Dr. Guerra

The applicant sought medical and rehabilitation benefits following a 2015 motor vehicle accident, including an occupational therapy re-assessment and two physiotherapy treatment plans.

The respondent denied the benefits, arguing they were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant failed to meet his burden of proving the treatments were reasonable and necessary, noting a lack of contemporaneous medical evidence supporting ongoing physiotherapy and an occupational therapy re-assessment.

The application was dismissed in its entirety.

The applicant sought reconsideration of a decision that dismissed his claim for a chronic pain assessment, neurological assessment, and interest.

The applicant argued the Tribunal made errors of fact and law, including failing to properly consider the AMA Guides criteria for chronic pain and various medical reports.

The Tribunal found no error, noting the lack of ongoing pain complaints in the family physician's records, the applicant's return to modified work and pre-accident activities, and the fact that the objective medical findings contradicted a chronic pain diagnosis.

The request for reconsideration was dismissed.

The applicant sought statutory accident benefits for physiotherapy and an orthopedic assessment following a motor vehicle accident.

The adjudicator found that the proposed treatments and assessment were not reasonable or necessary, as the medical evidence, including the applicant's own assessor and family physician records, indicated her accident-related injuries had resolved and her ongoing back pain was related to a subsequent pregnancy.

The adjudicator also found the insurer was not liable to pay for the treatment plans under the non-compliance provisions of section 38(11) of the Schedule.

The application was dismissed.

The applicant sought payment for statutory accident benefits following a motor vehicle accident, including attendant care benefits, a non-earner benefit, and the cost of various assessments.

The Licence Appeal Tribunal found the applicant was not entitled to attendant care benefits or a non-earner benefit, as she failed to prove the expenses were reasonable and necessary or that she suffered a complete inability to carry on a normal life.

However, the Tribunal ordered the respondent to pay for a chronic pain assessment and two Assessments of Attendant Care Needs, finding them to be reasonable and necessary expenses, along with applicable interest.