Dr. Cowman

The applicant sought statutory accident benefits following a motor vehicle accident, including treatment plans for an orthopaedic assessment, assistive devices, chiropractic services, and a non-earner benefit.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the treatment plans were reasonable and necessary, largely due to a lack of supporting medical evidence and failure to submit the OCF-18 forms.

The Tribunal also denied the non-earner benefit, relying on insurer examinations and surveillance evidence showing the applicant continued to engage in normal daily activities and employment.

The applicant sought statutory accident benefits following a motor vehicle accident, including funding for chiropractic services, psychological services, and a catastrophic impairment assessment.

The Licence Appeal Tribunal denied the chiropractic services due to a lack of objective evidence and a significant gap in treatment.

The Tribunal granted the psychological services, noting consistent recommendations from both the applicant's and insurer's assessors.

The catastrophic impairment assessment was partially approved, with the Tribunal funding the psychological and occupational therapy components but denying the physiatry and neurological components as not reasonable or necessary.

The claim for a special award was dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits, which the respondent insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

Prior to the hearing, the respondent approved the disputed treatment plans.

The remaining issues were whether the applicant was entitled to an award for unreasonably delayed payments and whether either party was entitled to costs.

The Tribunal found that the respondent unreasonably withheld payments by maintaining its MIG denial despite having an independent medical examination report diagnosing a psychological impairment outside the MIG.

The Tribunal awarded the applicant 25% of the delayed benefits, totaling $2,316.38, plus interest.

Both parties' requests for costs were dismissed.

The Applicant sought accident benefits for physiotherapy and massage therapy following a rear-end motor vehicle collision.

The Insurer denied the claims on the basis that the Applicant's injuries fell within the Minor Injury Guideline (MIG) and the treatment plans were unsigned.

The Arbitrator dismissed the Applicant's claims, finding that the Applicant failed to sign the OCF-18 treatment plans as required by section 38(3) of the SABS.

Furthermore, the Arbitrator accepted the Insurer's expert medical evidence that the Applicant's soft tissue injuries were treatable within the MIG and that the Applicant did not suffer from chronic pain.

The Insurer was awarded its expenses for the arbitration.

Following a decision denying the insured's claim for income replacement benefits, the insurer sought to recover its expenses.

The arbitrator assessed the insurer's bill of costs, reducing the claimed legal fees by applying a 2.5 to 1 ratio of preparation to hearing time and deducting time spent on an ill-founded medical argument.

The arbitrator also disallowed disbursements for official examiner fees (transcripts) and the attendance fee of the insurer's medical expert.

The insurer was awarded $15,750 in legal fees and $7,440.21 in disbursements.