Dr. Ikejiani

The applicant sought statutory accident benefits following a 2017 motor vehicle accident.

The adjudicator found that the applicant was barred from proceeding with her claims for non-earner benefits and an OCF-18 for assistive devices because she failed to commence her application within the two-year limitation period under s. 56 of the Schedule.

The adjudicator granted the OCF-18s for a physiatry assessment and chiropractic treatment, finding them reasonable and necessary to address ongoing pain complaints, and noted that the insurer's assessors lacked key medical records.

The remaining OCF-18s and a claim for an OCF-3 were dismissed.

The adjudicator awarded the applicant 10 percent of the payable OCF-18s under s. 10 of Regulation 664, finding the insurer's continued reliance on incomplete assessment reports to be inflexible.

The applicant was injured in a motor vehicle accident and sought payment for a chiropractic treatment plan and a chronic pain assessment under the Statutory Accident Benefits Schedule.

The insurer denied the benefits.

The Licence Appeal Tribunal found that the insurer's denial of the chiropractic treatment plan failed to comply with the notice requirements under section 38(8) of the Schedule, making the benefit payable.

The Tribunal also found the chronic pain assessment was reasonable and necessary given the applicant's consistent pain complaints and medical history.

The applicant's request for a special award was denied as the insurer's reliance on its medical assessors did not constitute unreasonable withholding of benefits.