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Applicant awarded chronic pain program and physical therapies for accident-related impairments; special award denied.
The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits from her insurer under the Statutory Accident Benefits Schedule.
The insurer denied several treatment plans, including physiotherapy, psychological and neurological assessments, and a chronic pain program.
The Licence Appeal Tribunal found that the applicant continued to suffer from significant accident-related pain and granted entitlement to the physiotherapy, neurological assessment, disability certificate, chronic pain assessment, chronic pain program, and a portion of the shockwave therapy.
Claims for further psychological assessment and treatment were denied as duplicative or unnecessary given previously approved funding.
The Tribunal declined to order a special award or costs, finding the insurer's adjusting of the file was reasonable.
Ongoing income replacement benefits granted due to psychological impairments; medical benefits denied for missing treatment plans.
The applicant was struck by a vehicle as a pedestrian and sought income replacement and medical benefits.
The Tribunal found the applicant was entitled to ongoing income replacement benefits beyond the 104-week mark, as his accident-related psychological and cognitive impairments rendered him completely unable to engage in any employment for which he was reasonably suited.
The claims for medical benefits were dismissed because the applicant failed to provide the required treatment plans (OCF-18s) to establish that the treatments were reasonable and necessary.
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