4 total
Application for accident benefits dismissed; applicant failed to prove injuries fell outside the Minor Injury Guideline.
The applicant sought accident benefits following a 2016 motor vehicle accident.
The insurer classified the injuries as minor and denied a chiropractic treatment plan of $1,096.00 once the $3,500.00 funding limit was exhausted.
The applicant argued his pre-existing multiple sclerosis and back pain, along with a concussion and adjustment disorder, warranted removal from the Minor Injury Guideline.
The Tribunal found insufficient evidence linking the psychological disorder or concussion to the accident, and no evidence that the accident worsened his pre-existing conditions.
The application was dismissed.
Reconsideration request denied; no error of law or fact in finding injuries fell within the Minor Injury Guideline.
The applicant sought reconsideration of a decision denying income replacement benefits and various treatment plans on the basis that his injuries fell within the Minor Injury Guideline (MIG).
The applicant argued the adjudicator made significant errors of law and fact in weighing the medical evidence regarding his physical limitations, psychological impairment, and chronic pain.
The adjudicator dismissed the reconsideration request, finding no errors of law or fact in the original decision.
The adjudicator reaffirmed that the applicant failed to meet the burden of proving his injuries fell outside the MIG or that he suffered a substantial inability to perform the essential tasks of his employment.
Applicant awarded post-104 week income replacement benefits due to complete inability to work from chronic pain.
The applicant was injured in a motor vehicle accident and sought post-104 week income replacement benefits (IRBs).
The respondent denied the benefits, arguing the applicant did not suffer a complete inability to engage in suitable employment.
The Tribunal found the applicant credible and preferred the evidence of her medical experts, concluding that her chronic pain and psychological impairments prevented her from returning to work.
The Tribunal ordered the respondent to pay IRBs of $400 per week from October 4, 2016, ongoing, plus interest.
Insurer waived signature requirement on treatment plans; chiropractic and occupational therapy benefits awarded for chronic pain.
The applicant sought statutory accident benefits for chiropractic, psychological, and occupational therapy services following a 2006 motor vehicle accident.
The insurer denied the treatment plans and raised a preliminary issue that the plans were initially unsigned.
The Tribunal held that the insurer waived the signature requirement by failing to raise it in the initial denial letters.
On the merits, the Tribunal found the chiropractic and occupational therapy plans were reasonable and necessary to address the applicant's chronic pain, though mileage expenses for the occupational therapist were excluded.
The psychological treatment plans were denied due to insufficient evidence of ongoing psychological distress and the applicant's failure to attend previously approved sessions.
No co-appearing lawyers found.
No judges found.