Dr. Alikhan

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to two physiotherapy treatment plans and a chronic pain assessment.

The adjudicator found that the applicant failed to provide sufficient objective medical evidence to demonstrate that the proposed treatments and assessment were reasonable and necessary.

The adjudicator also rejected the applicant's argument that the respondent's denial letters violated section 38(8) of the Schedule, finding that the insurer had clearly identified the medical reasons for the denials.

The application was dismissed in its entirety.

The applicant sought medical benefits for two physiotherapy treatment plans following a motor vehicle accident.

The respondent denied the benefits on the basis that they were not reasonable and necessary.

The Tribunal found that the first treatment plan was duplicative and the proposing clinic no longer existed.

For the second treatment plan, the Tribunal found a lack of medical evidence supporting the need for treatment and that the applicant failed to establish causation, noting a more serious prior accident.

The application was dismissed and no interest was payable.

The applicant sought a medical benefit for physiotherapy treatment following a motor vehicle accident, along with interest and an award for unreasonable delay.

The adjudicator found that the applicant failed to demonstrate that the proposed treatment was reasonable and necessary, relying on the respondent's section 44 assessment which concluded the physical impairments were soft-tissue in nature and had reached maximal medical improvement.

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

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for an in-home assessment, prescription medication, a chronic pain assessment, and chiropractic treatment.

The respondent insurer denied the claims.

The Licence Appeal Tribunal found that the applicant was not entitled to the in-home assessment or the prescription expenses, as the evidence did not establish they were reasonable and necessary for accident-related impairments.

However, the Tribunal granted the claims for the chronic pain assessment and chiropractic treatment, finding that the applicant's pre-existing chronic pain was exacerbated by the accident and that the proposed treatments were reasonable and necessary to manage her symptoms.

Interest was awarded on the overdue payments for the approved benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a chronic pain assessment and a neurological assessment, which the respondent insurer denied.

The Licence Appeal Tribunal found that both assessments were reasonable and necessary given the applicant's ongoing complaints of pain and headaches, preferring the recommendations of the applicant's assessors over the insurer's medical examiner.

The Tribunal ordered the respondent to pay for the assessments and interest on overdue benefits, but declined to order an award under O. Reg. 664, finding the insurer had properly considered the claims.

The applicant was injured in a motor vehicle accident and sought medical benefits for three chiropractic treatment plans under the Statutory Accident Benefits Schedule.

The respondent insurer denied the plans based on section 44 assessments.

The Licence Appeal Tribunal found the treatment plans reasonable and necessary, noting the applicant's pre-existing osteoarthritis and ongoing pain.

The Tribunal rejected the insurer's medical assessments because they failed to account for key medical evidence, including a diagnostic imaging report.

The applicant was awarded the disputed benefits and interest.

The applicant was injured when a garage door closed on her vehicle and sought accident benefits from her insurer.

The insurer denied treatment plans on the basis that the applicant's impairments fell within the Minor Injury Guideline (MIG).

At arbitration, the applicant failed to present medical evidence or expert testimony to establish that her injuries fell outside the MIG or that her ongoing pain was causally linked to the accident.

The arbitrator accepted the uncontradicted expert evidence of the insurer's medical and psychological assessors, concluding that the applicant's impairments were predominantly minor injuries.

The application for additional treatment was dismissed.