3 total
Insurer ordered to pay for treatment plans and special awards due to procedural non-compliance.
The applicants were injured in a motor vehicle accident and sought payment for chiropractic treatment and housekeeping expenses from their insurer.
The arbitrator found the applicants' evidence regarding the necessity of the treatment and housekeeping services to be implausible and unreliable.
However, because the insurer failed to comply with the mandatory procedures under section 38(12) of the Schedule for rejecting a treatment plan, the arbitrator ordered the insurer to pay for the second treatment plans submitted by the applicants.
The arbitrator also awarded each applicant a $500 special award due to the insurer's procedural non-compliance, but denied the claims for housekeeping expenses and ordered each party to bear their own arbitration expenses.
Application for accident benefits dismissed; ongoing chiropractic treatment found not reasonable or necessary.
The applicant was injured in a low-speed motor vehicle accident and sought statutory accident benefits for chiropractic and massage treatment.
The insurer refused to pay for one year of treatment, arguing it was not reasonable or necessary.
The arbitrator dismissed the application, finding the applicant's evidence of accident-related pain unreliable due to his pre-accident medical history and pre-occupation with his health.
The arbitrator rejected the opinions of the applicant's chiropractors, citing methodological flaws, deficient record-keeping, and a failure to consider the applicant's full medical history.
The arbitrator accepted expert evidence that the applicant would benefit more from cognitive therapy and an exercise program rather than ongoing passive physical therapy.
Claims for weekly and childcare benefits dismissed due to lack of credibility and pre-existing psychogenic disability.
The applicant was injured in a motor vehicle accident and applied for weekly and childcare benefits under the No-Fault Benefits Schedule.
The insurer denied the benefits, arguing that the applicant's disability resulted from a previous workplace injury.
The arbitrator found the applicant lacked credibility due to inconsistencies between his testimony and prior statements regarding his pre-accident activities.
Relying on medical reports indicating that the applicant's post-accident condition was substantially the same as his pre-accident condition and that his disability was largely psychogenic, the arbitrator concluded the applicant failed to prove he was substantially unable to perform his essential tasks as a result of the accident.
The claims for weekly and childcare benefits were dismissed, but the applicant was awarded his arbitration expenses.
No co-appearing lawyers found.
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