As the applicant remained within the MIG and the $3,500 limit was exhausted, the claims for further medical benefits, an award, and interest were dismissed.
Application for removal from the Minor Injury Guideline dismissed due to insufficient evidence of chronic pain or psychological impairment.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming chronic pain and psychological impairments warranted removal from the Minor Injury Guideline (MIG).
The Licence Appeal Tribunal found the applicant failed to provide compelling medical evidence of chronic pain syndrome or psychological impairment caused by the accident.
The Tribunal preferred the respondent's section 44 assessments, which found the applicant's injuries were minor and did not result in functional impairment.
The application was dismissed, and the disputed treatment plans were denied.
Application for accident benefits dismissed; applicant's injuries found to fall within the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming his psychological impairments and chronic pain warranted removal from the Minor Injury Guideline (MIG).
The respondent denied the benefits, arguing the injuries were predominantly minor soft tissue injuries.
The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from a psychological impairment or chronic pain with functional impairment that would remove him from the MIG.
The Tribunal preferred the respondent's medical assessments, noting the applicant had returned to full-time work and had not reported psychological symptoms to his treating physicians.
The application was dismissed, and the disputed treatment plans were found not payable as they exceeded the $3,500 MIG limit.
Treatment plans approved as reasonable and necessary; claims for special award and costs dismissed.
The applicant was struck by a vehicle while crossing the street and sought statutory accident benefits for injuries sustained.
The insurer denied two treatment plans for chiropractic services and assistive devices.
The Licence Appeal Tribunal found both treatment plans to be reasonable and necessary, preferring the applicant's medical evidence over the insurer's examination reports, which were primarily focused on a withdrawn non-earner benefit claim.
The Tribunal awarded interest on the overdue benefits but dismissed the applicant's claim for a special award, finding the insurer had applied proper due diligence.
The Tribunal also dismissed the insurer's request for costs related to the late withdrawal of the non-earner benefit claim.
Application for statutory accident benefits dismissed as treatment plans and assessments were not reasonable and necessary.
The applicant sought various medical and rehabilitation benefits, as well as the cost of several assessments, following a motor vehicle accident.
The respondent insurer denied the treatment plans.
The Tribunal found that the applicant failed to prove the disputed treatment plans and assessments were reasonable and necessary.
The Tribunal preferred the evidence of the respondent's medical assessors, who reviewed the applicant's complete medical records and found that further facility-based treatment would not lead to significant improvements and that the applicant's psychological issues were largely pre-existing or subclinical.
The application was dismissed in its entirety.
No linked lawyers found.
No linked judges found.