Dr. Dilkas

The applicant was involved in a motor vehicle accident and sought statutory accident benefits for physiotherapy and an attendant care assessment.

The respondent denied the benefits.

The Tribunal found that the applicant failed to prove on a balance of probabilities that the treatment plans were reasonable and necessary, noting that the applicant's family doctor records did not mention accident-related pain and the respondent's examiner found no musculoskeletal impairments.

The Tribunal also found the respondent's denial letter was sufficient under s. 38(8) of the Schedule.

The application was dismissed, and claims for interest and an award were denied.

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

The respondent insurer denied a treatment plan for psychological services on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that while the applicant's physical injuries initially met the definition of a minor injury, she subsequently developed chronic pain and psychological impairments, including adjustment disorder and somatic symptom disorder, which warranted removal from the MIG.

The Tribunal concluded that the proposed psychological services were reasonable and necessary to address her chronic pain and emotional issues, approving the treatment plan at a reduced rate.