Dr. K. Efala

The applicant sought entitlement to statutory accident benefits for chiropractic and massage services, cognitive devices, and physiatry and orthopaedic assessments following a 2019 motor vehicle accident.

The adjudicator found that the applicant failed to prove the treatment plans for chiropractic and massage services were reasonable and necessary, noting a lack of recommendation from her treating physicians and conclusions from assessors that she had reached maximum medical improvement.

The adjudicator partially approved the treatment plan for cognitive devices, awarding $89.95 for a Lumosity subscription but denying the cost of a tablet, as the applicant did not establish why a cell phone could not be used.

The requests for physiatry and orthopaedic assessments were denied as they were not recommended by treating practitioners and were duplicative of an already approved chronic pain assessment.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, including physiotherapy, psychological treatment, and chronic pain programs, which the respondent insurer denied.

The Licence Appeal Tribunal found that the first two physiotherapy plans were reasonable and necessary based on contemporaneous clinical notes and records showing ongoing physical impairment.

However, the Tribunal dismissed the claims for the remaining physiotherapy plans and all other treatment and assessment plans, finding the applicant failed to meet his evidentiary burden and relying on unpersuasive or unsupported expert reports.

The applicant was awarded the first two physiotherapy plans with interest, and the remainder of the application was dismissed.