3 total
Application for catastrophic impairment designation dismissed; surveillance and employment records contradicted self-reported limitations.
The applicant sought a determination of catastrophic impairment following a motor vehicle accident, claiming entitlement under Criteria 6, 7, and 8 of the Statutory Accident Benefits Schedule.
The Tribunal found that the applicant did not meet the threshold for catastrophic impairment, preferring the respondent's multidisciplinary assessments which were supported by objective evidence, including surveillance footage and employment records showing the applicant had returned to full-time work.
The Tribunal also dismissed the applicant's claims for the outstanding balance of a catastrophic impairment assessment plan, finding that clinical file reviews were subject to the $2,000 cap per assessment and that transportation expenses were not proven to exceed the 50-kilometre deductible.
Claims for interest and an award for unreasonable withholding of benefits were consequently dismissed.
Application for accident benefits dismissed as treatment plans were not proven reasonable and necessary.
The applicant sought entitlement to several treatment plans for physiotherapy, chiropractic, and psychological services following a motor vehicle accident, as well as an award for unreasonable delay.
The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the treatment plans were reasonable and necessary.
The Tribunal preferred the respondent's medical evidence, which indicated that further physical therapy would not provide lasting relief and that the applicant's psychological symptoms did not warrant the requested interventions.
Claims for interest and a special award were also dismissed.
Application for statutory accident benefits dismissed as treatment plans and attendant care were not reasonable and necessary.
The applicant sought entitlement to statutory accident benefits following a motor vehicle accident, including multiple treatment plans for physiotherapy, chiropractic, and psychological services, as well as attendant care benefits.
The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove on a balance of probabilities that the disputed treatment plans and attendant care expenses were reasonable and necessary.
The Tribunal preferred the evidence of the respondent's independent examiners over the applicant's assessors and noted the applicant's failure to provide requested information to the insurer.
Claims for interest and an award under s. 10 of Reg. 664 were also dismissed.
No co-appearing lawyers found.
No judges found.