Dr. Maano

The applicant sought payment of $11,533.24 for the unapproved balance of a treatment plan (OCF-18) for multi-disciplinary catastrophic impairment assessments.

The insurer had partially approved the plan for $12,000.

The Tribunal found that the unapproved assessment items were needless bifurcations or duplications of assessments already conducted by the insurer, and the applicant failed to prove they were reasonable and necessary.

The Tribunal awarded $400 for the cost of completing the OCF-18 and OCF-19 forms, but denied the remainder of the claim.

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

The respondent denied the claims, asserting the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued he should be removed from the MIG due to a pre-existing condition, psychological impairments, and chronic pain.

The adjudicator found insufficient evidence of a pre-existing condition that would prevent maximal recovery.

The adjudicator also rejected the psychological and chronic pain claims, noting they were based on a chiropractor's report that relied entirely on self-reporting without objective assessment or appropriate expertise.

The application was dismissed as the applicant's injuries remained within the MIG.