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Applicant removed from Minor Injury Guideline due to chronic pain; treatment plans approved but income replacement benefits denied.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits.
The insurer denied certain benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Licence Appeal Tribunal found that the applicant suffered from chronic pain that caused significant functional impairment, thereby removing her from the MIG.
The Tribunal ordered the insurer to pay for disputed occupational therapy and chiropractic treatment plans, finding them reasonable and necessary.
However, the Tribunal dismissed the applicant's claim for ongoing income replacement benefits, concluding she failed to prove a substantial inability to perform the essential tasks of her pre-accident employment.
Insurer ordered to pay income replacement, medical, attendant care, and housekeeping benefits outside the Pre-Approved Framework.
The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.
The insurer denied her claims for income replacement, medical, attendant care, and housekeeping benefits.
At arbitration, the arbitrator found that the applicant's injuries, which included her left hand, wrist, and knee, took her impairments outside the Pre-Approved Framework Guideline.
The arbitrator awarded income replacement benefits for a specific period of disability, medical benefits for chiropractic and physiotherapy treatment, and attendant care and housekeeping benefits, finding the expenses were reasonable, necessary, and adequately supported by medical evidence.
Interest was also awarded on the overdue benefits.
Claims for statutory accident benefits dismissed where applicant failed to attend and insurer's medical evidence preferred.
The applicant sought statutory accident benefits following a motor vehicle accident, including medical benefits, housekeeping expenses, and a special award.
Despite the applicant's failure to attend the hearing, his counsel proceeded.
The arbitrator dismissed the claims for medical benefits, preferring the evidence of the insurer's medical experts who conducted physical examinations over the applicant's expert who only performed a paper review.
The arbitrator also found that the treatment facility had overbilled for the duration of sessions.
The claims for housekeeping and a special award were dismissed due to lack of evidence and the finding that no benefits were unreasonably withheld.
The insurer was awarded its arbitration expenses.
Arbitrator reduced excessive clinic fees and treatment frequency for accident benefits claim following tibia fracture.
The applicant was struck by a vehicle and sustained a fractured tibia.
She sought statutory accident benefits for chiropractic and active rehabilitation therapy.
The insurer disputed the reasonableness of the treatment and the fees charged by the clinics.
The arbitrator found that the treatment was reasonable and necessary to assist in the applicant's recovery, but determined that the frequency and duration of the treatments, as well as the fees charged by the clinics, were excessive.
The arbitrator reduced the compensable sessions and the hourly rates, awarding $1,080.50 for chiropractic expenses and $635 for rehabilitation expenses, plus interest.
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