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Insured entitled to most disputed medical benefits for chronic pain and psychological impairments; FAE denied.
The applicant sought various medical and rehabilitation benefits following a motor vehicle accident, which the respondent insurer denied.
The Licence Appeal Tribunal found that the treatment plans for lidocaine injections, an EEG assessment, physiotherapy, a dietician assessment, assistive devices, and psychological services were reasonable and necessary to treat the applicant's chronic pain and psychological impairments.
The Tribunal denied the functional abilities evaluation due to the applicant's pain-focused behaviour rendering it inaccurate, and dismissed the claim for a Regulation 664 award.
Applicant awarded medical and rehabilitation benefits for chronic pain materially contributed to by the accident.
The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits under the Statutory Accident Benefits Schedule for chronic pain.
The respondent insurer denied the claims, arguing the applicant's symptoms were due to pre-existing arthritis and that she had reached maximum recovery.
The adjudicator applied the material contribution test and found that the accident materially contributed to the applicant's pre-existing condition, resulting in chronic pain.
The adjudicator granted the claims for chiropractic and physiotherapy services, a pain management program, Lidocaine infusions, an exercise program, and an occupational therapy assessment, finding them reasonable and necessary for pain relief and management.
The claim for an EEG assessment was denied as there was no evidence of a traumatic brain injury.
The applicant was also awarded interest on overdue payments.
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