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Insurer's defective notices under s. 38(8) entitle applicant to incurred costs; several treatment plans approved.
The applicant sought statutory accident benefits following a motor vehicle accident.
The Licence Appeal Tribunal found that the insurer failed to provide adequate medical reasons in its notices denying certain treatment plans under s. 38(8) of the Schedule, entitling the applicant to incurred costs until proper notice is given.
The Tribunal also found three chiropractic treatment plans and one psychological treatment plan to be reasonable and necessary.
However, a second psychological treatment plan, a chronic pain assessment, and a cognitive assessment were deemed not reasonable and necessary.
The applicant's claim for an award under Regulation 664 was dismissed.
Tribunal approves most chiropractic and psychological treatment plans but denies duplicative chiropractic plan and cognitive assessment.
The insurer denied several treatment plans for chiropractic services, psychological treatment, and a functional cognitive assessment, arguing the applicant's injuries fell within the Minor Injury Guideline.
The Tribunal found that three of the four chiropractic treatment plans and the psychological treatment plan were reasonable and necessary, ordering the insurer to pay them with interest.
However, the Tribunal denied the fourth chiropractic plan as it was duplicative and lacked a home exercise progression, and denied the cognitive assessment due to a lack of evidence of significant cognitive impairment.
Accident benefits claim dismissed; applicant failed to prove injuries fell outside the Minor Injury Guideline.
The respondent insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant argued for removal from the MIG due to a pre-existing condition, chronic pain, and psychological injuries.
The Tribunal found that the applicant failed to prove that his pre-existing conditions prevented maximal recovery within the MIG limits, failed to establish a psychological injury warranting removal, and did not meet the criteria for chronic pain.
Consequently, the applicant's injuries were deemed minor, his entitlement to medical benefits was governed by the MIG, and the appeal was denied.