3 total
Application for accident benefits dismissed; applicant failed to establish grounds for removal from Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied various treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.
The applicant argued for removal from the MIG based on pre-existing conditions, chronic pain, and psychological impairments.
The Tribunal found that while the applicant had pre-existing lower back and knee conditions, she failed to provide compelling medical evidence that these conditions precluded her recovery within the MIG.
The Tribunal also found insufficient evidence of chronic pain with functional impairment or psychological injury.
The application was dismissed.
Application for statutory accident benefits dismissed; applicant failed to prove treatment and assessment plans were reasonable and necessary.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to various treatment and assessment plans, including neuropsychological and neurological assessments, chiropractic services, massage therapy, acupuncture, and a functional ability assessment.
The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove on a balance of probabilities that the disputed plans were reasonable and necessary.
The Tribunal noted a lack of contemporaneous evidence from the applicant's treating family physician supporting the need for the requested interventions, and preferred the evidence of the respondent's section 44 assessor who found no objective evidence of residual musculoskeletal impairment.
Non-earner benefit denied for failure to meet the Heath test; psychological treatment plan approved.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit (NEB) and a partially denied treatment plan for psychological services.
The Licence Appeal Tribunal found that the applicant did not meet the test for a complete inability to carry on a normal life, as medical evidence and an in-home assessment showed he could continue his pre-accident activities, albeit at a slower pace.
The NEB claim was dismissed.
However, the Tribunal approved the disputed treatment plan for psychological services, preferring the applicant's expert evidence which thoroughly detailed the need for 1.5-hour therapy sessions.
The applicant was awarded the cost of the treatment plan with interest, but his claim for an award under s. 10 of Regulation 664 was dismissed due to lack of evidence of unreasonable delay by the insurer.
No co-appearing lawyers found.
No judges found.