Dr. Stacey

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, claiming catastrophic impairment, income replacement benefits, attendant care benefits, and various treatment plans.

The Licence Appeal Tribunal found that the applicant did not meet the threshold for catastrophic impairment under Criterion 7 (55% whole person impairment) or Criterion 8 (mental and behavioural disorders).

The Tribunal preferred the respondent's medical evidence, noting the applicant's pre-existing conditions and post-accident functioning, including international travel.

Claims for income replacement and attendant care benefits were dismissed as the applicant failed to prove a substantial inability to perform his pre-accident employment and the benefits had expired past the 260-week mark.

The application was dismissed in its entirety.

The applicant was injured in a motor vehicle accident and sought payment for three treatment plans (OCF-18s) for chiropractic and psychological services, which the respondent insurer denied in whole or in part.

The Tribunal found that the applicant failed to prove the balances of the first two treatment plans were reasonable and necessary, as they exceeded maximum guideline amounts or lacked supporting evidence for report writing fees.

However, the Tribunal partially approved the third treatment plan for chiropractic, massage, and physiotherapy, finding it reasonable and necessary based on consistent medical evidence of ongoing pain and functional improvement.

Interest was awarded on the overdue benefits.