Dr. J. Heitzner

The applicant was injured in a motor vehicle accident and sought medical benefits for physiotherapy, massage therapy, and swim passes.

The respondent denied the treatment plan based on an insurer's examination report which opined that no further facility-based treatment was required.

The Tribunal found the treatment plan was reasonable and necessary to address the applicant's ongoing pain and functional limitations, preferring the clinical notes and records over the insurer's examination prognosis.

The Tribunal ordered the respondent to pay the treatment plan with interest, but declined to grant an award under section 10 of Regulation 664, finding the respondent did not act unreasonably in relying on the assessment report.

The applicant sought ongoing income replacement benefits (IRBs) more than 104 weeks after a motor vehicle accident, claiming a complete inability to work due to chronic pain and psychological impairments.

The respondent insurer terminated IRBs based on insurer examinations indicating the applicant could perform alternative employment.

The Licence Appeal Tribunal found that the applicant's condition had improved, she had reached maximum medical improvement, and she possessed transferable skills suitable for roles such as a beauty salon attendant or cashier.

The Tribunal concluded the applicant failed to meet the post-104 week disability test.

Additionally, the applicant's claim for the cost of a chronic pain assessment was denied because it was incurred before submitting a treatment plan, contrary to section 38(2) of the Schedule.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought payment for five medical assessments under the Statutory Accident Benefits Schedule.

The insurer denied the assessments.

The Licence Appeal Tribunal found that the psychological, orthopaedic, and physiatry assessments were not reasonable and necessary.

However, the Tribunal ordered the insurer to pay for the chronic pain assessment, finding it reasonable and necessary to explore treatment options, and the functional impairment assessment, as the insurer failed to provide a proper medical reason for denial within the required timeframe.

The applicant was awarded interest on overdue payments but denied a special award under section 10 of Regulation 664.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and chiropractic treatment plans.

The respondent denied the plans on the basis that they were not reasonable and necessary, not causally related to the accident, and not incurred.

The Tribunal found the physiotherapy treatment plan was reasonable and necessary, less fees for previous plans, as the medical evidence supported ongoing therapy for low back pain.

The chiropractic treatment plan was denied for lack of supporting evidence.

The Tribunal also held that the respondent is liable to pay for reasonable and necessary treatment once incurred, rejecting the argument that treatment must be incurred before it can be approved.

No interest was awarded as no payments were overdue.