Dr. J. Guerra

The applicant sought medical benefits for physiotherapy and a bone growth stimulator following a motor vehicle accident.

The respondent denied the benefits and sought repayment of an income replacement benefit overpayment.

The Tribunal found that the treatment plans were not reasonable and necessary, relying on insurer's examination reports and surveillance indicating the applicant had reached maximum medical improvement.

The Tribunal also denied the respondent's request for repayment, finding that the formal request was made outside the 12-month statutory limitation period under section 52 of the Schedule.

The application was dismissed in its entirety.

The applicant sought medical benefits for acupuncture and catastrophic determination assessments following a motor vehicle accident.

The Licence Appeal Tribunal found that the acupuncture treatment plans were not reasonable or necessary, as the applicant had achieved maximum therapeutic benefit and met his goals of returning to work and daily activities.

The Tribunal also denied the catastrophic determination assessments because the applicant provided no submissions to prove entitlement.

The application was dismissed in its entirety.

The applicant sought a medical benefit of $3,483.14 for chiropractic services following a motor vehicle accident.

The respondent denied the treatment plan, relying on an insurer's examination which concluded the applicant's soft tissue injuries were treatable within the Minor Injury Guideline and that maximum medical recovery had been reached.

The Tribunal found the applicant's expert reports did not specifically address the disputed treatment plan or were outside the assessor's area of expertise.

The Tribunal concluded the treatment plan was not reasonable and necessary, and dismissed the claims for the medical benefit, an award for unreasonable delay, and interest.