Dr. Tran

The applicant sought statutory accident benefits for two chiropractic treatment plans following a rear-end motor vehicle accident.

The insurer denied the plans.

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

The medical evidence, including clinical notes and records, did not support an ongoing physical impairment requiring the proposed treatment.

The adjudicator accepted the insurer's orthopaedic assessment that the applicant's soft tissue injuries had resolved.

The application was dismissed.

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

The respondent insurer denied certain treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant contended that pre-existing chronic neck pain, psychological impairments, and accident-related chronic pain removed him from the MIG.

The Tribunal found that the applicant's physical injuries were soft tissue in nature and predominantly minor.

The Tribunal also rejected the psychological and chronic pain claims, noting inconsistencies in self-reporting, lack of objective medical evidence, and the applicant's continued high level of functioning, including working and attending the gym.

As the applicant failed to prove his injuries fell outside the MIG and the $3,500 limit was exhausted, the application was dismissed.

The applicant was injured as a pedestrian in a motor vehicle accident and sought a medical benefit of $4,447.56 for a physiotherapy treatment plan under the Statutory Accident Benefits Schedule.

The respondent conceded that the applicant sustained an impairment.

However, the Tribunal found that the applicant failed to prove the treatment plan was reasonable and necessary.

The Tribunal preferred the evidence of the respondent's insurer examination chiropractor, who found full range of motion and no objective need for facility-based treatment, over the applicant's medical evidence which lacked clarity and corroboration.

The claim for the medical benefit was denied.