Dr. Suneel Upadhye

The applicant sought statutory accident benefits following a 2016 motor vehicle accident.

The respondent denied several expenses and treatment plans.

The adjudicator found the applicant was entitled to medication expenses as they do not require a prior treatment plan.

The claim for a left knee brace was dismissed because the expense was incurred before a treatment plan was submitted, contrary to s. 38(2) of the Schedule.

The adjudicator granted the treatment plans for a chronic pain assessment and an attendant care assessment because the respondent failed to provide proper notice under s. 38(8) after the applicant was removed from the Minor Injury Guideline.

The treatment plans for an occupational therapy assessment, occupational therapy services, and an OT jobsite analysis were found to be reasonable and necessary based on the applicant's functional limitations and supporting medical evidence.

Interest was awarded on all overdue benefits.

The applicant was injured in a motor vehicle accident and sought payment for two treatment plans (OCF-18s) for physiotherapy and massage therapy services, which the respondent insurer denied.

The Licence Appeal Tribunal found that the applicant failed to prove the treatments were reasonable and necessary.

The medical evidence, including the applicant's own treating practitioners, recommended active rehabilitation and home exercise programs rather than the passive therapies proposed in the disputed plans.

The Tribunal also accepted the respondent's insurer's examination report concluding the applicant had reached maximum medical recovery.

The application was dismissed.