Dr. Chris Aldridge

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming costs for medical cannabis and a social work assessment.

The Tribunal denied the claims for medical cannabis, finding it was not reasonable and necessary as the applicant reported deriving little benefit from it compared to other pharmaceuticals.

However, the Tribunal ordered the respondent to pay for the social work assessment because the respondent's denial letter relied on boilerplate language and failed to provide sufficient medical reasons, violating s. 38(8) of the Schedule.

Claims for an award under s. 10 of Reg. 664 were dismissed, but interest was awarded on the overdue payment for the social work assessment.

The applicant sought payment for a $1,463.52 physiotherapy treatment plan following a motor vehicle accident.

The respondent insurer denied the plan based on insurer examinations indicating the applicant's soft tissue injuries had substantially resolved.

The Tribunal found that the applicant failed to prove the treatment was reasonable and necessary, as there was no current medical evidence supporting the need for ongoing facility-based therapy.

Claims for an award for unreasonable delay and interest were also dismissed.

The applicant requested a reconsideration of a Tribunal decision that denied his entitlement to a post-104 week Income Replacement Benefit (IRB) and found that the quantum for his pre-104 week IRB could not be determined.

The Vice-Chair dismissed the request to admit new tax documents to determine the IRB quantum, finding the applicant failed to show the evidence could not have been obtained previously.

However, the Vice-Chair found the original adjudicator committed an error of law by failing to explicitly engage with the expert evidence regarding the post-104 week IRB test.

Upon reviewing the evidence, the Vice-Chair concluded the applicant suffers from a complete inability to engage in reasonably suited employment due to chronic pain and cognitive struggles.

The decision was varied to find entitlement to the post-104 week IRB, though no benefit is currently payable as the quantum remains undetermined.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB) and two treatment plans for devices and nutritional counseling.

The Tribunal found the applicant was not entitled to IRBs as he returned to full-time work for three months post-accident and failed to prove a substantial inability to perform the essential tasks of his employment.

The treatment plans were also denied as the applicant did not demonstrate they were reasonable and necessary, with the Tribunal preferring the insurer's medical examination which concluded the injuries were minor.

The Tribunal also found the insurer's denial notices complied with section 38 of the Schedule.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident.

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

The Tribunal found that the applicant's injuries were predominantly minor and that he failed to provide compelling medical evidence of a pre-existing condition, chronic pain with functional impairment, or a psychological impairment that would warrant removal from the MIG.

As the applicant remained subject to the $3,500 MIG limit, the disputed treatment plans were not payable and no interest was owed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming it exacerbated a pre-existing right shoulder injury sustained in a workplace accident two months prior.

The respondent denied treatment plans for a chronic pain assessment and physiotherapy.

The Tribunal found that while the motor vehicle accident was a necessary cause of the applicant's injuries, the disputed treatment plans were not reasonable and necessary.

The applicant was already receiving extensive treatment for her shoulder through a specialized program, and medical evidence indicated she had reached maximal medical recovery for the accident-related soft tissue injuries.

The application was dismissed.