Dr. Y. Ko

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

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant suffered from chronic pain and a T1-T2 herniated disc, warranting removal from the MIG.

The Tribunal also found the respondent failed to provide compliant denial notices under s. 38(8) of the Schedule for two treatment plans, triggering mandatory payment under s. 38(11).

The treatment plan for a chronic pain assessment was deemed reasonable and necessary.

The applicant sought statutory accident benefits for physiotherapy and a chronic pain assessment following a motor vehicle accident.

The insurer had removed the applicant from the Minor Injury Guideline due to a pre-existing psychological condition but denied the specific treatment plans.

The Licence Appeal Tribunal found that the applicant failed to prove the treatments were reasonable and necessary, preferring the evidence of the insurer's physiatrist over the applicant's psychologist regarding physical injuries.

The Tribunal also noted the applicant's high level of physical activity, such as skiing and golfing, which contradicted a chronic pain condition.

The application was dismissed.