Dr. D. Simon

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

The insurer classified his injuries under the Minor Injury Guideline (MIG) and denied various treatment plans and income replacement benefits (IRBs).

The Licence Appeal Tribunal found that the applicant developed a chronic pain condition, removing him from the MIG.

The Tribunal approved a chronic pain assessment plan but denied a psychological assessment and a chronic pain treatment plan, finding them not reasonable and necessary.

The claim for IRBs was also dismissed as the applicant failed to prove a substantial inability to perform the essential tasks of his employment as a cabinet maker.

The applicant, who was catastrophically impaired following a motor vehicle accident, sought payment for a $7,121.93 physiotherapy and massage treatment plan.

The insurer denied the plan, arguing the applicant had developed an inappropriate dependency on the treatment and that it would not promote recovery.

The Tribunal applied the Violi factors and found the treatment plan reasonable and necessary.

The adjudicator held that pain relief is a legitimate treatment goal and preferred the evidence of the applicant's treating practitioners over the insurer's assessors, noting the applicant's complex physical and psychological impairments.

The insurer was ordered to pay for the treatment plan with interest.