3 total
Insurer's defective notices under s. 38(8) entitle applicant to incurred costs; several treatment plans approved.
The applicant sought statutory accident benefits following a motor vehicle accident.
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.
Application for non-earner benefit dismissed; surveillance evidence contradicted claims of complete inability to carry on normal life.
The applicant sought a non-earner benefit following a motor vehicle accident, claiming a complete inability to carry on a normal life due to physical and psychological injuries.
The Licence Appeal Tribunal dismissed the application, finding the applicant's evidence lacked specificity and was contradicted by inconsistent self-reporting and surveillance evidence showing him jet skiing and lifting weights.
The Tribunal preferred the respondent's assessments, concluding the applicant failed to meet the stringent threshold for the benefit.
Tribunal approves most chiropractic and psychological treatment plans but denies duplicative chiropractic plan and cognitive assessment.
The insurer denied several treatment plans for chiropractic services, psychological treatment, and a functional cognitive assessment, arguing the applicant's injuries fell within the Minor Injury Guideline.
The Tribunal found that three of the four chiropractic treatment plans and the psychological treatment plan were reasonable and necessary, ordering the insurer to pay them with interest.
However, the Tribunal denied the fourth chiropractic plan as it was duplicative and lacked a home exercise progression, and denied the cognitive assessment due to a lack of evidence of significant cognitive impairment.
No co-appearing lawyers found.
No judges found.