Dr. H. Lad

The applicant, a pedestrian struck by a vehicle in 2014, sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule after being denied by the respondent insurer.

The Licence Appeal Tribunal found that further physical treatments, including occupational therapy, physiotherapy, and chiropractic services, were not reasonable and necessary, as the applicant had largely recovered from her physical injuries and could manage residual pain with self-directed exercises.

Claims for orthopaedic, neurocognitive, and certain psychological assessments were dismissed as statute-barred under s. 38(2) because they were incurred before the treatment plans were submitted.

However, the Tribunal granted entitlement to a psychological assessment and psychological services, preferring the applicant's expert evidence that she continued to suffer from somatic symptom disorder and adjustment disorder.

Claims for an award and costs were denied due to a lack of submissions.

The applicant was involved in two motor vehicle accidents and sought payment for various treatment and assessment plans under the Statutory Accident Benefits Schedule, which the respondent insurer denied.

The Licence Appeal Tribunal found the applicant's evidence regarding his accident details and symptoms lacked credibility, noting significant inconsistencies and a failure to disclose his return to full-time work.

The Tribunal approved an occupational therapy assessment, a psychological assessment, and assistive devices, finding them reasonable and necessary.

However, claims for ongoing chiropractic care, chronic pain programs, a neurocognitive assessment, and a vocational assessment were dismissed due to lack of credible evidence supporting their necessity and the applicant's pre-existing conditions.

The Tribunal also denied the applicant's request for a lump sum award, finding that the applicant's own refusal to attend insurer's examinations mitigated any delay by the insurer.