2 total
Income replacement benefit denied; applicant's completion of physical nursing placement contradicted claims of substantial inability.
The applicant sought an income replacement benefit (IRB) following a motor vehicle accident, claiming he was substantially unable to perform his pre-accident employment as a Quality Inspector due to chronic pain.
The respondent terminated the IRB based on an insurer's examination.
The Tribunal dismissed the application, preferring the respondent's orthopaedic expert who found normal range of motion.
The Tribunal also noted the applicant successfully completed a physically demanding nursing clinical placement during the disputed period without requesting accommodation, undermining his credibility regarding the severity of his impairment.
Insurer ordered to pay for treatment plans after failing to provide adequate medical reasons for denial.
The applicant sought reconsideration of a Tribunal decision dismissing her application for accident benefits.
The insurer had denied two Treatment and Assessment Plans and requested insurer examinations, providing only general statements that the medical documentation did not support the need for treatment.
The Executive Chair found that the insurer failed to satisfy the notice requirements under s. 38(8) of the Statutory Accident Benefits Schedule, as it did not provide specific medical reasons based on the applicant's file.
Consequently, under s. 38(11)2, the insurer was ordered to pay for the disputed benefits.
The request for a special award was denied.
No co-appearing lawyers found.
No judges found.