Dr. P. Kelly

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The insurer denied several treatment plans on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant failed to provide a persuasive analysis or sufficient medical evidence to establish that the disputed treatment plans were reasonable and necessary.

The Tribunal preferred the insurer's section 44 examination evidence, which concluded the applicant sustained uncomplicated soft tissue injuries requiring no further facility-based care.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for caregiver, housekeeping, and attendant care expenses.

The insurer denied the benefits and sought repayment of previously paid benefits, alleging the applicant made material misrepresentations regarding her impairments and the service providers.

The arbitrator found that the applicant suffered significant psychological impairments, including depression and anxiety, which substantially limited her ability to perform caregiving, housekeeping, and personal care tasks.

The arbitrator rejected the insurer's occupational therapy assessment, preferring the evidence of the applicant's treating psychiatrist and the insurer's own psychologists.

The arbitrator concluded the applicant was entitled to the claimed benefits and interest, and dismissed the insurer's claim for repayment, finding no wilful material misrepresentation.

The applicant's claim for a special award was dismissed on procedural fairness grounds.