5 total
Application for accident benefits dismissed; applicant failed to establish grounds for removal from the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the limits had been exhausted.
The applicant argued that pre-existing physical and psychological conditions warranted removal from the MIG.
The Tribunal found that the applicant failed to provide compelling medical evidence that his pre-existing conditions precluded recovery within the MIG.
Relying on the respondent's section 44 assessors, the Tribunal concluded the applicant's injuries were predominantly minor.
The application was dismissed.
Deficient notice of examination does not render subsequent medical report void ab initio if insured attends.
The applicant sought statutory accident benefits for chiropractic, physiotherapy, and biopsychosocial assessment treatment plans following a motor vehicle accident.
The respondent denied the benefits based on section 44 independent medical examinations.
The applicant argued the respondent's notices of examination were deficient under section 44(5) of the Schedule, rendering the resulting reports void ab initio and triggering mandatory payment under section 38(11).
The Tribunal found that while the notices for the physical treatments lacked sufficient reasons, the applicant's attendance at the assessments did not waive her rights, but the resulting reports were not void ab initio.
Because the ultimate denial letters complied with section 38(8) and the applicant provided no evidence that the treatments were reasonable and necessary, the claims were dismissed.
Application for chiropractic treatment plan dismissed as applicant failed to provide supporting medical evidence.
The applicant sought entitlement to a $2,416.63 treatment plan for chiropractic services, interest, and an award under s. 10 of Regulation 664 following a motor vehicle accident.
The Tribunal found that the applicant failed to provide medical evidence addressing the reasonableness and necessity of the proposed chiropractic treatment, relying instead on evidence of his psychological condition.
The respondent's medical assessment concluded the applicant no longer suffered from an accident-related musculoskeletal diagnosis.
The Tribunal dismissed the application, finding the treatment plan was not reasonable or necessary, and denied the claims for interest and an award.
Application for statutory accident benefits dismissed as proposed treatment and assessments were not reasonable and necessary.
The applicant sought statutory accident benefits following a motor vehicle accident, including psychological services, custom orthotic shoes, a functional cognitive assessment, and a driving reintegration assessment.
The adjudicator dismissed the application, finding that the applicant failed to prove the treatment and assessment plans were reasonable and necessary.
The adjudicator relied on insurer's examination reports which indicated the applicant's psychological symptoms had largely resolved and did not warrant further treatment or assessment.
Claims for an award and interest were also dismissed.
Application for accident benefits dismissed; applicant failed to prove injuries warranted removal from the Minor Injury Guideline.
The respondent denied certain medical and assessment benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant argued that a pre-existing knee condition, a concussion, and psychological impairments warranted removal from the MIG.
The Tribunal found insufficient evidence of a pre-existing condition precluding recovery, no medical diagnosis of a concussion, and preferred the respondent's psychological assessment which found no DSM-5 diagnosis.
The application was dismissed as the MIG limits were exhausted.
No co-appearing lawyers found.
No judges found.