11 total
Application for medical cannabis and chiropractic benefits dismissed due to lack of objective medical evidence.
The applicant sought statutory accident benefits for medical cannabis and chiropractic treatment following a 2017 motor vehicle accident.
The respondent denied the benefits, relying on insurer examination reports indicating the applicant had reached maximal medical improvement and did not suffer from chronic pain or a sleep disorder as a result of the accident.
The adjudicator dismissed the application, finding the applicant failed to provide objective medical evidence to prove the treatment plans were reasonable and necessary.
Claim for non-earner benefit dismissed as applicant's limitations stemmed from significant pre-existing conditions.
The applicant sought a non-earner benefit, an award, interest, and costs following a motor vehicle accident.
The respondent denied the benefits, arguing that the applicant's inability to carry on a normal life was due to significant pre-existing physical and psychological conditions, not the accident.
The Tribunal found that the applicant failed to demonstrate a complete inability to carry on a normal life as a result of the accident, noting that his pre-accident conditions had already rendered him unable to work and limited his activities of daily living.
The Tribunal accepted the respondent's insurer's examination reports, which concluded the applicant could still engage in his pre-accident activities.
The claims for a non-earner benefit, an award, interest, and costs were dismissed.
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied certain benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 treatment limit had been exhausted.
The applicant argued she had a pre-existing back condition, a psychological impairment, and chronic pain that removed her from the MIG.
The Tribunal found insufficient evidence of a pre-existing condition that prevented maximal recovery, and preferred the respondent's psychological assessments showing symptom amplification over the applicant's evidence.
The Tribunal concluded the injuries were predominantly minor, the disputed treatment plans were not payable, and no interest was owed.
The application was dismissed.
Insurer ordered to pay $6,482.72 for an adjustable bed and mattress to accommodate accident-related chronic pain.
The applicant sought a rehabilitation benefit of $6,482.72 for an adjustable bed and mattress following a motor vehicle accident.
The respondent denied the benefit, relying on a physiatrist's paper review which concluded the bed was not reasonable and necessary from a musculoskeletal perspective.
The Tribunal found the respondent's medical evidence unpersuasive and preferred the comprehensive reports of the applicant's occupational therapist and psychologist, which established that the applicant's chronic pain resulted in long-term sleep maintenance issues.
The Tribunal ordered the respondent to pay the cost of the bed and mattress, plus interest.
Application for catastrophic impairment and income replacement benefits dismissed; applicant failed to meet WPI threshold and complete inability test.
The applicant sought a determination that he sustained a catastrophic impairment as a result of a motorcycle accident, along with entitlement to income replacement benefits, medical benefits, an award, and interest.
The Licence Appeal Tribunal found that the applicant did not meet the 55% whole person impairment threshold under either Criterion 6 or 7 of the Statutory Accident Benefits Schedule, preferring the respondent's medical experts and video surveillance evidence over the applicant's experts.
The Tribunal also dismissed the claim for post-104 week income replacement benefits, finding the applicant did not suffer a complete inability to engage in employment, as he had returned to modified work and performed some DJ work.
The claims for unpaid assessments, assistive devices, an award, and interest were also dismissed.
Applicant awarded physiotherapy and chiropractic benefits; occupational therapy and psychological assessments denied for lack of qualified evidence.
The applicant, who was 11 years old at the time of the motor vehicle accident, sought various medical and rehabilitation benefits outside the Minor Injury Guideline.
The adjudicator found that the applicant established entitlement to a treatment plan for physiotherapy and chiropractic services, as they were reasonable and necessary as a result of the accident.
However, the remaining benefits for occupational therapy and psychological assessments were denied because they either exceeded the maximum amount payable for an assessment or were not supported by objective medical evidence from qualified practitioners.
Application for physiotherapy benefits dismissed as the proposed treatment plan was not reasonable and necessary.
The applicant sought a medical benefit of $6,103.09 for a physiotherapy treatment plan following a motor vehicle accident.
The respondent insurer denied the plan, arguing the applicant had reached maximum medical recovery and the treatment was not reasonable and necessary given her pre-existing chronic back pain and the length of time since the accident.
The adjudicator found that the applicant failed to prove the proposed treatment was reasonable and necessary, noting that after 3.5 years of similar treatment, there was no evidence showing how further facility-based treatment would achieve the stated goals.
The application was dismissed and no interest was payable.
Insurer's defective notices under s. 38(8) entitle applicant to incurred costs; several treatment plans approved.
The Licence Appeal Tribunal found that the insurer failed to provide adequate medical reasons in its notices denying certain treatment plans under s. 38(8) of the Schedule, entitling the applicant to incurred costs until proper notice is given.
The Tribunal also found three chiropractic treatment plans and one psychological treatment plan to be reasonable and necessary.
However, a second psychological treatment plan, a chronic pain assessment, and a cognitive assessment were deemed not reasonable and necessary.
The applicant's claim for an award under Regulation 664 was dismissed.
Applicant's chronic pain syndrome removes injuries from the Minor Injury Guideline; disputed medical benefits awarded.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and a chronic pain assessment.
The respondent insurer denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Licence Appeal Tribunal found that the applicant suffered from chronic pain syndrome, which removed him from the MIG.
The Tribunal ordered the respondent to pay for the disputed physiotherapy treatment plans and the chronic pain assessment, finding them reasonable and necessary, along with interest on the overdue payments.
Application for accident benefits for chronic pain program and assistive devices dismissed as not reasonable and necessary.
The applicant sought statutory accident benefits for a chronic pain program and assistive devices (a lawn mower and snow blower) following a motor vehicle accident.
The Tribunal found that the chronic pain program was not reasonable and necessary, relying on insurer's examinations indicating the applicant had reached maximum medical recovery and was an adaptive pain coper.
The Tribunal also denied the assistive devices, noting the applicant's pre-accident inability to perform lawn care and snow removal tasks.
Applicant entitled to limited IRBs and assessment costs, but barred from litigating treatment plan for missing insurer examinations.
The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs), medical and rehabilitation benefits, and costs of examinations.
The Tribunal found the applicant was entitled to IRBs for a limited period until she returned to full-time work, but denied ongoing IRBs due to a lack of financial evidence.
The Tribunal denied payment for two chiropractic treatment plans and found the applicant was barred from litigating a chronic pain treatment program because she failed to attend required insurer's examinations.
However, the Tribunal approved two assessment plans for physiatry and chronic pain, finding them reasonable and necessary.
The applicant's requests for a special award and costs were dismissed.
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