Dr. Polyvos

The applicant, who was injured in a motorcycle accident, sought payment for two physiotherapy treatment plans that were denied by the respondent insurer.

The insurer denied the plans based on section 44 insurer's examinations which concluded the treatments were not reasonable and necessary.

The Tribunal found that the applicant failed to meet his burden of proving the treatments were reasonable and necessary, noting that the applicant spent half the year in Florida without facility-based treatment and lacked objective medical evidence supporting the need for ongoing treatment.

The application was dismissed.

The applicant was involved in a motor vehicle accident and sought medical benefits for chiropractic treatment, a functional abilities assessment, and a catastrophic assessment.

The insurer denied the benefits on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant's physical injuries had largely resolved and her ongoing psychological issues and thumb injury were not related to the accident.

The Tribunal concluded that the requested treatment and assessments were not reasonable and necessary, and dismissed the application.

The applicant sought medical benefits for chiropractic treatment, a functional abilities assessment, and a catastrophic impairment assessment following a motor vehicle accident.

The respondent insurer denied the benefits on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant's physical injuries had largely resolved and her ongoing psychological issues and left thumb injury were not caused by the accident.

Relying on the family doctor's records and the insurer's examination reports, the Tribunal concluded the requested treatment and assessments were not reasonable and necessary.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for caregiving, housekeeping, attendant care, and medical treatments.

The insurer denied most of the claims, citing discrepancies in the evidence and surveillance footage that contradicted the applicant's reported limitations.

The arbitrator found the applicant and her husband lacked credibility, noting significant inconsistencies between their testimony, the submitted invoices, and the surveillance evidence.

The claims for caregiver, housekeeping, and attendant care benefits were dismissed due to insufficient reliable evidence that the expenses were incurred or that the applicant met the test for substantial inability.

The arbitrator partially allowed the claim for medical benefits, awarding $2,384.59 for treatment plans that were deemed reasonable and necessary or were deemed approved due to the insurer's failure to respond.

The claim for a special award was dismissed as the insurer did not unreasonably withhold payments.